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Ruan MZC, Meer E, Kaur G, Namiri NK, Ashraf DC, Winn BJ, Kersten R, Vagefi MR, Grob S. Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States. Clin Ophthalmol 2024; 18:809-816. [PMID: 38504934 PMCID: PMC10949383 DOI: 10.2147/opth.s452750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/09/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019. Methods The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries. Results Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%). Conclusion There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.
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Affiliation(s)
- Merry Z C Ruan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elana Meer
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gurbani Kaur
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nikan K Namiri
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Davin C Ashraf
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Oregon Health & Sciences University, Portland, OR, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Robert Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
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Smith LD, Ahmad M, Ashraf DC, Kersten RC, Winn BJ, Grob SR, Vagefi MR. Cutaneous Mucormycosis of the Eyelid Treated With Subcutaneous Liposomal Amphotericin B Injections. Ophthalmic Plast Reconstr Surg 2024; 40:e42-e45. [PMID: 37995143 PMCID: PMC10922450 DOI: 10.1097/iop.0000000000002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Cutaneous mucormycosis is a rare, opportunistic fungal infection that typically affects immunocompromised hosts. Current treatment consists of systemic antifungal therapy, surgical debridement, and when applicable, restoration of immune function. Despite intervention, the morbidity and mortality of invasive fungal disease remains high. There are few reports of primary or secondary cutaneous mucormycosis involving the ocular adnexa. The authors describe the course of 2 children with cutaneous mucormycosis of the eyelid treated with subcutaneous liposomal amphotericin B (LAmB) injections (3.5 mg/ml) in an off-label application as an adjunct to debridement and systemic antifungal therapy. To the authors' knowledge, these are the first 2 cases of invasive fungal disease involving the eyelid treated with subcutaneous LAmB injections, and the first reported case of disseminated fungal infection with secondary cutaneous involvement of the eyelid.
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Affiliation(s)
- Loreley D Smith
- The Pacific Center for Oculofacial and Aesthetic Plastic Surgery, San Francisco, California, U.S.A
- California Pacific Medical Center, San Francisco, California, U.S.A
- University of California San Francisco, San Francisco, California, U.S.A
| | - Meleha Ahmad
- University of California San Francisco, San Francisco, California, U.S.A
| | - Davin C Ashraf
- University of California San Francisco, San Francisco, California, U.S.A
- Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Robert C Kersten
- University of California San Francisco, San Francisco, California, U.S.A
- University of Utah, Salt Lake City, Utah, U.S.A
| | - Bryan J Winn
- University of California San Francisco, San Francisco, California, U.S.A
| | - Seanna R Grob
- University of California San Francisco, San Francisco, California, U.S.A
| | - M Reza Vagefi
- University of California San Francisco, San Francisco, California, U.S.A
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
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Meer E, Ahmad M, Grob S, Winn BJ. Bilateral Facial Palsy: A Rare Presenting Symptom for Inclusion Body Myositis. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00338. [PMID: 38319192 DOI: 10.1097/iop.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Inclusion body myositis is a common type of inflammatory myopathy among populations over the age of 50 years, classically presenting with weakness and atrophy of the forearms and quadriceps. While a third of patients may eventually present with mild facial weakness, findings of ptosis, facial palsy, or involvement of extraocular muscles are rarely, if ever, seen. The authors describe a unique case of inclusion body myositis in which a patient initially presented with bilateral severe facial palsy and exposure keratitis but minimal limb weakness. While midface weakness, unilateral lagophthalmos, and ptosis have been documented in one reported case, key presenting symptoms of bilateral facial palsy and symmetric paralytic lagophthalmos with corneal exposure have not been presented before. Therefore, this case serves as an important reminder to consider the inclusion body myositis in the differential diagnosis of bilateral facial palsy.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, University of California, San Francisco, California, U.S.A
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, California, U.S.A
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, U.S.A
| | - Seanna Grob
- Department of Ophthalmology, University of California, San Francisco, California, U.S.A
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, U.S.A
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, California, U.S.A
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, California, U.S.A
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Wang L, Ashraf DC, Deiner M, Idowu OO, Grob SR, Winn BJ, Vagefi MR, Kersten RC. Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition. Adv Ophthalmol Pract Res 2024; 4:39-44. [PMID: 38406664 PMCID: PMC10891280 DOI: 10.1016/j.aopr.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
Objective To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing. Methods In this retrospective pre-post study, an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020. Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses. As part of routine practice, glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition; taped examinations were excluded from analysis. Clinical and demographic characteristics, mean deviation, and pattern standard deviation were evaluated within a two year period before and after eyelid surgery. Results The final analysis included 60 eyes of 38 patients. Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses. Among patients with ptosis, the margin reflex distance-1 was not associated with change in mean deviation after surgery (Pearson R2 = 0.0061; P = 0.700). Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery. Conclusions Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields. Unreliable visual fields could be a sign of eyelid interference in this population.
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Affiliation(s)
- Linyan Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Oregon Health and Science University, Portland, USA
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, San Francisco, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Tufts Medical Center, Boston, USA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Tufts Medical Center, Salt Lake City, USA
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5
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Sood S, Lidder AK, Elgin C, Law JC, Shukla AG, Winn BJ, Khouri AS, Miller-Ellis EG, Laudi J, SooHoo JR, DeVience E, Syed MF, Zerkin A, Al-Aswad LA. Salary Negotiations: Gender Differences in Attitudes, Priorities, and Behaviors of Ophthalmologists. Am J Ophthalmol 2024; 257:154-164. [PMID: 37567433 DOI: 10.1016/j.ajo.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To investigate attitudes, priorities, and behaviors of ophthalmologists in salary negotiations. DESIGN Cross-sectional study. METHODS A Qualtrics survey was disseminated to U.S.-based practicing ophthalmologists between November 1, 2021 and March 31, 2022 and assessed attitudes, behaviors, and priorities surrounding salary negotiation during the respondents' first negotiation as a practicing physician and currently. Optional case-based scenarios were also included. RESULTS Of 424 respondents, 155 (36.5%) identified as male (M) and 269 (63.3%) identified as female (F). Men were more likely to negotiate salary for their first position as an independent ophthalmologist (M 78.3%, F 68.2%; P = .04). Respondents of both genders assessed their success similarly; 85.0% of men and 75.7% of women (P = .07) felt that their negotiation was very successful or somewhat successful. Women were more likely to select "flexibility in clinic/OR schedule for personal commitments" as a priority during salary negation for their first position (M 14.8%, F 23.1%; P = .04). Women ophthalmologists reported feeling more uncomfortable (M 36.1%, F 49.1%; P = .01), intimidated (M 20.0%, F 43.5%; P < .01), and were less likely to feel well-trained (M 24.5%, F 13.0%; P < .01). Most respondents never received formal training in negotiation. CONCLUSIONS We found significant gender differences among ophthalmologists in attitudes, priorities and behaviors surrounding salary negotiation. There were low reported levels of formal negotiation training, which appears to disadvantage women more than men. These gender disparities suggest that incorporating education about negotiation skills and career development early in training may be impactful.
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Affiliation(s)
- Shefali Sood
- From the Department of Ophthalmology (S.S.), Georgetown University School of Medicine, Washington, DC, USA
| | - Alcina K Lidder
- Department of Ophthalmology/Bascom Palmer Eye Institute (A.K.L.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ceyhun Elgin
- American University in Bulgaria; Bogazici University, Turkey
| | - Janice C Law
- Department of Ophthalmology (J.C.L), Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Aakriti Garg Shukla
- Department of Ophthalmology (A.G.S.), Columbia University Vagelos School of Medicine, New York, New York, USA
| | - Bryan J Winn
- Department of Ophthalmology (B.J.W.), University of California - San Francisco School of Medicine, San Francisco, California, USA; Ophthalmology Section (B.J.W.), San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Albert S Khouri
- Department of Ophthalmology (A.S.K.), Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Eydie G Miller-Ellis
- Department of Ophthalmology (E.G.M-E.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Laudi
- Department of Ophthalmology (J.L.), State University of New York - Downstate School of Medicine, Brooklyn, New York, USA
| | - Jeffrey R SooHoo
- Department of Ophthalmology (J.R.S.), University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eva DeVience
- Department of Ophthalmology (E.D.), University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Misha F Syed
- Department of Ophthalmology (M.F.S.), University of Texas Medical Branch, Galveston, Texas, USA
| | - Allen Zerkin
- New York University Robert F. Wagner Graduate School of Public Service (A.Z.), New York, New York, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology (L.A.A.), Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA..
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Chang CC, Saifee M, Ton L, Ashraf D, Winn BJ, Kersten R, Vagefi MR, Deiner M, Grob SR. Eye Trauma in Mixed Martial Arts and Boxing. Ophthalmic Plast Reconstr Surg 2024; 40:75-87. [PMID: 37656909 PMCID: PMC10926996 DOI: 10.1097/iop.0000000000002510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN Retrospective cohort study. METHODS Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.
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Affiliation(s)
- Chih-Chiun Chang
- University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Murtaza Saifee
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Lauren Ton
- University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Davin Ashraf
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, Oregon Health & Sciences University, Portland, Oregon, U.S.A
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert Kersten
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- F.I. Proctor Foundation, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
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Kamboj A, Caruana SM, Winn BJ. Removal of an Intraosseous Venous Malformation of the Maxilla via a Transoral-transconjunctival-Transcaruncular Approach. Plast Reconstr Surg Glob Open 2023; 11:e5155. [PMID: 37547351 PMCID: PMC10400051 DOI: 10.1097/gox.0000000000005155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/15/2023] [Indexed: 08/08/2023]
Abstract
Intraosseous vascular anomalies represent less than 1% of all bony tumors. When they involve the maxillofacial skeleton, these masses may cause substantial morbidity and aesthetic concern. Herein, we highlight a case of a maxillary intraosseous venous malformation manifesting as functional lacrimal duct obstruction with epiphora, sinus pressure, and increasing medial canthal/maxillary fullness over 2 years in a young, healthy woman. Surgical excision of the lesion was accomplished without a skin incision by coupling a transoral, midface degloving technique with a transconjunctival-transcaruncular approach. This minimally invasive technique led to complete resolution of symptoms and a satisfactory cosmetic outcome, without a cutaneous scar.
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Affiliation(s)
- Alisha Kamboj
- From the Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minn
| | - Salvatore M. Caruana
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital Columbia University Medical Center, New York, N.Y
| | - Bryan J. Winn
- Department of Ophthalmology, University of California–San Francisco, San Francisco, Calif
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif
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Vagefi MR, Idowu OO, Miller A, Doan T, Chen C, Hinterwirth A, Zhong L, Ahmad M, Ashraf DC, Grob SR, Kersten RC, Winn BJ. Metagenomic Deep Sequencing for Orbital Inflammatory Disease. Ocul Immunol Inflamm 2023:1-4. [PMID: 37068263 PMCID: PMC10579447 DOI: 10.1080/09273948.2023.2199061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Orbital inflammatory disease (OID) is a heterogeneous group of immunologic disorders whose etiology is often non-specific despite routine investigation. In this proof-of-concept study, metagenomic deep sequencing (MDS) is applied to examine host gene expression in two subtypes of OID. METHODS Prospectively collected lacrimal gland tissue from patients with OID was processed for MDS. Differential gene expression analysis was performed to evaluate for host transcriptome signatures. Proof-of-concept comparison was made between histologically confirmed samples of idiopathic dacryoadenitis and IgG4-related disease (IgG4-RD). RESULTS Twelve genes were identified to be differentially expressed between idiopathic dacryoadenitis and IgG4-RD. Differences in innate humoral immunity gene expression were observed. Several additional genes of interests were also found to be upregulated in idiopathic dacryoadenitis. CONCLUSIONS A unique transcriptome signature was found when comparing idiopathic dacryoadenitis to IgG4-RD. This suggests that MDS can identify differentially expressed genes in OID. Such insight could potentially provide a better understanding of host gene expression and the inflammatory pathways involved in OID.
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Affiliation(s)
- M. Reza Vagefi
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Amanda Miller
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Thuy Doan
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Cindi Chen
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Meleha Ahmad
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Davin C. Ashraf
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Seanna R. Grob
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Robert C. Kersten
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121
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9
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Chang CCJ, Winn BJ. Perturbations of the ocular surface microbiome and their effect on host immune function. Curr Opin Ophthalmol 2023; 34:181-188. [PMID: 36728960 PMCID: PMC9908829 DOI: 10.1097/icu.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Current literature describing the ocular surface microbiome and host immunity are reviewed alongside experiments studying perturbations of the microbiome to explore the hypothesis that disruption of a healthy microbiome may predispose the ocular surface to inflammation and infection. RECENT FINDINGS The ocular surface of healthy subjects is colonized by stable, pauci-microbial communities that are tolerant to the host immune response and are dominated by the genera Corynebacterium , Propionibacterium , and Staphylococcus . In animal studies, commensal microbes on the ocular surface interact with toll-like receptors to regulate the immune system through immune cell and inflammatory cytokine production, promoting homeostasis and protecting against infection. Contact lens wear, lens wash solutions, and preserved topical medications can disrupt the native microbiome and alter the relative diversity and composition of microbes on the ocular surface. SUMMARY The ocular surface microbiome confers protection against pathogenic colonization and immune dysregulation. Disruption of this microbiome by exogenous factors may alter the resistance of the ocular surface to infection. Further study of the relationships between human ocular surface microbiome and the local immune response are needed.
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Affiliation(s)
- Chih-Chiun Jamie Chang
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, CA
- Department of Ophthalmology, New York Eye and Ear Infirmary – Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, CA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA
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10
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Lu TJ, Amarikwa L, Winn BJ, Inserra M, Dosiou C, Kossler AL. Oral Corticosteroids for Teprotumumab-Related Hearing Loss: A Case Report. Case Rep Ophthalmol 2023; 14:134-139. [PMID: 37034380 PMCID: PMC10074260 DOI: 10.1159/000529422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/10/2023] [Indexed: 04/11/2023] Open
Abstract
Teprotumumab is a novel insulin-like growth factor-1 receptor inhibitor approved for the treatment of thyroid eye disease, but growing reports of hearing loss require further investigation. To date, an effective protocol for managing hearing loss in this setting has not been determined. Here, we present the first report of the resolution of teprotumumab-related hearing loss with prompt oral prednisone. A 70-year-old woman on teprotumumab experienced sudden hearing loss and tinnitus after her first infusion. An audiogram demonstrated a mild down-sloping to moderately severe mixed conductive and sensorineural hearing loss that was promptly treated with prednisone 60 mg for 6 days with a 1-week gradual taper. An audiogram 3 weeks later demonstrated return of hearing to normal thresholds, and the whole teprotumumab treatment course was completed without further issue. This case highlights the importance of audiometric monitoring, prompt identification of hearing symptoms, and the potential for oral steroids to reverse teprotumumab-related hearing loss.
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Affiliation(s)
- Tracy J Lu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Linus Amarikwa
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | | | - Chrysoula Dosiou
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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11
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Idowu OO, Soderlund KA, Laguna B, Ashraf DC, Arnold BF, Grob SR, Winn BJ, Russell MS, Kersten RC, Dillon WP, Vagefi MR. Magnetic Resonance Imaging Prognostic Findings for Visual and Mortality Outcomes in Acute Invasive Fungal Rhinosinusitis. Ophthalmology 2022; 129:1313-1322. [PMID: 35768053 DOI: 10.1016/j.ophtha.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To identify initial, preintervention magnetic resonance imaging (MRI) findings that are predictive of visual and mortality outcomes in acute invasive fungal rhinosinusitis (AIFRS). DESIGN Retrospective cohort study. PARTICIPANTS Patients with histopathologically or microbiologically confirmed AIFRS cared for at a single, tertiary academic institution between January 2000 and February 2020. METHODS A retrospective review of MRI scans and clinical records of patients with confirmed diagnosis of AIFRS was performed. For each radiologic characteristic, a modified Poisson regression with robust standard errors was used to estimate the risk ratio for blindness. A multivariate Cox proportional hazards model was used to study AIFRS-specific risk factors associated with mortality. MAIN OUTCOME MEASURE Identification of initial, preintervention MRI findings associated with visual and mortality outcomes. RESULTS The study comprised 78 patients (93 orbits, 63 with unilateral disease and 15 with bilateral disease) with AIFRS. The leading causes of immunosuppression were hematologic malignancy (38%) and diabetes mellitus (36%). Mucormycota constituted 56% of infections, and Ascomycota constituted 37%. The overall death rate resulting from infection was 38%. Risk factors for poor visual acuity outcomes on initial MRI included involvement of the orbital apex (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1-3.8; P = 0.026) and cerebral arteries (RR, 1.8; 95% CI, 1.3-2.5; P < 0.001). Increased mortality was associated with involvement of the facial soft tissues (hazard ratio [HR], 4.9; 95% CI, 1.3-18.2; P = 0.017), nasolacrimal drainage apparatus (HR, 5.0; 95% CI, 1.5-16.1; P = 0.008), and intracranial space (HR, 3.5; 95% CI, 1.4-8.6; P = 0.006). Orbital soft tissue involvement was associated with decreased mortality (HR, 0.3; 95% CI, 0.1-0.6; P = 0.001). CONCLUSIONS Extrasinonasal involvement in AIFRS typically signals advanced infection with the facial soft tissues most commonly affected. The initial, preintervention MRI is prognostic for a poor visual acuity outcome when orbital apex or cerebral arterial involvement, or both, are present. Facial soft tissues, nasolacrimal drainage apparatus, intracranial involvement, or a combination thereof is associated with increased mortality risk, whereas orbital soft tissue involvement is correlated with a reduced risk of mortality.
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Affiliation(s)
- Oluwatobi O Idowu
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Karl A Soderlund
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Benjamin Laguna
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Davin C Ashraf
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Benjamin F Arnold
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Seanna R Grob
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Bryan J Winn
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Matthew S Russell
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Robert C Kersten
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - M Reza Vagefi
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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12
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Sohail M, Maniar A, Winn BJ, Patel S, Famuyide A, Dagi Glass LR. Orbital tuberculosis: a case report and update on the role of imaging in treatment. Orbit 2022:1-6. [PMID: 36154445 DOI: 10.1080/01676830.2022.2126499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
Orbital tuberculosis is a manifestation of extra-pulmonary tuberculosis that is challenging to diagnose and treat. Here, we describe the pivotal role of serial imaging in the diagnosis and treatment of orbital tuberculosis. A 28-year-old male presented with recurrent right upper eyelid swelling and a supraduction deficit associated with a firm painless orbital mass, seen on initial computed tomography to be an extensive superomedial lesion producing mass effect. Biopsy revealed a tuberculosis-like granulomatous inflammation, which, coupled with a positive QuantiFERON gold test, led to empiric anti-tuberculin treatment. Serial radiologic imaging following initiation of treatment showed progressive reduction in mass size, supporting the diagnosis and determining the length of treatment. This rare case demonstrates the utility of serial radiologic exams in the diagnosis and treatment of orbital tuberculosis.
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Affiliation(s)
- Marium Sohail
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Arpita Maniar
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Bryan J Winn
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Shreya Patel
- Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Akinrinola Famuyide
- Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
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13
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Ashraf DC, Miller A, Ahmad M, Smith LD, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Augmentation of telemedicine post-operative follow-up after oculofacial plastic surgery with a self-guided patient tool. Orbit 2022:1-11. [PMID: 35920583 DOI: 10.1080/01676830.2022.2104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery. METHODS Adult, English-speaking patients undergoing periocular surgery with telemedicine follow-up were studied prospectively in this interventional case series. Participants submitted visual acuity measurements and photographs via a web-based tool prior to routine telemedicine post-operative visits. An after-visit survey assessed patient perceptions. Surgeons rated photographs and live video for quality and blurriness; external raters also evaluated photographs. Images were analyzed for facial centration, resolution, and algorithmically detected blur. Complications were recorded and graded for severity and relation to telemedicine. RESULTS Seventy-nine patients were recruited. Surgeons requested an in-person assessment for six patients (7.6%) due to inadequate evaluation by telemedicine. Surgeons rated patient-provided photographs to be of higher quality than live video at the time of the post-operative visit (p < 0.001). Image blur and resolution had moderate and weak correlation with photograph quality, respectively. A photograph blur detection algorithm demonstrated sensitivity of 85.5% and specificity of 75.1%. One patient experienced a wound dehiscence with a possible relationship to inadequate evaluation during telemedicine follow-up. Patients rated the telemedicine experience and their comfort with the structure of the visit highly. CONCLUSIONS Augmented telemedicine follow-up after oculofacial plastic surgery is associated with high patient satisfaction, rare conversion to clinic evaluation, and few related post-operative complications. Automated detection of image resolution and blur may play a role in screening photographs for subsequent iterations of the web-based tool.
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Affiliation(s)
- Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Amanda Miller
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Loreley D Smith
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Ophthalmology Section, Surgical Service, San Francisco Veterans' Affairs Health Care System, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California, USA
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14
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Chang CCJ, Somohano K, Zemsky C, Uhlemann AC, Liebmann J, Cioffi GA, Al-Aswad LA, Lynch SV, Winn BJ. Topical Glaucoma Therapy Is Associated With Alterations of the Ocular Surface Microbiome. Invest Ophthalmol Vis Sci 2022; 63:32. [PMID: 36036910 PMCID: PMC9434984 DOI: 10.1167/iovs.63.9.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the ocular surface microbiome of patients with unilateral or asymmetric glaucoma being treated with topical ophthalmic medications in one eye and to determine whether microbial community changes were related to measures of ocular surface disease. Methods V3-V4 16S rRNA sequencing was conducted on ocular surface swabs collected from both eyes of 17 subjects: 10 patients with asymmetric/unilateral glaucoma using topical glaucoma therapy on only one eye and seven age-matched, healthy controls with no history of ocular disease or eyedrop use. Samples were categorized into three groups: patients’ glaucomatous eye treated with eyedrops, patients’ contralateral eye without eyedrops, and healthy control eyes. Comparisons were made for microbial diversity and composition, with differences in composition tested for association with ocular surface disease measures including tear meniscus height, tear break-up time, and Dry Eye Questionnaire. Results Samples obtained from the patients’ treated and untreated eyes both had significantly greater alpha-diversity and relative abundance of gram-negative organisms compared to healthy controls. The microbial composition of patient eyes was associated with decreased tear meniscus height and tear break-up time, whereas metagenomic predictions, based on 16S rRNA data, suggested increased synthesis of lipopolysaccharide. Conclusions The ocular surface microbiome of patients taking unilateral preserved glaucoma drops is characterized by a highly diverse array of gram-negative bacteria that is significantly different from the predominantly gram-positive microbes detected on healthy control eyes. These compositional differences were associated with decreased tear film measures and distinct inferred protein synthesis pathways, suggesting a potential link between microbial alterations and ocular surface inflammation.
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Affiliation(s)
- Chih-Chiun J Chang
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Karina Somohano
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Christine Zemsky
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Anne-Catrin Uhlemann
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Jeffrey Liebmann
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Lama A Al-Aswad
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States.,Department of Ophthalmology, New York University Langone Health, New York, New York, United States
| | - Susan V Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States.,Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States.,Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States
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15
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Moussa O, Frank T, Valenzuela IA, Aliancy J, Gong D, De Rojas JO, Dagi Glass LR, Winn BJ, Cioffi GA, Chen RWS. Efficacy of Preoperative Risk Stratification on Resident Phacoemulsification Surgeries. Clin Ophthalmol 2022; 16:2137-2144. [PMID: 35800673 PMCID: PMC9255418 DOI: 10.2147/opth.s368633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training. Materials and Methods This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests. Results Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 (β = 0.13, p < 0.0001) and POM1 (β = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2). Conclusion Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery.
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Affiliation(s)
- Omar Moussa
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Tahvi Frank
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ives A Valenzuela
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Joah Aliancy
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Dan Gong
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - George A Cioffi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Royce W S Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Correspondence: Royce WS Chen, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 W. 165th St, New York, NY, 10032, USA, Tel +1 212-305-9535, Email
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16
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Maru JA, Carvajal ND, de Alba Campomanes AG, Parikh N, Ashraf DC, Kersten RC, Winn BJ, Vagefi MR, Grob SR. Perceived Barriers to Increasing Diversity within Oculofacial Plastic Surgery. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0042-1758561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose Physician diversity is limited in ophthalmology and oculofacial plastic surgery. Determination of barriers within the application process for oculofacial plastic surgery may help target efforts to improve the recruitment of underrepresented groups. This study aimed to illuminate perceived barriers to increasing diversity in oculofacial plastic surgery trainees, according to the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellows and fellowship program directors (FPDs).
Methods During the month of February 2021, we sent surveys out to 54 current oculofacial plastic surgery fellows and 56 FPDs at 56 oculofacial plastic surgery programs recognized by the ASOPRS nationwide using a 15-question Qualtrics survey.
Results Sixty-three individuals (57%) responded to the survey: 34 fellows (63%) and 29 FPDs (52%). Eighty-eight percent of fellows and 68% of FPDs identified as non-underrepresented in medicine (UiM). Forty-four percent of fellows and 25% of FPDs identified as men. FPDs most commonly noted, “Not enough minorities applying to our program” and “The objective data (Ophthalmic Knowledge Assessment Program score, United States Medical Licensing Examination Step scores, clinical honors, Alpha Omega Alpha status, letter of recommendation) for minority applicants often do not meet the threshold required to offer an interview or to be ranked to match” as barriers. Among fellows, the lowest-rated considerations when applying to oculofacial plastic surgery were “Racially/ethnically diverse faculty” and “Perceptions of minority candidates by fellowship programs,” whereas “Likelihood of matching in program of choice” was ranked highest in considerations. Fellows identifying as men indicated greater concern for “Financial factors related to fellowship (e.g., loans, salary, cost of living, or cost of interviewing)” compared to fellows identifying as women who noted greater concern for “Program or preceptor acceptance of starting or having a family during fellowship.”
Conclusion Responses from FPDs suggest that efforts focused on recruiting and supporting diverse students to medicine and ophthalmology, mentoring applicants interested in oculofacial plastic surgery, and restructuring the application process to decrease bias, may improve diversity within the subspecialty. The lack of UiM representation in this study, 6% fellows and 7.4% FPDs identified as UiM, shows both the stark underrepresentation and the need for further research into this topic.
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Affiliation(s)
- Johsias A. Maru
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Nicole D. Carvajal
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Neeti Parikh
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Robert C. Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Seanna R. Grob
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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17
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Mosenia A, Shahlaee A, Giese I, Winn BJ. Polymicrobial odontogenic periorbital and orbital necrotizing fasciitis (PONF): A case report. Am J Ophthalmol Case Rep 2022; 26:101439. [PMID: 35243174 PMCID: PMC8881414 DOI: 10.1016/j.ajoc.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/30/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To present a case of periorbital and orbital necrotizing fasciitis (PONF) from an odontogenic source with a distinct microbiologic profile and highlight the need for emergent multidisciplinary management. Observations A 39-year-old man presented with periorbital swelling, pain, and erythema following facial trauma. Imaging revealed peri-dental collections, accompanying maxillary sinusitis, and pre- and post-septal involvement. Immediate surgical debridement of necrotic tissue along with broad-spectrum antibiotics were pursued for management. Cultures grew multiple organisms, most notably Streptococcus milleri group and Staphylococcus lugdunensis. Conclusions and Importance PONF is a rare yet potentially fatal disease. Streptococcus milleri group and a fulminant course are to be suspected when the source is odontogenic. Timely multidisciplinary surgical debridement and medical management with intravenous antibiotics is critical for best outcomes. Odontogenic cases of periorbital and orbital necrotizing fasciitis (PONF) may have a fulminant course. Streptococcus milleri group is associated with odontogenic PONF. An emergent multi-disciplinary surgical and medical approach to PONF is highly recommended. Antibiotics may be optimized based on known virulence factors of suspected organisms.
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Affiliation(s)
- Arman Mosenia
- Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
- School of Medicine, University of California, San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Abtin Shahlaee
- Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Isaiah Giese
- Department of Ophthalmology, California Pacific Medical Center, 711 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
- San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA
- Corresponding author. 490 Illinois Street, Floor 5, University of California, San Francisco, CA, 94143, USA.
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18
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Ashraf DC, Idowu OO, Hirabayashi KE, Kalin-Hajdu E, Grob SR, Winn BJ, Vagefi MR, Kersten RC. Outcomes of a Modified Treatment Ladder Algorithm Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital Sinusitis. Am J Ophthalmol 2022; 237:299-309. [PMID: 34116011 DOI: 10.1016/j.ajo.2021.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess whether a modified treatment ladder algorithm incorporating transcutaneous retrobulbar amphotericin B (TRAMB) for invasive fungal rhino-orbital sinusitis can reduce the risk of exenteration without compromising survival. DESIGN Retrospective, comparative clinical study with historical control subjects. METHODS Fifty consecutive patients with biopsy-proven invasive fungal sinusitis and radiographic evidence of orbital involvement were evaluated at a single tertiary institution from 1999-2020. TRAMB was incorporated as part of the treatment algorithm in 2015. Demographics, underlying immune derangement, infective organism, ophthalmic examination, surgical care, and survival were compared in a quasiexperimental pre-post format, dividing patients into a pre-2015 group and a post-2015 group. Risk of exenteration and mortality were the primary outcomes. RESULTS Baseline characteristics did not differ significantly between the 2 groups. Nearly all patients underwent a surgical intervention, most commonly functional endoscopic sinus surgery with debridement. TRAMB was administered to 72.7% of the post-2015 group. Exenteration was more common in the pre-2015 group (36.4% vs 9.1% [95% confidence interval {CI} 5.2-48.8]; P = .014), while mortality was similar (40.0% vs 36.7% [95% CI -22.1 to 29.3]; P = .816). After adjusting for potential confounders, patients treated after 2015 were found to have lower risk of exenteration (relative risk 0.28 [95% CI 0.08-0.99]; P = .049) and similar risk of mortality (relative risk 1.04 [95% CI 0.50-2.16]; P = .919). CONCLUSION Compared with historical control subjects, patients with invasive fungal rhino-orbital sinusitis who were treated with a modified treatment ladder algorithm incorporating TRAMB had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.
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Affiliation(s)
- Davin C Ashraf
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Oluwatobi O Idowu
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Kristin E Hirabayashi
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology (E.K-H.), Université de Montréal, Montreal, Quebec, Canada
| | - Seanna R Grob
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Bryan J Winn
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - M Reza Vagefi
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Robert C Kersten
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA.
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19
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Alsoudi AF, Ton L, Ashraf DC, Idowu OO, Kong AW, Wang L, Kersten RC, Winn BJ, Grob SR, Reza Vagefi M. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye Contact Lens 2022; 48:162-168. [PMID: 35296627 PMCID: PMC8931268 DOI: 10.1097/icl.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate whether use of an antibiotic improves the efficacy of care for a chalazion or hordeolum. METHODS A cross-sectional retrospective review was performed. All patients treated for a newly diagnosed chalazion or hordeolum at the University of California, San Francisco from 2012 to 2018 were identified. Patients were excluded when clinical notes were inaccessible or there was inadequate documentation of treatment modality or outcome. Patient demographics, setting of initial presentation, treatment modalities, antibiotic use, and outcomes were analyzed. RESULTS A total of 2,712 patients met inclusion criteria. Management with an antibiotic was observed in 36.5% of patients. An antibiotic was 1.53 times (95% confidence interval [CI], 1.06-2.22, P=0.025) more likely to be prescribed in emergency or acute care setting for a chalazion. Older age was associated with a higher risk of receiving an antibiotic for a hordeolum (adjusted RR 1.07 per decade, 95% CI, 1.05-1.11, P<0.001). The addition of an antibiotic to conservative measures for a chalazion (adjusted RR, 0.97, 95% CI, 0.89-1.04, P=0.393) or hordeolum (adjusted RR, 0.99, 95% CI, 0.96-1.02, P=0.489) was not associated with an increased likelihood of treatment success. CONCLUSION Although frequently prescribed, an antibiotic is unlikely to improve the resolution of a chalazion or hordeolum.
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Affiliation(s)
- Amer F. Alsoudi
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Alan W. Kong
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Linyan Wang
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
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20
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Dagi Glass LR, De Moraes CG, Wright MA, Winn BJ, Chen RWS, Cioffi GA. Ophthalmology Medical Student Directors, Associate Residency Program Directors, and Program Directors: A Benchmarking Study of Work and Life Metrics. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0041-1741460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction During a time of increased interest in physician well-being, this study benchmarks current work life, home life, and burnout scores for ophthalmology medical student directors (MSD), associate program directors (APD), and program directors (PD).
Methods An anonymous cross-sectional survey was disseminated through the Association of University Professors of Ophthalmology (AUPO) listserve, with queries regarding leadership positions, work time allotment, extracurricular activities, family life, and burnout. Answers were analyzed descriptively through Fisher's exact test, Kruskal–Wallis test, and Poisson regression models.
Results Nineteen percent of listed MSD, 15% of APD, and 29% of PD queried responded to the survey. MSD, APD, and PD are statistically similar in terms of work and home life, with the exception of time spent performing administrative tasks for the position. PD spend more time on administrative tasks, and are paid more. All groups score positively on burnout surveys.
Conclusion This benchmarking survey demonstrates that MSD, APD, and PD are intensively involved in both their work and home lives, with a seemingly high correlation of sense of worth both personally and in their careers.
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Affiliation(s)
- Lora R. Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Melissa A. Wright
- Center for Teaching and Learning, Columbia University, New York, New York
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Royce W. S. Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - George A. Cioffi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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21
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Ashraf DC, Jankovic I, El-Nachef N, Winn BJ, Kim GE, Kersten RC. New-Onset of Inflammatory Bowel Disease in a Patient Treated With Teprotumumab for Thyroid Associated Ophthalmopathy. Ophthalmic Plast Reconstr Surg 2021; 37:e160-e164. [PMID: 33710035 DOI: 10.1097/iop.0000000000001943] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A patient with thyroid-associated ophthalmopathy was treated with teprotumumab and developed symptoms concerning for inflammatory bowel disease after her sixth infusion. Colonoscopy was performed, and mucosal biopsies identified evidence of active colitis consistent with a diagnosis of ulcerative colitis. Despite treatment with budesonide and mesalamine, the patient continued to be symptomatic one and a half months after cessation of teprotumumab and required infliximab to achieve good control of her inflammatory bowel disease. This case represents the first report of new-onset inflammatory bowel disease arising during treatment with teprotumumab.
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Affiliation(s)
- Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Ivana Jankovic
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford
| | - Najwa El-Nachef
- Department of Gastroenterology, University of California, San Francisco, San Francisco
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Grace E Kim
- Department of Pathology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco
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22
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Kinde B, Idowu OO, Ashraf DC, Chen RM, Hirabayashi KE, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Quality-of-Life Outcomes for Excision and Reconstruction of Periocular Nonmelanoma Skin Cancer. Facial Plast Surg Aesthet Med 2021. [PMID: 34227877 DOI: 10.1089/fpsam.2020.0647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding how periocular nonmelanoma skin cancer (NMSC) impacts quality of life (QoL) provides insight into the patient experience. Objective: To prospectively measure QoL of individuals with surgically treated periocular NMSC. Methods: Responses to the skin cancer index (SCI) and FACE-Q questionnaires were obtained at preoperative (PRE), postoperative week 1 (POW1), and postoperative month 3 (POM3) visits. Statistical analysis was performed using paired t-test and stepwise linear regression. Results: Forty-five patients participated in the study. Improved QoL as reflected in an increased mean difference of the total SCI score at PRE and POM3 visits (25.8, 95% confidence interval [CI 20.0 to 31.6]) and FACE-Q early life impact of treatment score at POW1 and POM3 visits (19.0, 95% CI [14.9 to 23.0), and a decreased mean difference of the FACE-Q adverse effects score at POW1 and POM3 visits (-1.3, 95% CI [-2.4 to -0.1]) was observed. Linear regression of the SCI and FACE-Q scores using demographic and clinical attributes revealed several predictors of postoperative QoL. Conclusions: Surgical management of periocular NMSC results in improved QoL, demonstrated at the final postoperative visit.
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Affiliation(s)
- Benyam Kinde
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Davin C Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Kristin E Hirabayashi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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23
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Bian Y, Scofield-Kaplan SM, Zemsky C, Campagnoli T, Ghadiali L, Glass LRD, Sallee B, Belsito DV, Winn BJ. Punctal Congestion Syndrome: A Reversible, Functional Punctal Stenosis Causing Epiphora in the Setting of Chronic Pretarsal Conjunctivitis. Ophthalmic Plast Reconstr Surg 2021; 37:S92-S97. [PMID: 32890120 PMCID: PMC7904972 DOI: 10.1097/iop.0000000000001840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a reversible syndrome of epiphora, functional punctal stenosis, and chronic pretarsal conjunctivitis associated with corticosteroid or corticosteroid-antibiotic eyedrop use. METHODS This is an Institutional Review Board-approved retrospective review of patients diagnosed with epiphora, punctal stenosis, and chronic conjunctivitis by a single surgeon (B.J.W.). These patients were subsequently invited to participate in a prospective study involving allergy skin patch testing for ophthalmic drops, common excipients, and active ingredients. RESULTS Thirteen patients received a diagnosis of punctal congestion syndrome. The average age was 63 years (range, 41-93) and 69.2% were female. Findings were bilateral in 61.5%. All had used preserved drops in the affected eye(s). Various antecedent diagnoses resulted in treatment with preserved drops. Patients experienced epiphora for an average of 3.8 months (median, 3 months; mode, 3 months; range, 1-8 months) prior to presentation. Two patients had undergone punctoplasty which failed to resolve symptoms. 92.3% of patients had been taking tobramycin-dexamethasone drops, loteprednol drops, or a combination of both prior to presentation. All were taken off preserved drops. 69.2% were also treated with a preservative-free loteprednol etabonate 0.5% ophthalmic ointment taper. All improved. Partial relief of symptoms was achieved by an average of 1.6 months (median, 2 months; mode, 2 months; standard deviation, ±0.7 months) and resolution of symptoms by 2.5 months (median, 2 months; mode, 2 months; standard deviation, ±1.7 months). One patient underwent patch testing with strong positive reactions to formaldehyde and neomycin and a weak positive reaction to gentamicin. CONCLUSIONS Functional punctal stenosis is associated with topical ophthalmic preparations, especially preserved corticosteroids and antibiotic-corticosteroid combinations. Treatment consists of removal of all preserved eyedrops. Symptoms often improve over several months.
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Affiliation(s)
- Yandong Bian
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | | | - Christine Zemsky
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | - Thalmon Campagnoli
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | - Larissa Ghadiali
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
- Hinsdale Eye Center, Hinsdale, IL
| | - Lora R. Dagi Glass
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | - Brigitte Sallee
- Department of Dermatology, Columbia University Irving
Medical Center, New York, NY
| | - Donald V. Belsito
- Department of Dermatology, Columbia University Irving
Medical Center, New York, NY
| | - Bryan J. Winn
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
- Department of Ophthalmology, University of California, San
Francisco, San Francisco, CA
- Surgical Section, San Francisco Veterans Affairs Medical
Center, San Francisco, CA
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24
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Rubenstein JA, Chang CC, Idowu OO, Winn BJ. Intravenous Catheter Employed in Peritrochlear Injection of Triamcinolone in the Treatment of Trochleitis. Ophthalmic Plast Reconstr Surg 2021; 37:280-283. [PMID: 32852370 PMCID: PMC7902732 DOI: 10.1097/iop.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Injection of corticosteroid into the peritrochlear region is a widely practiced and highly successful treatment option for trochleitis, conventionally using a 25- or 27-gauge needle for the steroid injection. Injection into the vascular-rich peritrochlear region poses a risk, albeit rare, of central retinal artery occlusion or orbital hemorrhage. We describe a potentially safer method of delivering triamcinolone to the peritrochlear region using a 24-gauge intravenous catheter. METHODS Interventional retrospective case series including all patients who received peritrochlear injections of triamcinolone via intravenous catheter for trochleitis by a single surgeon (BJW). Surgical technique: After a subcutaneous wheel of local anesthetic was delivered to the medial upper eyelid skin nearest to the trochlea, a 24-gauge intravenous catheter was used to penetrate the skin and orbital septum. Once past the septum, the needle was removed and the blunt catheter was advanced into the peritrochlear region. A 1-ml syringe filled with 40 mg/ml triamcinolone was attached to the catheter. After pulling back to ensure that the catheter was not intravascular, triamcinolone was delivered to the orbit. The catheter was then removed. RESULTS Ten catheter injections were performed on 3 patients over an 8-year period. There were no complications. CONCLUSION Injection of corticosteroid into the peritrochlear region using the commonly available 24-gauge intravenous catheter is an effective and theoretically safer alternative to typical injection using a 25-gauge needle for treatment of trochleitis. Use of nonparticulate steroid solutions may further decrease the risk of adverse events.
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Affiliation(s)
| | - Chih-Chiun Chang
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, NY
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA
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25
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Winn BJ, Kersten RC. Teprotumumab: Interpreting the Clinical Trials in the Context of Thyroid Eye Disease Pathogenesis and Current Therapies. Ophthalmology 2021; 128:1627-1651. [PMID: 33930408 DOI: 10.1016/j.ophtha.2021.04.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
Teprotumumab, a monoclonal antibody targeted against the insulin-like growth factor 1 (IGF-1) receptor, was recently approved by the United States Food and Drug Administration for the treatment of thyroid eye disease (TED). Phase 1 studies of teprotumumab for the treatment of malignancies demonstrated an acceptable safety profile but limited effectiveness. Basic research implicating the IGF-1 receptor on the CD-34+ orbital fibrocyte in the pathogenesis of TED renewed interest in the drug. Two multicenter, randomized, double-masked, clinical trials (phase 2 and 3) evaluated the efficacy of 8 infusions of teprotumumab every 3 weeks versus placebo in 170 patients with recent-onset active TED, as defined by a clinical activity score (CAS) of at least 4. Teprotumumab was superior to placebo for the primary efficacy end points in both studies: overall responder rate as defined by a reduction of 2 or more CAS points and a reduction of 2 mm or more in proptosis (69% vs. 20%; P < 0.001; phase 2 study) and proptosis responder rate as defined by a reduction of 2 mm or more in proptosis (83% vs. 10%; P < 0.001; phase 3 study). In both studies, treatment with teprotumumab compared with placebo achieved a significant mean reduction of proptosis (-3.0 mm vs. -0.3 mm, phase 2 study; -3.32 mm vs. -0.53 mm, phase 3 study) and CAS (-4.0 vs. -2.5, phase 2 study; -3.7 vs. -2.0, phase 3 study). Teprotumumab also resulted in a greater proportion of patients with a final CAS of 0 or 1, higher diplopia responder rate, and a larger improvement in the Graves' Ophthalmopathy Quality of Life overall score. More than half of patients (62%, phase 2 trial; 56%, phase 3 trial) who were primary end point responders maintained this response at 51 weeks after the last dose of therapy. The most common adverse events reported with teprotumumab included muscle spasms (25%), nausea (17%), alopecia (13%), diarrhea (13%), fatigue (10%), hearing impairment (10%), and hyperglycemia (8%). Teprotumumab is contraindicated for those with inflammatory bowel disease and who are pregnant. Although the current dosing regimen has proven effective for TED, dose-ranging studies including variable concentrations, infusion frequencies, and durations of teprotumumab therapy in the setting of TED have not been performed.
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Affiliation(s)
- Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California.
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Abstract
SIGNIFICANCE Hemolacria (bloody tears) is a rare clinical presentation with varied underlying etiologies. Thorough clinical evaluation is essential to diagnosis and management. PURPOSE This study aimed to report unilateral hemolacria in a known contact lens wearer with an occult, palpebral, conjunctival pyogenic granuloma and review the literature. CASE REPORT A 21-year-old female contact lens wearer presented to the clinic after three episodes of sudden painless bloody tears from the right eye. She was referred to the oculoplastic clinic for evaluation. On everting her right upper lid, a fleshy, nontender, ovoid, pedunculated mass was found attached to the palpebral conjunctiva of the right, nasal, upper tarsus. Surgical excision was performed in the office, and pathological examination of the lesion was consistent with pyogenic granuloma. CONCLUSIONS Unilateral hemolacria should raise clinical suspicion for a hidden conjunctival lesion such as pyogenic granuloma, although other more sinister causes of hemolacria must also be considered. Thorough evaluation including eyelid eversion is critical in identifying and managing occult conjunctival lesions.
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Affiliation(s)
- Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Georgia Kaidonis
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Sameera Husain
- Division of Dermatopathology, Columbia University Medical Center, New York, New York
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27
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Mekonnen ZK, Ashraf DC, Jankowski T, Grob SR, Vagefi MR, Kersten RC, Simko JP, Winn BJ. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthalmic Plast Reconstr Surg 2021; 37:e40-e80. [PMID: 33229953 PMCID: PMC7927902 DOI: 10.1097/iop.0000000000001889] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
Acute invasive fungal rhinosinusitis is a rare, although highly morbid, infection primarily affecting immunosuppressed individuals. The same population is at particularly high risk of complications and mortality in the setting of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. The authors present a case of acute invasive fungal rhino-orbital mucormycosis in a patient with COVID-19 and discuss the prevalence, diagnosis, and treatment of fungal coinfections in COVID-19. Prompt recognition, initiation of therapy, and consideration of the challenges of rapidly evolving COVID-19 therapy guidelines are important for improving patient survival.
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Affiliation(s)
| | | | - Tyler Jankowski
- Department of Pathology, University of California, San Francisco
| | | | | | | | - Jeffry P. Simko
- Department of Pathology, University of California, San Francisco
| | - Bryan J. Winn
- Department of Ophthalmology
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, U.S.A
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28
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Jia JS, Lazzaro A, Lidder AK, Elgin C, Alcantara-Castillo J, Gedde SJ, Khouri AS, Garg Shukla A, Sperber LTD, Law JC, Modi YS, Kim ET, SooHoo JR, Winn BJ, Chen RW, Al-Aswad LA. Gender Compensation Gap for Ophthalmologists in the First Year of Clinical Practice. Ophthalmology 2020; 128:971-980. [PMID: 33248156 DOI: 10.1016/j.ophtha.2020.11.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To identify the role of gender and other factors in influencing ophthalmologists' compensation. DESIGN Cross-sectional study. PARTICIPANTS U.S. practicing ophthalmologists. METHODS Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables. MAIN OUTCOME MEASURES Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus. RESULTS Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P = 0.00). The PSM analysis showed an SWB difference of -$27 273.89 (10.3% gap, P = 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (-$27 793.67 [10.5% gap, P = 0.0013]) and clinic days (-$23 597.57 [8.90% gap, P = 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22 261.49, $-18 604.65, and $-16 191.26, respectively; P = 0.017, P = 0.015, P = 0.002, respectively). Gender independently predicted income in all 3 analyses (P < 0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P = 0.03). CONCLUSIONS Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.
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Affiliation(s)
- Jing Sasha Jia
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alexander Lazzaro
- SUNY Downstate Health Sciences University College of Medicine, Brooklyn, New York
| | - Alcina K Lidder
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Ceyhun Elgin
- Columbia University, New York, New York; and Bogazici University, Istanbul, Turkey
| | | | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Albert S Khouri
- Institute of Ophthalmology and Visual Science, Rutgers - New Jersey Medical School, Newark, New Jersey
| | - Aakriti Garg Shukla
- Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Janice C Law
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yasha S Modi
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Eleanore T Kim
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Jeffrey R SooHoo
- UCHealth Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, Colorado
| | - Bryan J Winn
- UCSF Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | - Royce W Chen
- Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lama A Al-Aswad
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York.
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29
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Shahlaee A, Hennein LM, Winn BJ, Dillon WP, Rasool N. Bilateral superior ophthalmic vein thrombosis associated with high altitude. Orbit 2020; 40:407-411. [PMID: 32727245 DOI: 10.1080/01676830.2020.1797825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a case of a 47-year-old female who experienced periorbital swelling while descending from a Himalayan mountain climb and was found to have bilateral superior ophthalmic vein thromboses (SOVT). Infectious, autoimmune, and hypercoagulability work-up were negative with no cavernous sinus involvement. Symptoms resolved upon initiation of anticoagulation and oral steroids. SOVT is a rare but serious condition and has a risk of extending into the cavernous sinus if not treated early. Although infection is the most common etiology, venous thrombosis can be precipitated under high altitude and low oxygen pressure environments. We present a case of superior ophthalmic vein thrombosis associated with high-altitude conditions.
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Affiliation(s)
- Abtin Shahlaee
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Lauren M Hennein
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Nailyn Rasool
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Gong D, Winn BJ, Beal CJ, Blomquist PH, Chen RW, Culican SM, Dagi Glass LR, Domeracki GF, Goshe JM, Jones JK, Khouri AS, Legault GL, Martin TJ, Mitchell KT, Naseri A, Oetting TA, Olson JH, Pettey JH, Reinoso MA, Reynolds AL, Siatkowski RM, SooHoo JR, Sun G, Syed MF, Tao JP, Taravati P, WuDunn D, Al-Aswad LA. Gender Differences in Case Volume Among Ophthalmology Residents. JAMA Ophthalmol 2019; 137:1015-1020. [PMID: 31318390 DOI: 10.1001/jamaophthalmol.2019.2427] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P < .001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P < .001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P < .001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P = .81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P < .001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P < .001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P = .11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P = .008). Conclusions and Relevance Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study.
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Affiliation(s)
- Dan Gong
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Bryan J Winn
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Casey J Beal
- Department of Ophthalmology, University of Florida, Gainesville
| | - Preston H Blomquist
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
| | - Royce W Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Gary F Domeracki
- Department of Ophthalmology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - Jeremy K Jones
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Albert S Khouri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
| | | | - Timothy J Martin
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kelly T Mitchell
- Department of Ophthalmology & Visual Sciences, Texas Tech University Health Sciences Center, Lubbock
| | - Ayman Naseri
- Department of Ophthalmology, University of California, San Francisco
| | - Thomas A Oetting
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Joshua H Olson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Maria A Reinoso
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans
| | - Andrew L Reynolds
- Ross Eye Institute, University at Buffalo Jacobs School of Medicine, Buffalo, New York
| | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Misha F Syed
- Ophthalmology and Visual Science, University of Texas Medical Branch, Galveston
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine
| | - Parisa Taravati
- Department of Ophthalmology, University of Washington, Seattle
| | - Darrell WuDunn
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis
| | - Lama A Al-Aswad
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.,Department of Ophthalmology, New York University School of Medicine, NYU Langone Health, New York, New York
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Oh JK, Winn BJ, Dagi Glass LR. Young Woman Referred for a Drooping Eyelid. JAMA FACIAL PLAST SU 2018; 20:515-516. [PMID: 30128542 DOI: 10.1001/jamafacial.2018.0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jin Kyun Oh
- SUNY Downstate College of Medicine, Brooklyn, New York
| | - Bryan J Winn
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York
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Ing EB, Bedi H, Hussain A, Zakrewski H, Ing R, Nijhawan N, Al-Sayyed A, Winn BJ. Meta-analysis of randomized controlled trials in dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol 2018; 53:466-470. [DOI: 10.1016/j.jcjo.2017.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/06/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
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Abstract
The management of cicatricial ectropion resulting from epidermal growth factor receptor (EGFR) inhibitors is unclear. We describe two cases of bilateral cicatricial ectropion following the use of an EGFR inhibitor who were treated with oral doxycycline, topical ophthalmic steroid and antibiotic ointment to the eyelids, and topical facial steroid cream with lubrication. The first case resolved with discontinuation of panitumumab infusions along with institution of the aforementioned regimen. However, it is unclear whether the resolution was from discontinuation of the infusions or from the instituted regimen. The second case resolved without a dose adjustment of cituximab. This case may provide support for the use of this regimen prior to discontinuation of the offending agent, as there was a successful outcome without alteration of the infusions. Additional cases are necessary to determine if this is a successful means of treating bilateral lower-lid cicatricial ectropion from EGFR inhibitors.
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Affiliation(s)
- Stacy Scofield-Kaplan
- a Department of Ophthalmology , Columbia University Medical Center , New York , New York , USA
| | - James Todaro
- b Department of Ophthalmology , Kresge Eye Institute , Detroit , Michigan , USA
| | - Bryan J Winn
- a Department of Ophthalmology , Columbia University Medical Center , New York , New York , USA
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Glass LRD, Lira J, Enkhbold E, Dimont E, Scofield S, Sherwood PR, Winn BJ. The lateral brow: position in relation to age, gender, and ethnicity. Ophthalmic Plast Reconstr Surg 2014; 30:295-300. [PMID: 25069068 PMCID: PMC4114322 DOI: 10.1097/iop.0000000000000095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite multiple studies regarding modes of eyebrow measurement and movement over time, the lateral aspect of the brow has been relatively ignored in the literature. Therefore, we arranged a study of the most lateral aspect of the eyebrow; in doing so, we hoped to ascertain the most practical line or angle of measurement. METHODS In this cross-sectional study, adults age 18 years and older with no history of congenital or acquired periorbital or orbital pathology or surgery, brow tattooing or heavy plucking, phthisis, or strabismus were measured using a combination of in-office metrics and computer analysis. Subjects were asked to identify their ethnicity and country of origin. Models of age, gender, and ethnicity were created. RESULTS One thousand twenty-four subjects were included (1,944 eyes). Measurements of nasal ala to lateral brow (NALB), lateral brow plumb line (LBPL; the vertical line between the tail of the brow and a horizontal line extending from the lateral canthus), and angle from the midbrow to the lateral brow tail showed statistically significant decline over time. The angle and LBPL varied mostly by ethnicity. The angle narrowed approximately 3° per 20 years, while the LBPL fell approximately 2.5 mm per 20 years. The NALB varied most by age and fell approximately 3 mm per 20 years. CONCLUSIONS The lateral tail of the brow descends with age. Measurements of its location and rate of change vary between genders and within ethnic groups. Two easily measured values-NALB and LBPL-can be used for preoperative planning and postoperative documentation.
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Affiliation(s)
- Lora Rabin Dagi Glass
- *Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A.; †Amherst College, Amherst, Massachusetts, U.S.A.; and ‡Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, U.S.A
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Abstract
OBJECTIVE To report a refinement of small-incision external levator advancement with a standardized method for suture placement for correction of acquired blepharoptosis and 1 surgeon's results with this technique. METHODS Retrospective medical record review of data from all patients with unilateral or bilateral acquired blepharoptosis who underwent small-incision external levator advancement from October 1, 2007, through January 31, 2011. RESULTS Ninety-two eyelids from 66 patients with acquired blepharoptosis were treated with small-incision external levator advancement with uniform suture placement. Forty patients underwent unilateral surgery and 26 underwent bilateral surgery. The mean preoperative margin-to-reflex distance was 0.70 mm. The mean postoperative margin-to-reflex distance was 2.95 mm. Symmetry was achieved in 49 patients (74%) on the basis of a less than 1-mm difference in margin-to-reflex distance. When stratified by unilateral ptosis repair vs bilateral ptosis repair, bilateral ptosis repair achieved greater symmetry on average (81% vs 70%). Nine patients underwent revision. There were only 2 postoperative complications: one was postoperative upper eyelid bleeding and the other was exposure keratopathy. CONCLUSION The simplified method of suture placement for small-incision external levator advancement is an effective, safe, and efficient option for acquired ptosis correction.
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Affiliation(s)
- Audrey E Ahuero
- Allure Facial Laser Center and Medispa, Kirkland, Washington, USA
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Winn BJ, Sires BS. Electromyographic differences between normal upper and lower facial muscles and the influence of onabotulinum toxin a. JAMA FACIAL PLAST SU 2013; 15:211-7. [PMID: 23430072 DOI: 10.1001/jamafacial.2013.692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Empirically determined doses of onabotulinum toxin A for aesthetic treatments are as much as 5 times higher for the upper than for the lower facial muscles. OBJECTIVE To use electromyography (EMG) to determine objectively whether the disparity between doses is due to intrinsic differences between the muscle groups' responses to onabotulinum toxin A or to variable amounts of paralysis required to achieve the desired aesthetic outcomes. DESIGN We collected EMG data before and at 2 to 4 weeks and 3 months after 8- and 2-U onabotulinum toxin A injections to the corrugator and depressor anguli oris muscles, respectively. SETTING A private oculofacial plastic surgery practice. PARTICIPANTS Twenty-six subjects recruited from February 1 through April 1, 2009. INTERVENTIONS Electromyography recordings and cosmetic onabotulinum toxin A injections. MAIN OUTCOME MEASURES Mean motor unit (MU) durations and maximal amplitudes at baseline and 2 to 4 weeks and 3 months after injection. RESULTS Baseline mean MU amplitudes were similar for the corrugator and depressor anguli oris muscles. At 2 to 4 weeks after injection, 78% MU and 64% maximal amplitude reduction for the corrugator muscle were detected, but only 54% MU and 18% maximal amplitude reduction for the depressor anguli oris (P = 2.7 × 10-8 and P = 1.3 × 10-14, respectively). At 3 months, function was partially recovered for both muscle groups. CONCLUSIONS AND RELEVANCE Onabotulinum toxin A causes a similar dose-dependent reduction in MU and maximal voluntary amplitudes for muscles of the upper and lower face. The dose disparity appears to result from differences in the amount of paralysis required to achieve desirable aesthetic results. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Bryan J Winn
- Harkness Eye Institute, Department of Ophthalmology, Columbia University, New York, NY 10032, USA.
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Affiliation(s)
- Audrey E. Ahuero
- Allure Facial Laser Center and Medispa, Kirkland, Washington (Drs Ahuero and Sires); Department of Ophthalmology, University of Washington, Seattle (Drs Ahuero and Sires); Ophthalmic Plastic Surgeons of Texas, Houston (Dr Ahuero); and Department of Ophthalmology, Columbia University Medical Center, New York, New York (Dr Winn)
| | - Bryan J. Winn
- Allure Facial Laser Center and Medispa, Kirkland, Washington (Drs Ahuero and Sires); Department of Ophthalmology, University of Washington, Seattle (Drs Ahuero and Sires); Ophthalmic Plastic Surgeons of Texas, Houston (Dr Ahuero); and Department of Ophthalmology, Columbia University Medical Center, New York, New York (Dr Winn)
| | - Bryan S. Sires
- Allure Facial Laser Center and Medispa, Kirkland, Washington (Drs Ahuero and Sires); Department of Ophthalmology, University of Washington, Seattle (Drs Ahuero and Sires); Ophthalmic Plastic Surgeons of Texas, Houston (Dr Ahuero); and Department of Ophthalmology, Columbia University Medical Center, New York, New York (Dr Winn)
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Cabrera MT, Winn BJ, Porco T, Strominger Z, Barkovich AJ, Hoyt CS, Wakahiro M, Sherr EH. Laterality of brain and ocular lesions in Aicardi syndrome. Pediatr Neurol 2011; 45:149-54. [PMID: 21824560 PMCID: PMC3153732 DOI: 10.1016/j.pediatrneurol.2011.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 04/19/2011] [Indexed: 01/20/2023]
Abstract
This study reports a large case series of children with Aicardi syndrome. A new severity scoring system is established to assess sidedness of ocular and brain lesions. Thirty-five children were recruited from Aicardi syndrome family conferences. All children received dilated ophthalmologic examinations, and brain magnetic resonance images (MRIs) were reviewed. Ocular and brain MRI Aicardi lesion severity scores were devised. A linear mixed model was used to compare each side for the ocular and brain MRI severity scores of Aicardi-associated disease. Twenty-six children met the inclusion criteria for the study. All subjects were female, ages 3 months to 19 years. Rates per child of optic nerve coloboma, severe lacunae, and microphthalmos in one or both eyes (among those with complete fundus examinations available) were 10/24 (42%), 8/22 (36%), and 7/26 (27%), respectively. Ocular and brain MRI asymmetry was found in 18% (4/22) and 58% (15/26) of subjects, respectively, with more right-sided brain lesions than left-sided ones (V = 52, P = 0.028). A significant correlation between sidedness of brain disease and microphthalmos was noted (T = 2.54, P = 0.02). This study substantiates the range and severity of Aicardi syndrome-associated ophthalmologic and brain MRI lesions from prior smaller case series.
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Affiliation(s)
- Michelle T. Cabrera
- Department of Ophthalmology, University of California, 10 Koret Way, Box 0730, San Francisco, CA 94143-0730
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, 10 Koret Way, Box 0730, San Francisco, CA 94143-0730
| | - Travis Porco
- Department of Ophthalmology, University of California, 10 Koret Way, Box 0730, San Francisco, CA 94143-0730,Francis I. Proctor Foundation, University of California, 95 Kirkham St, San Francisco, CA 94143-0944
| | - Zoe Strominger
- Department of Neurology, University of California, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143-0114
| | - A. James Barkovich
- Departments of Radiology, Pediatrics, and Neurological Surgery, University of California, Box 0628, San Francisco, CA 94143-0622,Department of Neurology, University of California, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143-0114
| | - Creig S. Hoyt
- Department of Ophthalmology, University of California, 10 Koret Way, Box 0730, San Francisco, CA 94143-0730
| | - Mari Wakahiro
- Department of Neurology, University of California, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143-0114
| | - Elliott H. Sherr
- Department of Neurology, University of California, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143-0114
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Vagefi MR, Winn BJ, Lin CC, Sires BS, LauKaitis SJ, Anderson RL, McCann JD. Facial Nerve Injury during External Dacryocystorhinostomy. Ophthalmology 2009; 116:585-90. [DOI: 10.1016/j.ophtha.2008.09.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Revised: 09/19/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022] Open
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Bhisitkul RB, Winn BJ, Lee OT, Wong J, Pereira DDS, Porco TC, He X, Hahn P, Dunaief JL. Neuroprotective Effect of Intravitreal Triamcinolone Acetonide against Photoreceptor Apoptosis in a Rabbit Model of Subretinal Hemorrhage. Invest Ophthalmol Vis Sci 2008; 49:4071-7. [DOI: 10.1167/iovs.08-1892] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - On-Tat Lee
- From the Department of Ophthalmology and the
| | - Joshua Wong
- From the Department of Ophthalmology and the
| | | | - Travis C. Porco
- Francis I. Proctor Foundation, Epidemiology and Biostatistics Division, University of California at San Francisco, School of Medicine, San Francisco, California; and the
| | - Xining He
- F. M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania
| | - Paul Hahn
- F. M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania
| | - Joshua L. Dunaief
- F. M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania
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Rofagha S, Day S, Winn BJ, Ou JI, Bhisitkul RB, Chiu CS. Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body. J Cataract Refract Surg 2008; 34:1033-5. [PMID: 18499015 DOI: 10.1016/j.jcrs.2008.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 01/06/2008] [Indexed: 11/26/2022]
Abstract
A 49-year-old man presented with an intralenticular metal foreign body incurred while he was sawing wood. The metal chard had violated the lens capsule and was lodged in the cortex of the lens. It was removed using a lens-preservation technique during open-globe repair. Subsequently, a dense posterior cortical cataract developed, which spontaneously resolved over the ensuing months. The cataract had a cruciate configuration with wave-like disruption of the stromal lamellae. To our knowledge, this is the first case of spontaneous resolution of a cataract after capsule violation by an intralenticular foreign body. The unique appearance of the cataract and its unusual resolution led to a new theory of lens injury by shockwave.
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Affiliation(s)
- Soraya Rofagha
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143-0730, USA
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Winn BJ. Repair of Descemet Membrane Detachments With the Assistance of Anterior Segment Optical Coherence Tomography. ACTA ACUST UNITED AC 2008; 126:730-2. [DOI: 10.1001/archopht.126.5.730] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Holopigian K, Shuwairi SM, Greenstein VC, Winn BJ, Zhang X, Carr RE, Hood DC. Multifocal visual evoked potentials to cone specific stimuli in patients with retinitis pigmentosa. Vision Res 2005; 45:3244-52. [PMID: 16023698 DOI: 10.1016/j.visres.2005.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Revised: 05/13/2005] [Accepted: 05/17/2005] [Indexed: 10/25/2022]
Abstract
Our aim was to determine whether patients with retinitis pigmentosa show differences in L- and M-cone multifocal visual evoked potential (mfVEP) responses that are eccentricity dependent, as has been shown for control subjects. Second, we compared the losses for mfVEPs to losses on achromatic visual field and multifocal electroretinogram (mfERG) measures in the patients. Monocular mfVEPs were recorded to a pattern reversing display that modulated only the L- or M-cones. Also, standard automated achromatic visual fields and mfERGs were obtained. For the control subjects, the ratio of L-cone to M-cone mfVEP amplitudes increased as a function of retinal eccentricity. For the patients, the ratio did not vary with eccentricity. For all measures, responses were least affected for the first ring (central 2.4 degrees ) and most affected for the third ring (11.6 degrees - 44.4 degrees ). For the first ring, mfERG amplitudes were more impaired than were the mfVEPs or the visual field thresholds. For most of the patients, there was local response correspondence among our measures of visual function.
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Affiliation(s)
- K Holopigian
- Department of Ophthalmology, New York University School of Medicine, BEL 5N15, 462 First Avenue, New York, NY 10016, USA.
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Winn BJ, Shin E, Odel JG, Greenstein VC, Hood DC. Interpreting the multifocal visual evoked potential: the effects of refractive errors, cataracts, and fixation errors. Br J Ophthalmol 2005; 89:340-4. [PMID: 15722316 PMCID: PMC1772554 DOI: 10.1136/bjo.2004.047910] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To understand how refractive errors, cataracts, and fixation errors affect multifocal visual evoked potential (mfVEP) responses. METHODS Monocular mfVEP responses were obtained using a pattern reversal dartboard display. For the control condition, visual acuity was corrected to > or =20/20 and foveal fixation was maintained. The right eye was tested under the following conditions: simulated refractive error, simulated cataract, steady eccentric fixation, and unsteady fixation. RESULTS No subject demonstrated significant abnormalities under control conditions. For the simulated refractive error condition, significant centrally located abnormalities were seen for all subjects. For the simulated cataract condition, significant abnormalities were found for three subjects. The steady eccentric fixation condition yielded abnormalities in both eyes for all subjects while the unsteady fixation condition yielded significant central abnormalities in the tested eye. With eccentric and unsteady fixation conditions, all subjects had at least one sector with a waveform polarity reversal. CONCLUSIONS While the mfVEP is a useful tool for identifying local optic nerve damage or ruling out non-organic aetiology of visual field defects, factors such as uncorrected refractive errors, cataract, eccentric fixation, and unsteady fixation can produce apparent field defects on the mfVEP. With care, these problems can be correctly identified.
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Affiliation(s)
- B J Winn
- Department of Psychology, Columbia University, New York, NY 10027, USA
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Hood DC, Thienprasiddhi P, Greenstein VC, Winn BJ, Ohri N, Liebmann JM, Ritch R. Detecting early to mild glaucomatous damage: a comparison of the multifocal VEP and automated perimetry. Invest Ophthalmol Vis Sci 2004; 45:492-8. [PMID: 14744890 DOI: 10.1167/iovs.03-0602] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To gain better understanding of the relationship between abnormalities detected by the multifocal VEP (mfVEP) compared with those detected by static achromatic, automated perimetry in patients with glaucoma. METHODS Fifty patients were studied who had open-angle glaucoma that met the following criteria: (1) a mean deviation (MD) of better than -8 dB in both eyes on the 24-2 Humphrey visual field (HVF) test (Carl Zeiss Meditec, Dublin, CA); and (2) glaucomatous damage in at least one eye, as defined by a glaucomatous optic disc and an abnormal 24-2 HVF test result (pattern standard deviation [PSD] <5% and/or glaucoma hemifield test [GHT] results outside normal limits). Monocular mfVEPs were obtained from each eye by using a pattern-reversal dartboard array, 44.5 degrees in diameter, which contained 60 sectors. Recording electrodes were placed at the inion (I) and I+4 cm, and also at two lateral locations up 1 cm and over 4 cm from I. Monocular and interocular mfVEP probability plots were derived by comparing the results with those of normal control subjects. For both the HVF and mfVEP probability plots, a hemifield was classified as abnormal if three or more contiguous points were significant at less than 5%, with at least one at less than 1%. RESULTS Of the 200 hemifields tested (50 patients x two eyes x two hemifields), 75 showed significant clusters on the HVF, and 74 (monocular probability plot) and 93 (monocular or interocular plot) showed significant clusters on the mfVEP. Overall, the HVF and mfVEP results agreed on 74% of the hemifields, and 90 hemifields were normal and 58 were abnormal on both the mfVEP (interocular and/or monocular abnormal) and HVF cluster tests. Of the 52 disagreements, 35 hemifields had a significant cluster on the mfVEP, but not on the HVF, whereas the reverse was true of 17 hemifields. A case-by-case analysis indicated that misses and false-positive results occurred on both the HVF and mfVEP tests. CONCLUSIONS As predicted from a theoretical analysis, under these conditions (i.e., the signal-to-noise level) the HVF and monocular mfVEP tests showed a comparable number of defects, and, with the addition of the interocular test, the mfVEP showed more abnormalities than the HVF. However, although there were abnormalities detected by the mfVEP that were missed by the HVF, the reverse was true as well.
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Affiliation(s)
- Donald C Hood
- Department of Psychology, Columbia University, New York, New York 10027, USA.
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Abstract
With the multifocal technique, visual evoked potentials (VEPs) can be recorded simultaneously from many regions of the visual field. For the multifocal VEP (mfVEP), the patient views a display that typically contains 60 sectors, each with a checkerboard pattern. The display covers about the same retinal area as the 24-2 Humphrey visual field (HVF). However, due to the scaling of the sectors of the mfVEP display, the fields are sampled differently by the mfVEP and HVF. To assess local defects in the visual field, the mfVEP responses must be compared with normal controls. These comparisons require relatively sophisticated analyses and software. Whereas the mfVEP can be recorded relatively easily with the same equipment used to record multifocal electroretinograms (mfERGs), the software needed to perform the analysis is not yet widely available. The mfVEP is valuable for ruling out non-organic visual loss, diagnosing and following patients with optic neuritis/multiple sclerosis, evaluating patients with unreliable or questionable HVFs, and following disease progression. When combined with the mfERG, diseases of the outer retina (before the retinal ganglion cells) can be distinguished from diseases of the ganglion cells and/or optic nerve. The difficulties encountered in recording and analyzing mfVEP responses are greater than those involved in full-field VEP testing. Thus, in its current form, the mfVEP is best recorded and interpreted by ophthalmologists and electrophysiologists experienced with the technique. However, this technique is developing rapidly; advances in commercial hardware and software are expected in the near future.
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Affiliation(s)
- Donald C Hood
- Departments of Psychology, Columbia University, New York, New York 10027, USA.
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Abstract
The multifocal electroretinogram (mfERG) technique allows local ERG responses to be recorded simultaneously from many regions of the retina. As in the case of the full-field ERG, the ganglion cells contribute relatively little to the response, which originates largely from the outer retina. The mfERG is particularly valuable in cases in which the fundus appears normal, and it is difficult to distinguish between diseases of the outer retina and diseases of the ganglion cells and/or optic nerve. The mfERG can also help to differentiate among outer retinal diseases, to follow the progression of retinal diseases, and, with the addition of the mfVEP, to differentiate between organic and nonorganic causes of visual loss. However, because the difficulties encountered in recording and analyzing mfERG responses are greater than those involved in full-field ERG testing, mfERG testing is best left to centers with an electrophysiologist familiar with the mfERG test. Although this technique is relatively new and standards are still being developed, centers capable of recording reliable mfERG responses can be found in hundreds of locations around the world.
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Affiliation(s)
- Donald C Hood
- Department of Psychology, 405 Schermerhorn, Columbia University, New York, NY 10027, USA
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