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Chen JJ, McNussen PJ, Lee AG, Subramanian PS. Re: Pakravan et al.: Demographics, practice analysis and geographic distribution of neuro-ophthalmologists in the United States in 2023 (Ophthalmology. 2024;131:333-340). Ophthalmology 2024; 131:e17-e18. [PMID: 38189696 DOI: 10.1016/j.ophtha.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota.
| | | | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Neurology, Neurosurgery, and Ophthalmology, Weill Cornell Medicine, New York, New York; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Ophthalmology, Texas A&M University College of Medicine, Houston, Texas; Baylor College of Medicine and Center for Space Medicine, Houston, Texas; University of Iowa Hospitals and Clinics, Iowa City, Iowa; University of Buffalo, Buffalo, New York
| | - Prem S Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine and Sue Anschutz-Rodgers UC Health Eye Center, Aurora, Colorado
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Yu-Wai-Man P, Carelli V, Newman NJ, Silva MJ, Linden A, Van Stavern G, Szaflik JP, Banik R, Lubiński W, Pemp B, Liao YJ, Subramanian PS, Misiuk-Hojło M, Newman S, Castillo L, Kocięcki J, Levin MH, Muñoz-Negrete FJ, Yagan A, Cherninkova S, Katz D, Meunier A, Votruba M, Korwin M, Dziedziak J, Jurkutė N, Harvey JP, La Morgia C, Priglinger C, Llòria X, Tomasso L, Klopstock T. Therapeutic benefit of idebenone in patients with Leber hereditary optic neuropathy: The LEROS nonrandomized controlled trial. Cell Rep Med 2024; 5:101437. [PMID: 38428428 PMCID: PMC10982982 DOI: 10.1016/j.xcrm.2024.101437] [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: 07/03/2023] [Revised: 10/24/2023] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
Leber hereditary optic neuropathy (LHON) is a mitochondrial disease leading to rapid and severe bilateral vision loss. Idebenone has been shown to be effective in stabilizing and restoring vision in patients treated within 1 year of onset of vision loss. The open-label, international, multicenter, natural history-controlled LEROS study (ClinicalTrials.gov NCT02774005) assesses the efficacy and safety of idebenone treatment (900 mg/day) in patients with LHON up to 5 years after symptom onset (N = 199) and over a treatment period of 24 months, compared to an external natural history control cohort (N = 372), matched by time since symptom onset. LEROS meets its primary endpoint and confirms the long-term efficacy of idebenone in the subacute/dynamic and chronic phases; the treatment effect varies depending on disease phase and the causative mtDNA mutation. The findings of the LEROS study will help guide the clinical management of patients with LHON.
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Affiliation(s)
- Patrick Yu-Wai-Man
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, UK; MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0XY, UK; Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Valerio Carelli
- IRCCS Istituto di Scienze Neurologiche di Bologna, Programma di Neurogenetica, 40139 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy
| | - Nancy J Newman
- Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | | | | | - Jacek P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, 02-091 Warsaw, Poland; SPKSO Ophthalmic University Hospital, 00-576 Warsaw, Poland
| | - Rudrani Banik
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Wojciech Lubiński
- Samodzielny Publiczny Szpital Kliniczny Nr 2 PUM w Szczecinie, 70-111 Szczecin, Poland
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center, Aurora, CO 80045, USA
| | | | - Steven Newman
- University of Virginia, Charlottesville, VA 22903, USA
| | | | - Jarosław Kocięcki
- Department of Ophthalmology, University of Medical Sciences, 60-806 Poznan, Poland
| | - Marc H Levin
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA 94303, USA
| | | | - Ali Yagan
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
| | | | - David Katz
- Bethesda Neurology LLC, Bethesda, MD 20852, USA
| | - Audrey Meunier
- Department of Ophthalmology, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Marcela Votruba
- Cardiff Eye Unit, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Magdalena Korwin
- Department of Ophthalmology, Medical University of Warsaw, 02-091 Warsaw, Poland; SPKSO Ophthalmic University Hospital, 00-576 Warsaw, Poland
| | - Jacek Dziedziak
- Department of Ophthalmology, Medical University of Warsaw, 02-091 Warsaw, Poland; SPKSO Ophthalmic University Hospital, 00-576 Warsaw, Poland; Department of Experimental and Clinical Physiology, Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Neringa Jurkutė
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK; The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Joshua P Harvey
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Chiara La Morgia
- IRCCS Istituto di Scienze Neurologiche di Bologna, Programma di Neurogenetica, 40139 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Claudia Priglinger
- Department of Ophthalmology, University Hospital of the Ludwig-Maximilians-University (LMU), 80336 Munich, Germany
| | | | | | - Thomas Klopstock
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany; Friedrich Baur Institute at the Department of Neurology, LMU University Hospital, LMU Munich, 80336 Munich, Germany.
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Subramanian PS, Digre KB. NANOS had a Prominent Showing at the American Academy of Ophthalmology. J Neuroophthalmol 2024; 44:e1-e2. [PMID: 38277224 DOI: 10.1097/wno.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Prem S Subramanian
- Department of Ophthalmology (PS), UC Health Eye Center, Denver, Colorado; and Departments of Ophthalmology and Neurology (KBD), University of Utah Moran Eye Center, Salt Lake City, Utah
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Chen H, Subramanian PS. Conversion of Superior Oblique Myokymia to Superior Oblique Neuromyotonia in a Patient With History of Superior Oblique Palsy. J Neuroophthalmol 2024; 44:e190-e191. [PMID: 37389971 DOI: 10.1097/wno.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Affiliation(s)
- Hongan Chen
- Department of Ophthalmology and Sue Anschutz-Rodgers Eye Center (HC, PSS), Departments of Neurology (PSS) and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, Colorado; and Division of Ophthalmology (PSS), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Jalili J, Nadimi M, Jafari B, Esfandiari A, Mojarad M, Subramanian PS, Aghsaei Fard M. Vessel Density Features of Optical Coherence Tomography Angiography for Classification of Optic Neuropathies Using Machine Learning. J Neuroophthalmol 2024; 44:41-46. [PMID: 37440373 DOI: 10.1097/wno.0000000000001925] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND To evaluate the classification performance of machine learning based on the 4 vessel density features of peripapillary optical coherence tomography angiography (OCT-A) for classifying healthy, nonarteritic anterior ischemic optic neuropathy (NAION), and optic neuritis (ON) eyes. METHODS Forty-five eyes of 45 NAION patients, 32 eyes of 32 ON patients, and 76 eyes of 76 healthy individuals with optic nerve head OCT-A were included. Four vessel density features of OCT-A images were developed using a threshold-based segmentation method and were integrated in 3 models of machine learning classifiers. Classification performances of support vector machine (SVM), random forest, and Gaussian Naive Bayes (GNB) models were evaluated with the area under the receiver-operating-characteristic curve (AUC) and accuracy. RESULTS We divided 121 images into a 70% training set and 30% test set. For ON-NAION classification, best results were achieved with 50% threshold, in which 3 classifiers (SVM, RF, and GNB) discriminated ON from NAION with an AUC of 1 and accuracy of 1. For ON-Normal classification, with 100% threshold, SVM and RF classifiers were able to discriminate normal from ON with AUCs of 1 and accuracies of 1. For NAION-normal classification, with 50% threshold, the SVM and RF classified the NAION from normal with AUC and accuracy of 1. CONCLUSIONS ML based on the combined peripapillary vessel density features of total vessels and capillaries in the whole image and ring image could provide excellent performance for NAION and ON distinction.
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Affiliation(s)
- Jalil Jalili
- Biomedical Engineering Unit (JJ, MN), Cardiovascular Disease Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; Farabi Eye Hospital (BJ, AE, MAF), Tehran University of Medical Sciences, Tehran, Iran; School of Medicine (MM), Guilan University of Medical Sciences, Rasht, Iran; and Department of Ophthalmology (PSS), University of Colorado, School of Medicine, Aurora, Colorado
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Nguyen AAK, Sammel AM, Mollan SP, Subramanian PS, Fraser CL. Giant Cell Arteritis Incidence During the COVID Pandemic. J Neuroophthalmol 2024; 44:e62-e63. [PMID: 36166709 DOI: 10.1097/wno.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew A K Nguyen
- Sydney Eye Hospital (AAKN, AMS, CLF), Sydney, Australia; Birmingham Neuro-Ophthalmology (SPM), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Metabolic Neurology (SPM), Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Sue Anschutz-Rodgers UC Health Eye Center and Departments of Ophthalmology (PSS), Neurology (PSS), and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, Maryland; and Save Sight Institute (CLF), The University of Sydney, Sydney, Australia
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Godbole S, Leroux A, Brooks-Russell A, Subramanian PS, Kosnett MJ, Wrobel J. A Study of Pupil Response to Light as a Digital Biomarker of Recent Cannabis Use. Digit Biomark 2024; 8:83-92. [PMID: 38682092 PMCID: PMC11052563 DOI: 10.1159/000538561] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/23/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Given the traffic safety and occupational injury prevention implications associated with cannabis impairment, there is a need for objective and validated measures of recent cannabis use. Pupillary light response may offer an approach for detection. Method Eighty-four participants (mean age: 32, 42% female) with daily, occasional, and no-use cannabis use histories participated in pupillary light response tests before and after smoking cannabis ad libitum or relaxing for 15 min (no use). The impact of recent cannabis consumption on trajectories of the pupillary light response was modeled using functional data analysis tools. Logistic regression models for detecting recent cannabis use were compared, and average pupil trajectories across cannabis use groups and times since light test administration were estimated. Results Models revealed small, significant differences in pupil response to light after cannabis use comparing the occasional use group to the no-use control group, and similar statistically significant differences in pupil response patterns comparing the daily use group to the no-use comparison group. Trajectories of pupillary light response estimated using functional data analysis found that acute cannabis smoking was associated with less initial and sustained pupil constriction compared to no cannabis smoking. Conclusion These analyses show the promise of pairing pupillary light response and functional data analysis methods to assess recent cannabis use.
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Affiliation(s)
- Suneeta Godbole
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Leroux
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Prem S. Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, Sue Anschutz-Rodgers Eye Center, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael J. Kosnett
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julia Wrobel
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
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Douglas RS, Couch S, Wester ST, Fowler BT, Liu CY, Subramanian PS, Tang R, Nguyen QT, Maamari RN, Ugradar S, Hsu K, Karon M, Stan MN. Efficacy and Safety of Teprotumumab in Patients With Thyroid Eye Disease of Long Duration and Low Disease Activity. J Clin Endocrinol Metab 2023; 109:25-35. [PMID: 37925673 PMCID: PMC10735297 DOI: 10.1210/clinem/dgad637] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
CONTEXT Early inflammatory thyroid eye disease (TED) can lead to symptomatic chronic disease, including disabling proptosis. Teprotumumab, an insulin-like growth factor-1 receptor (IGF-1R) inhibitor, previously demonstrated efficacy in acute, high-inflammation TED trials. OBJECTIVE We present data from the first placebo-controlled trial with teprotumumab in chronic/low disease activity TED. METHODS This randomized double-masked, placebo-controlled trial, conducted at 11 US centers, enrolled adult participants with TED duration of 2 to 10 years, Clinical Activity Score (CAS) ≤ 1 or no additional inflammation or progression in proptosis/diplopia for ≥1 year, proptosis ≥3 mm from before TED and/or from normal, euthyroid/mildly hypo/hyperthyroid, no prior teprotumumab, and no steroids within 3 weeks of baseline. Patients received (2:1) intravenous teprotumumab or placebo once every 3 weeks (total 8 infusions). The primary endpoint was proptosis (mm) improvement at Week 24. Adverse events (AEs) were assessed. RESULTS A total of 62 (42 teprotumumab and 20 placebo) patients were randomized. At Week 24, least squares mean (SE) proptosis improvement was greater with teprotumumab (-2.41 [0.228]) than with placebo (-0.92 [0.323]), difference -1.48 (95% CI -2.28, -0.69; P = .0004). Proportions of patients with AEs were similar between groups. Hyperglycemia was reported in 6 (15%) vs 2 (10%) and hearing impairment in 9 (22%) vs 2 (10%) with teprotumumab and placebo, respectively. AEs led to discontinuation in 1 teprotumumab (left ear conductive hearing loss with congenital anomaly) and 1 placebo patient (infusion-related). There were no deaths. CONCLUSION Teprotumumab significantly improved proptosis vs placebo in longstanding/low inflammation TED, demonstrating efficacy regardless of disease duration/activity. The safety profile was comparable to that previously reported.
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Affiliation(s)
- Raymond S Douglas
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Steven Couch
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Sara T Wester
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Brian T Fowler
- Department of Ophthalmology, The University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, TN 38163, USA
| | - Catherine Y Liu
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92037, USA
| | - Prem S Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, UC Health Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Surgery, Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rosa Tang
- Eye Wellness Center, Neuro-Eye Clinical Trials, Inc., Houston, TX 77074, USA
| | - Quang T Nguyen
- Department of Endocrinology, Touro University, Henderson, NV 89014, USA
| | - Robi N Maamari
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Shoaib Ugradar
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Kate Hsu
- Clinical Development, Horizon Therapeutics plc, Deerfield, IL 60015, USA
| | - Michael Karon
- Clinical Development, Horizon Therapeutics plc, Deerfield, IL 60015, USA
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
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Affiliation(s)
- Madina Tugizova
- Department of Neurology and Neurological Sciences (MT, ES, SB, NV), Stanford University, Stanford, California; Sue Anschutz-Rodgers University of Colorado Eye Institute and Department of Ophthalmology (DTS, PSS), University of Colorado School of Medicine, Aurora, Colorado; Department of Psychiatry (SH), Stanford University, Stanford, California; Departments of Neurology (PSS) and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, Colorado; and Division of Ophthalmology (PSS), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Larochelle RD, Koduri V, Chen R, Subramanian PS. Reply to Comment on Embolic Abducens Palsy and Central Retinal Artery Occlusion (CRAO) in a Patient With COVID-19: Response. J Neuroophthalmol 2023; 43:e359-e360. [PMID: 35421044 DOI: 10.1097/wno.0000000000001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ryan D Larochelle
- Sue Anschutz-Rodgers UCHealth Eye Center and Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, Sue Anschutz-Rodgers UCHealth Eye Center and Departments of Ophthalmology, Neurology, and, Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado; and Division of Ophthalmology, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Coburn W, Fonteh CN, Subramanian PS. Isolated Compressive Optic Neuropathy Due to Cavernous Carotid Aneurysms: A 2-Patient Case Report. J Neuroophthalmol 2023; 43:e237-e238. [PMID: 35471262 DOI: 10.1097/wno.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- William Coburn
- Departments of Ophthalmology (WC, CNF, PSS), Neurology (PSS), and Neurosurgery (PSS), University of Colorado School of Medicine and Sue Anschutz-Rodgers UCHealth Eye Center, Aurora, Colorado ; and Division of Ophthalmology (PSS), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract
PURPOSE OF REVIEW Teprotumumab, an inhibitor of the insulin-like growth factor 1 receptor (IGF-1R), was approved by the US Food and Drug Administration in January 2020 for the treatment of thyroid eye disease (TED). The clinical trials leading to its approval enrolled patients with recent disease onset and significant inflammatory symptoms and signs. Subsequent real-world teprotumumab use in patients with longer duration of disease also may be effective, and there have been several publications reporting on experience in these patient groups. RECENT FINDINGS TED results in disfiguring changes such as ocular proptosis and affects visual function by altering extraocular muscle function, leading to diplopia. Compressive optic neuropathy also may occur, and disease manifestations may persist for years. Teprotumumab treatment in cases of TED in which prior interventions (medical or surgical) had failed, or in treatment-naïve patients whose disease had been stable for years, has been reported to improve both clinical signs and symptoms (proptosis, diplopia) and to reduce the pathologic orbital changes as assessed by orbital imaging. SUMMARY Teprotumumab may be an appropriate treatment for TED regardless of disease duration and irrespective of the presence or absence of markers of active inflammation within the orbit.
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Affiliation(s)
- Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center
- Departments of Ophthalmology, Neurology, and Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
- Department of Surgery (Division of Ophthalmology), Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Surgery (Division of Ophthalmology), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Raymond I Cho
- Department of Ophthalmology, The Ohio State University School of Medicine, Columbus, Ohio
| | - Alon Kahana
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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Abstract
PURPOSE OF REVIEW Spaceflight-associated neuro-ocular syndrome (SANS) remains a phenomenological term, and advances in ophthalmic imaging as well as new insights from ground-based experiments have given support to new theories of how SANS develops and what may be done to counter it. RECENT FINDINGS SANS has been postulated to arise from elevated intracranial pressure (ICP) during long-duration spaceflight (LDSF). However, recent work has shown that acute microgravity exposure does not increase ICP, and the effect of cephalad fluid shifts on ICP in microgravity remain unknown. In addition, structural imaging of the retina and optic nerve show changes after LDSF that are distinct from findings in terrestrial patients with elevated ICP. Since astronauts have not reported symptoms that would be expected with chronic ICP elevation, new theories that orbital and/or intracranial venous pressure may be the primary contributors to the development of SANS. SUMMARY Research has been filling knowledge gaps that exist regarding the cause(s) of SANS, and these advances are crucial steps in the effort to design countermeasures that will be required before human deep space exploration missions can be undertaken.
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Affiliation(s)
- Dallin C Milner
- Sue Anschutz-Rodgers University of Colorado Eye Center and Department of Ophthalmology
| | - Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center and Department of Ophthalmology
- Department of Neurology
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
- Department of Surgery (Division of Ophthalmology), Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Larochelle RD, Mandava N, Subramanian PS. Binasal Center-Involving Hemianopia of Presumed Congenital Etiology. J Neuroophthalmol 2023; 43:e82-e84. [PMID: 36268882 DOI: 10.1097/wno.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ryan D Larochelle
- Departments of Ophthalmology (RDL, NM, PSS), Neurology and Neurosurgery (PSS), Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora, Colorado; Division of Ophthalmology (PSS), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Caldwell AS, Mehta N, Subramanian PS. Malignant Idiopathic Intracranial Hypertension. Ophthalmology 2023; 130:957. [PMID: 36229275 DOI: 10.1016/j.ophtha.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023] Open
Affiliation(s)
- Anne Strong Caldwell
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nihaal Mehta
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Prem S Subramanian
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado; Neurology, University of Colorado School of Medicine, Aurora, Colorado; Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Echalier EL, Larochelle RD, Patnaik JL, Echalier BR, Wagner A, Hink EM, Subramanian PS, Liao SD. Orbital Compartment Syndrome in Severe Burns: Predictive Factors, Timing, and Complications of Intervention. Ophthalmic Plast Reconstr Surg 2023; 39:341-346. [PMID: 36700833 DOI: 10.1097/iop.0000000000002313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Severe burn patients require high-volume fluid resuscitation, which increases risk for orbital compartment syndrome (OCS). We aimed to understand surgeons' practice patterns and to examine risk factors for OCS, timing of lateral canthotomy and cantholysis (LCC), and complications of intervention. METHODS A survey of American Society of Ophthalmic Plastic and Reconstructive Surgery and North American Society of Academic Orbital Surgeons' practice patterns in burn patients was undertaken. In addition, a retrospective analysis was conducted of 107 patients with burns greater than 20% total body surface area at 1 institution from January 1, 2009, to June 1, 2018. Patients with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, frostbite, or no ophthalmologic consultation were excluded. Risk factors for OCS, timing of LCC, and complications of the intervention were examined. RESULTS In the survey, 37 of 54 respondents had treated burn patients, of which 29 followed no protocol. Threshold intraocular pressure for intervention varied widely, and nearly all reported having seen complications from LCC in burn patients. For the retrospective analysis, 107 patients met criteria, of which 22 (20.6%) required LCC. Renal failure, inhalation injury, eyelid burns, higher total body surface area, elevated lactate, increased number of escharotomies, and greater total fluid required were significantly associated with the clinical decision that the patient was at risk for OCS requiring LCC. Fluid resuscitation in excess of the Ivy Index (250 ml/kg) increased odds of LCC 8.6 times. Average time of LCC was 15.8 hours after burn. LCC patients experienced higher rates of complications including eyelid retraction, exposure keratopathy, and corneal ulceration. CONCLUSIONS Severe burn patients should be monitored closely by an ophthalmologist during the first 48 hours for signs of OCS. Further studies should aim to recommend protocols guiding evaluation and intervention.
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Affiliation(s)
- E Lacey Echalier
- Department of Ophthalmology, University of Colorado, Aurora, Colorado, U.S.A
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17
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Subramanian PS, Turbin RE, Dinkin MJ, Lee AG, Van Stavern GP. What Is the Best Surgical Intervention for Patients With Idiopathic Intracranial Hypertension? J Neuroophthalmol 2023; 43:261-272. [PMID: 37078925 DOI: 10.1097/wno.0000000000001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Prem S Subramanian
- Sue-Anschutz Rodgers University of Colorado Eye Center (PS), University of Colorado School of Medicine, Aurora, Colorado; Institute of Ophthalmology and Visual Science (RET), Rutgers New Jersey Medical School, Newark, New Jersey; Departments of Ophthalmology and Neurology (MD), Weill Cornell Medicine, NY Presbyterian Hospital, New York, New York; Blanton Eye Institute (AGL), Houston Methodist Hospital, Houston Texas; and Department of Ophthalmology and Visual Sciences (GPVS), Washington University in St. Louis School of Medicine, St Louis, Missouri
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18
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Marin AI, Zarubina AV, Bennett JL, Subramanian PS. Seropositive Neuromyelitis Optica Spectrum Disorder Presenting With Optic Nerve Sheath Enhancement and Optic Disc Edema Resembling Optic Nerve Sheath Meningioma. J Neuroophthalmol 2023:00041327-990000000-00362. [PMID: 37247229 DOI: 10.1097/wno.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Alejandro I Marin
- Sue Anschutz-Rodgers Eye Center (AIM, AVZ, JLB, PSS), Departments of Ophthalmology (AIM, AVZ, JLB, PSS), Neurology (AVZ, JLB, PSS), and Neurosurgery (PSS), University of Colorado School of Medicine, Aurora, Colorado; and Department of Surgery (Division of Ophthalmology) (PSS), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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19
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Subramanian PS, Miller NR. Optic nerve sheath fenestration: Does it still have a role in treating patients with elevated intracranial pressure? Clin Exp Ophthalmol 2023; 51:287-288. [PMID: 37314300 DOI: 10.1111/ceo.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center, Aurora, Colorado, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Surgery (Division of Ophthalmology), Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Neil R Miller
- Wilmer Eye Institute and Departments of Ophthalmology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Steinhart B, Brooks-Russell A, Kosnett MJ, Subramanian PS, Wrobel J. A Video Segmentation Pipeline for Assessing changes in Pupil Response to Light After Cannabis Consumption. bioRxiv 2023:2023.03.17.533144. [PMID: 36993434 PMCID: PMC10055178 DOI: 10.1101/2023.03.17.533144] [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] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Due to long-standing federal restrictions on cannabis-related research, the implications of cannabis legalization on traffic and occupational safety are understudied. Accordingly, there is a need for objective and validated measures of acute cannabis impairment that may be applied in public safety and occupational settings. Pupillary response to light may offer an avenue for detection that outperforms typical sobriety tests and THC concentrations. We developed a video processing and analysis pipeline that extracts pupil sizes during a light stimulus test administered with goggles utilizing infrared videography. The analysis compared pupil size trajectories in response to a light for those with occasional, daily, and no cannabis use before and after smoking. Pupils were segmented using a combination of image pre-processing techniques and segmentation algorithms which were validated using manually segmented data and found to achieve 99% precision and 94% F-score. Features extracted from the pupil size trajectories captured pupil constriction and rebound dilation and were analyzed using generalized estimating equations. We find that acute cannabis use results in less pupil constriction and slower pupil rebound dilation in the light stimulus test.
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Affiliation(s)
- Benjamin Steinhart
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael J. Kosnett
- Department of Medicine, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Prem S. Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, Sue Anschutz-Rodgers Eye Center, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Julia Wrobel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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21
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Vali M, Mohammadi M, Zarei N, Samadi M, Atapour-Abarghouei A, Supakontanasan W, Suwan Y, Subramanian PS, Miller NR, Kafieh R, Aghsaei Fard M. Differentiating Glaucomatous Optic Neuropathy from Non-Glaucomatous Optic Neuropathies Using Deep Learning Algorithms. Am J Ophthalmol 2023; 252:1-8. [PMID: 36868341 DOI: 10.1016/j.ajo.2023.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE A deep learning framework to differentiate glaucomatous optic disc changes (GON) from non-glaucomatous optic neuropathy-related disc changes (NGON). DESIGN Cross-sectional study. METHOD A deep-learning system was trained, validated, and externally tested to classify optic discs as normal, GON, or NGON using 2,183 digital color fundus photographs. A Single-Center data set of 1,822 images-660 images of NGON, 676 images of GON, and 486 images of normal optic discs-was used for training and validation, whereas 361 photographs from four different data sets were used for external testing. Our algorithm removed the redundant information from the images using an optic disc segmentation (OD-SEG) network, following which we performed transfer learning with various pre-trained networks. Finally, we calculated sensitivity, specificity, F1-score, and precision to show the performance of the discrimination network in the validation and independent external data set. RESULTS For classification, the algorithm with the best performance for the Single-Center data set was DenseNet121, with a sensitivity of 95.36%, precision of 95.35%, specificity of 92.19%, and F1 score of 95.40%. For the external validation data, the sensitivity and specificity of our network for differentiating GON from NGON were 85.53% and 89.02%, respectively. The glaucoma specialist who diagnosed those cases in masked fashion, had a sensitivity of 71.05% and a specificity of 82.21%. CONCLUSIONS The proposed algorithm for the differentiation of GON from NGON yields results that have a higher sensitivity than those of a glaucoma specialist, and its application for unseen data thus is extremely promising.
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Affiliation(s)
- Mahsa Vali
- From the Department of Electrical and Computer Engineering (M.V.), Isfahan University of Technology, Isfahan, Iran
| | - Massood Mohammadi
- Farabi Eye Hospital (M.M., N.Z., M.S.M.A.F.), Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Zarei
- Farabi Eye Hospital (M.M., N.Z., M.S.M.A.F.), Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Samadi
- Farabi Eye Hospital (M.M., N.Z., M.S.M.A.F.), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Wasu Supakontanasan
- Glaucoma Service (W.S., Y.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanin Suwan
- Glaucoma Service (W.S., Y.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prem S Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery (P.S.S.), Sue Anschutz-Rodgers University of Colorado Eye Center, Aurora, Colorado, USA
| | - Neil R Miller
- Department of Neuro-ophthalmology (N.R.M.), Johns Hopkins Hospital, Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Rahele Kafieh
- Department of Engineering (R.K.), Durham University, South Road, Durham, UK
| | - Masoud Aghsaei Fard
- Farabi Eye Hospital (M.M., N.Z., M.S.M.A.F.), Tehran University of Medical Sciences, Tehran, Iran.
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22
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Tugizova M, Siegel DT, Huang S, Su E, Subramanian PS, Beres S, Vora N. Reply to Letter to the Editor: Atypical Optic Neuritis After COVID-19 Vaccination: Response. J Neuroophthalmol 2023; 43:e37-e38. [PMID: 35439209 DOI: 10.1097/wno.0000000000001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Madina Tugizova
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
| | - Diane T Siegel
- Sue Anschutz-Rodgers University of Colorado Eye Institute and Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sally Huang
- Department of Psychiatry, Stanford University, Stanford, California
| | - Elaine Su
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
| | - Prem S Subramanian
- Departments of Neurology and Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
- Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shannon Beres
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
| | - Nirali Vora
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
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23
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Carelli V, Newman NJ, Yu-Wai-Man P, Biousse V, Moster ML, Subramanian PS, Vignal-Clermont C, Wang AG, Donahue SP, Leroy BP, Sergott RC, Klopstock T, Sadun AA, Rebolleda Fernández G, Chwalisz BK, Banik R, Girmens JF, La Morgia C, DeBusk AA, Jurkute N, Priglinger C, Karanjia R, Josse C, Salzmann J, Montestruc F, Roux M, Taiel M, Sahel JA. Indirect Comparison of Lenadogene Nolparvovec Gene Therapy Versus Natural History in Patients with Leber Hereditary Optic Neuropathy Carrying the m.11778G>A MT-ND4 Mutation. Ophthalmol Ther 2023; 12:401-429. [PMID: 36449262 PMCID: PMC9834474 DOI: 10.1007/s40123-022-00611-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Lenadogene nolparvovec is a promising novel gene therapy for patients with Leber hereditary optic neuropathy (LHON) carrying the m.11778G>A ND4 mutation (MT-ND4). A previous pooled analysis of phase 3 studies showed an improvement in visual acuity of patients injected with lenadogene nolparvovec compared to natural history. Here, we report updated results by incorporating data from the latest phase 3 trial REFLECT in the pool, increasing the number of treated patients from 76 to 174. METHODS The visual acuity of 174 MT-ND4-carrying patients with LHON injected in one or both eyes with lenadogene nolparvovec from four pooled phase 3 studies (REVERSE, RESCUE and their long-term extension trial RESTORE; and REFLECT trial) was compared to the spontaneous evolution of an external control group of 208 matched patients from 11 natural history studies. RESULTS Treated patients showed a clinically relevant and sustained improvement in their visual acuity when compared to natural history. Mean improvement versus natural history was - 0.30 logMAR (+ 15 ETDRS letters equivalent) at last observation (P < 0.01) with a maximal follow-up of 3.9 years after injection. Most treated eyes were on-chart as compared to less than half of natural history eyes at 48 months after vision loss (89.6% versus 48.1%; P < 0.01) and at last observation (76.1% versus 44.4%; P < 0.01). When we adjusted for covariates of interest (gender, age of onset, ethnicity, and duration of follow-up), the estimated mean gain was - 0.43 logMAR (+ 21.5 ETDRS letters equivalent) versus natural history at last observation (P < 0.0001). Treatment effect was consistent across all phase 3 clinical trials. Analyses from REFLECT suggest a larger treatment effect in patients receiving bilateral injection compared to unilateral injection. CONCLUSION The efficacy of lenadogene nolparvovec in improving visual acuity in MT-ND4 LHON was confirmed in a large cohort of patients, compared to the spontaneous natural history decline. Bilateral injection of gene therapy may offer added benefits over unilateral injection. TRIAL REGISTRATION NUMBERS NCT02652780 (REVERSE); NCT02652767 (RESCUE); NCT03406104 (RESTORE); NCT03293524 (REFLECT); NCT03295071 (REALITY).
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Affiliation(s)
- Valerio Carelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Via Altura, 3, 40139, Bologna, BO, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Yu-Wai-Man
- Department of Clinical Neurosciences, Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Valerie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark L Moster
- Department of Neurology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine Vignal-Clermont
- Department of Neuro Ophthalmology and Emergencies, Rothschild Foundation Hospital, Paris, France
- Centre d'Investigation Clinique, Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, Paris, France
| | - An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sean P Donahue
- Department of Ophthalmology, Neurology, and Pediatrics, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Bart P Leroy
- Department of Ophthalmology and Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Head & Skin, Ghent University, Ghent, Belgium
| | - Robert C Sergott
- Department of Neurology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Alfredo A Sadun
- David Geffen, Doheny Eye Institute, School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Bart K Chwalisz
- Department of Ophthalmology, Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA
| | - Rudrani Banik
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean François Girmens
- Centre d'Investigation Clinique, Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, Paris, France
| | - Chiara La Morgia
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Via Altura, 3, 40139, Bologna, BO, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Adam A DeBusk
- Department of Neurology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - Neringa Jurkute
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- Department of Neuro-Ophthalmology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Priglinger
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rustum Karanjia
- David Geffen, Doheny Eye Institute, School of Medicine, University of California, Los Angeles, CA, USA
- Department of Ophthalmology, University of Ottawa Eye, Ottawa, ON, Canada
| | - Constant Josse
- eXYSTAT, Data Management and Statistic, Malakoff, France
| | | | | | | | | | - José-Alain Sahel
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France
- Rothschild Foundation Hospital, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France
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Subramanian PS. Spaceflight-Associated Neuro-Ocular Syndrome and Increased Intracranial Pressure-Are We Closer to Understanding the Relationship? JAMA Ophthalmol 2023; 141:176-177. [PMID: 36602792 DOI: 10.1001/jamaophthalmol.2022.5686] [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: 01/06/2023]
Affiliation(s)
- Prem S Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora.,Division of Ophthalmology, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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25
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Asseyer S, Asgari N, Bennett J, Bialer O, Blanco Y, Bosello F, Camos-Carreras A, Carnero Contentti E, Carta S, Chen J, Chien C, Chomba M, Dale RC, Dalmau J, Feldmann K, Flanagan EP, Froment Tilikete C, Garcia-Alfonso C, Havla J, Hellmann M, Kim HJ, Klyscz P, Konietschke F, La Morgia C, Lana-Peixoto M, Leite MI, Levin N, Levy M, Llufriu S, Lopez P, Lotan I, Lugaresi A, Marignier R, Mariotto S, Mollan SP, Ocampo C, Cosima Oertel F, Olszewska M, Palace J, Pandit L, Peralta Uribe JL, Pittock S, Ramanathan S, Rattanathamsakul N, Saiz A, Samadzadeh S, Sanchez-Dalmau B, Saylor D, Scheel M, Schmitz-Hübsch T, Shifa J, Siritho S, Sperber PS, Subramanian PS, Tiosano A, Vaknin-Dembinsky A, Mejia Vergara AJ, Wilf-Yarkoni A, Zarco LA, Zimmermann HG, Paul F, Stiebel-Kalish H. The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis. Front Neurol 2023; 14:1102353. [PMID: 36908609 PMCID: PMC9998999 DOI: 10.3389/fneur.2023.1102353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/18/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Optic neuritis (ON) often occurs at the presentation of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). The recommended treatment of high-dose corticosteroids for ON is based on a North American study population, which did not address treatment timing or antibody serostatus. The Acute Optic Neuritis Network (ACON) presents a global, prospective, observational study protocol primarily designed to investigate the effect of time to high-dose corticosteroid treatment on 6-month visual outcomes in ON. Patients presenting within 30 days of the inaugural ON will be enrolled. For the primary analysis, patients will subsequently be assigned into the MS-ON group, the aquapotin-4-IgG positive ON (AQP4-IgG+ON) group or the MOG-IgG positive ON (MOG-IgG+ON) group and then further sub-stratified according to the number of days from the onset of visual loss to high-dose corticosteroids (days-to-Rx). The primary outcome measure will be high-contrast best-corrected visual acuity (HC-BCVA) at 6 months. In addition, multimodal data will be collected in subjects with any ON (CIS-ON, MS-ON, AQP4-IgG+ON or MOG-IgG+ON, and seronegative non-MS-ON), excluding infectious and granulomatous ON. Secondary outcomes include low-contrast best-corrected visual acuity (LC-BCVA), optical coherence tomography (OCT), magnetic resonance imaging (MRI) measurements, serum and cerebrospinal fluid (CSF) biomarkers (AQP4-IgG and MOG-IgG levels, neurofilament, and glial fibrillary protein), and patient reported outcome measures (headache, visual function in daily routine, depression, and quality of life questionnaires) at presentation at 6-month and 12-month follow-up visits. Data will be collected from 28 academic hospitals from Africa, Asia, the Middle East, Europe, North America, South America, and Australia. Planned recruitment consists of 100 MS-ON, 50 AQP4-IgG+ON, and 50 MOG-IgG+ON. This prospective, multimodal data collection will assess the potential value of early high-dose corticosteroid treatment, investigate the interrelations between functional impairments and structural changes, and evaluate the diagnostic yield of laboratory biomarkers. This analysis has the ability to substantially improve treatment strategies and the accuracy of diagnostic stratification in acute demyelinating ON. Trial registration ClinicalTrials.gov, identifier: NCT05605951.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jeffrey Bennett
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, and Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Francesca Bosello
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Camos-Carreras
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
| | - Claudia Chien
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Sydney, NSW, Australia.,Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Josep Dalmau
- ICREA-IDIBAPS, Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristina Feldmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Eoin P Flanagan
- Laboratory Medicine and Pathology, Departments of Neurology, Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Caroline Froment Tilikete
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | | | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Republic of Korea
| | - Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Chiara La Morgia
- Neurology Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Michael Levy
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Romain Marignier
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Translational Brian Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, United Kingdom
| | | | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacqueline Palace
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | | | - Sean Pittock
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital Westmead, Sydney, NSW, Australia.,Department of Neurology, Concord Hospital, Sydney, NSW, Australia
| | - Natthapon Rattanathamsakul
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Sara Samadzadeh
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Bernardo Sanchez-Dalmau
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Scheel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Pia S Sperber
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Prem S Subramanian
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Adi Wilf-Yarkoni
- Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Unviersitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Vignal-Clermont C, Yu-Wai-Man P, Newman NJ, Carelli V, Moster ML, Biousse V, Subramanian PS, Wang AG, Donahue SP, Leroy BP, Sadun AA, Klopstock T, Sergott RC, Fernandez R, Chwalisz BK, Banik R, Taiel M, Roux M, Sahel JA. Safety of Lenadogene Nolparvovec Gene Therapy Over 5 Years in 189 Patients With Leber Hereditary Optic Neuropathy. Am J Ophthalmol 2022; 249:108-125. [PMID: 36496192 DOI: 10.1016/j.ajo.2022.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/24/2022] [Revised: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the safety profile of lenadogene nolparvovec (Lumevoq) in patients with Leber hereditary optic neuropathy. DESIGN Pooled analysis of safety data from 5 clinical studies. METHODS A total of 189 patients received single unilateral or bilateral intravitreal injections of a recombinant adeno-associated virus 2 (rAAV2/2) vector encoding the human wild-type ND4 gene. Adverse events (AEs) were collected throughout the studies, up to 5 years. Intraocular inflammation and increased intraocular pressure (IOP) were ocular AEs of special interest. Other assessments included ocular examinations, vector bio-dissemination, and systemic immune responses against rAAV2/2. RESULTS Almost all patients (95.2%) received 9 × 1010 viral genomes and 87.8% had at least 2 years of follow-up. Most patients (75.1%) experienced at least one systemic AE, but systemic treatment-related AEs occurred in 3 patients; none were serious. Intraocular inflammation was reported in 75.6% of lenadogene nolparvovec-treated eyes. Almost all intraocular inflammations occurred in the anterior chamber (58.8%) or in the vitreous (40.3%), and were of mild (90.3%) or moderate (8.8%) intensity; most resolved with topical corticosteroids alone. All IOP increases were mild to moderate in intensity. No AE led to study discontinuation. Bio-dissemination of lenadogene nolparvovec and systemic immune response were limited. The safety profile was comparable for patients treated bilaterally and unilaterally. CONCLUSIONS Lenadogene nolparvovec had a good overall safety profile with excellent systemic tolerability, consistent with limited bio-dissemination. The product was well tolerated, with mostly mild ocular side effects responsive to conventional ophthalmologic treatments.
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Affiliation(s)
- Catherine Vignal-Clermont
- From Department of Neuro Ophthalmology and Emergencies, Rothschild Foundation Hospital, Paris, France (C.V-C.); Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, Paris, France (C.V-C.).
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK (P.Y-W-M.); Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK (P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, UK (P.Y-W-M.); Moorfields Eye Hospital, London, UK
| | - Nancy J Newman
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA (P.Y-W-M.)
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy (V.C.); Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (V.C.)
| | - Mark L Moster
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA (M.L.M.)
| | - Valerie Biousse
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA (P.Y-W-M.)
| | - Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora, CO, USA (P.S.S.)
| | - An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan (A-G.W.)
| | - Sean P Donahue
- Department of Ophthalmology, Neurology, and Pediatrics, Vanderbilt University, and Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA (S.P.D.)
| | - Bart P Leroy
- Department of Ophthalmology and Center for Medical Genetics, Ghent University Hospital, and Department of Head & Skin, Ghent University, Ghent, Belgium (B.P.L.)
| | - Alfredo A Sadun
- Doheny Eye Institute, Los Angeles, CA, USA (A.A.S.); Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (A.A.S.)
| | - Thomas Klopstock
- Friedrich Baur Institute at the Department of Neurology, University Hospital, LMU Munich, Munich, Germany (T.K.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (T.K.)
| | - Robert C Sergott
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA (M.L.M.)
| | | | - Bart K Chwalisz
- Department of Ophthalmology, Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA (B.K.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA (B.K.C.)
| | - Rudrani Banik
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA (R.B.)
| | | | - Michel Roux
- GenSight Biologics, Paris, France (M.T., M.R.)
| | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France (J-A.S.); Rothschild Foundation Hospital, Paris, France (J-A.S.); Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (J-A.S.); Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC, Paris, France (J-A.S.)
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27
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Newman NJ, Yu-Wai-Man P, Subramanian PS, Moster ML, Wang AG, Donahue SP, Leroy BP, Carelli V, Biousse V, Vignal-Clermont C, Sergott RC, Sadun AA, Fernández GR, Chwalisz BK, Banik R, Bazin F, Roux M, Cox ED, Taiel M, Sahel JA. Randomized trial of bilateral gene therapy injection for m.11778G > A MT-ND4 Leber optic neuropathy. Brain 2022; 146:1328-1341. [PMID: 36350566 PMCID: PMC10115230 DOI: 10.1093/brain/awac421] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/20/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022] Open
Abstract
Leber hereditary optic neuropathy (LHON) is an important example of mitochondrial blindness with the m.11778G > A mutation in the MT-ND4 gene being the most common disease-causing mitochondrial DNA (mtDNA) variant worldwide. The REFLECT phase 3 pivotal study is a randomized, double-masked, placebo-controlled trial investigating the efficacy and safety of bilateral intravitreal injection of lenadogene nolparvovec in patients with a confirmed m.11778G > A mutation, using a recombinant adeno-associated virus vector 2, serotype 2 (rAAV2/2-ND4). The first-affected eye received gene therapy; the fellow (affected/not-yet-affected) eye was randomly injected with gene therapy or placebo. The primary endpoint was the difference in change from baseline of best-corrected visual acuity (BCVA) in second-affected/not-yet-affected eyes treated with lenadogene nolparvovec versus placebo at 1.5 years post-treatment, expressed in logarithm of the minimal angle of resolution (LogMAR). Forty-eight patients were treated bilaterally and 50 unilaterally. At 1.5 years, the change from baseline in BCVA was not statistically different between second-affected/not-yet-affected eyes receiving lenadogene nolparvovec and placebo (primary endpoint). A statistically significant improvement in BCVA was reported from baseline to 1.5 years in lenadogene nolparvovec-treated eyes: -0.23 LogMAR for the first-affected eyes of bilaterally treated patients (p < 0.01); and -0.15 LogMAR for second-affected/not-yet-affected eyes of bilaterally treated patients and the first-affected eyes of unilaterally treated patients (p < 0.05). The mean improvement in BCVA from nadir to 1.5 years was -0.38 (0.052) LogMAR and -0.33 (0.052) LogMAR in first-affected and second-affected/not-yet-affected eyes treated with lenadogene nolparvovec, respectively (bilateral treatment group). A mean improvement of -0.33 (0.051) LogMAR and -0.26 (0.051) LogMAR was observed in first-affected lenadogene nolparvovec-treated eyes and second-affected/not-yet-affected placebo-treated eyes, respectively (unilateral treatment group). The proportion of patients with one or both eyes on-chart at 1.5 years was 85.4% and 72.0% for bilaterally and unilaterally treated patients, respectively. The gene therapy was well tolerated, with no systemic issues. Intraocular inflammation, which was mostly mild and well controlled with topical corticosteroids, occurred in 70.7% of lenadogene nolparvovec-treated eyes versus 10.2% of placebo-treated eyes. Among eyes treated with lenadogene nolparvovec, there was no difference in the incidence of intraocular inflammation between bilaterally and unilaterally treated patients. Overall, the REFLECT trial demonstrated an improvement of BCVA in LHON eyes carrying the m.11778G > A mtDNA mutation treated with lenadogene nolparvovec or placebo to a degree not reported in natural history studies and supports an improved benefit/risk profile for bilateral injections of lenadogene nolparvovec relative to unilateral injections.
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Affiliation(s)
- Nancy J Newman
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark L Moster
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sean P Donahue
- Department of Ophthalmology, Neurology, and Pediatrics, Vanderbilt University, and Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bart P Leroy
- Department of Ophthalmology and Center for Medical Genetics, Ghent University Hospital, and Department of Head & Skin, Ghent University, Ghent, Belgium
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
- Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valerie Biousse
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Catherine Vignal-Clermont
- Department of Neuro Ophthalmology and Emergencies, Rothschild Foundation Hospital, Paris, France
- Centre Hospitalier National D'Ophtalmologie des Quinze Vingts, Paris, France
| | - Robert C Sergott
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alfredo A Sadun
- Doheny Eye Institute, UCLA School of Medicine, Los Angeles, CA, USA
| | | | - Bart K Chwalisz
- Department of Ophthalmology, Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Rudrani Banik
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- Fondation Ophtalmologique A. de Rothschild, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- CHNO des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC, Paris, France
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28
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Subramanian PS, Newman NJ, Moster M, Wang AG, Yu-Wai-Man P, Donahue S, Leroy BP, Carelli V, Biousse V, Vignal-Clermont C, Sergott RC, Sadun AA, Rebolleda G, Chwalisz BK, Banik R, Bazin F, Cox E, Roux M, Taiel M, Sahel JA. Study design and baseline characteristics for the reflect gene therapy trial ofm.11778g>A/ ND4-LHON. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveREFLECT is the first randomised, double-masked, placebo-controlled multicentre phase 3 clinical trial that evaluated the efficacy and safety of bilateral intravitreal (IVT) injection of lenadogene nolparvovec in subjects with Leber hereditary optic neuropathy carrying the m.11778G>A mutation.Methods and analysisA total of 98 subjects were enrolled with vision loss of ≤12 months. The subjects were randomised to one of two treatment arms with all subjects receiving an intravitreal (IVT) injection of lenadogene nolparvovec in their first affected eye and the second-affected eye randomised to receive IVT of either lenadogene nolparvovec or placebo.ResultsThe majority of subjects were male with a mean duration of vision loss of 8.3 months. All but one subject experienced bilateral loss of vision at the time of injection. The mean best-corrected visual acuity of first-affected eyes was worse compared with second/not-yet-affected eyes. Analysis of retinal anatomical parameters showed increased thinning in the first-affected eyes when compared with the second/not-yet-affected eyes with both treatment arms showing significant changes compared with unaffected individuals.ConclusionThe REFLECT trial is the third and the largest phase 3 clinical study evaluating lenadogene nolparvovec in m.11778G>A Leber hereditary optic neuropathy (LHON) subjects. The observed demographics in REFLECT are consistent with previous reports in LHON subjects in the acute and dynamic phases of LHON disease. Combined with the visual function and anatomical parameters obtained in the previous RESCUE and REVERSE trials, REFLECT has provided a uniformly collected data set that should help direct future LHON clinical trials.
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29
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Pelak VS, Paez YM, Patnaik JL, Holden SK, Subramanian PS, Mathias MT, Mandava N, Lynch AM. An Exploratory Study to Investigate the Utility of Clinical Screening for Neurodegenerative Disease in Age-Related Eye Disease Research. J Neuroophthalmol 2022; 42:346-352. [PMID: 35483065 PMCID: PMC9529756 DOI: 10.1097/wno.0000000000001550] [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: 11/25/2022]
Abstract
BACKGROUND Unrecognized neurodegenerative diseases (NDD) in age-related eye disease research studies have the potential to confound vision-specific quality of life and retinal optical coherence tomography (OCT) outcome measures. The aim of this exploratory study was to investigate relationships between NDD screening tools and visual outcome measures in a small cohort of controls from the Colorado Age-Related Macular Degeneration Registry (CO-AMD), to consider the utility of future studies. METHODS Twenty-nine controls from the CO-AMD were screened using the Montreal Cognitive Assessment (MoCA), a Colorado Parkinsonian Checklist, and the Lewy Body Composite Risk Score. Univariate and multivariable linear regression modeling was used to assess associations between screening tools and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and macular OCT outcome measures, and t tests were used to evaluate outcome measure differences between those with normal vs abnormal MoCA scores. RESULTS One patient withdrew. The average age was 72.8 years, and 68% were female patients. Ten participants (36%) had abnormal MoCA scores, and their VFQ-25 scores were only 1 point less and not statistically different than those with normal MoCA scores. Macular OCT volumes and thicknesses for retinal nerve fiber layer (RNFL) and retinal ganglion cell layer were consistently and moderately lower for those with abnormal MoCA scores, and a positive association between MoCA and macular RNFL volume was observed, although differences and regression were not significant. Parkinson screening tests were abnormal for only 4 participants and were not associated with OCT or VFQ-25 measures by regression modeling. CONCLUSIONS Given the degree and direction of observed differences, further investigation is warranted regarding the relationship between cognitive screening tools and macular OCT measures in age-related eye disease research, but future investigations regarding the relationship between NDD screening tools and VFQ-25 seem unwarranted.
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Affiliation(s)
- Victoria S. Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yosbelkys Martin Paez
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Prem S. Subramanian
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Surgery, Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marc T. Mathias
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Subramanian PS, Barton JJS, Ranalli P, Smith C, Francis CE, Frishberg B. Consensus Statement on Visual Rehabilitation in Mild Traumatic Brain Injury. Neurol Clin Pract 2022; 12:422-428. [DOI: 10.1212/cpj.0000000000200071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022]
Abstract
AbstractOptometric visual rehabilitation therapy has been employed for a variety of visual disorders. Descriptively-named entities such as post trauma visual syndrome (PTVS), visual midline shift syndrome (VMSS), and vertical heterophoria syndrome (VHS) are frequently diagnosed by neuro-optometrists and/or behavioral optometrist in patients after stroke or head injury or in the setting of dizziness and/or headache. The scientific underpinnings of these diagnoses and treatments are weak, and published clinical studies comprise case reports and case series without comparison to control populations. Neuro-ophthalmologists are frequently questioned by patients about the utility of such treatment strategies. Many ophthalmologists and neurologists also are involved in the care of patients who carry these diagnoses and undergo these visual therapies. Involved physicians may benefit from guidance about the rationale, evidence, and level of evidence for the efficacy of these therapeutic approaches.
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Sedhom JA, Patnaik JL, McCourt EA, Liao S, Subramanian PS, Davidson RS, Palestine AG, Kahook MY, Seibold LK. Physician burnout in ophthalmology: U.S. survey. J Cataract Refract Surg 2022; 48:723-729. [PMID: 34596630 DOI: 10.1097/j.jcrs.0000000000000837] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 08/03/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the prevalence of physician burnout among ophthalmologists in the United States and identify associated risks. SETTING All practice types within the United States. DESIGN Cross-sectional study. METHODS A survey was distributed through email listservs to several national ophthalmology societies. Participants completed a modified Mini Z Burnout Survey, a 10-item questionnaire measured in 5-point Likert scales, followed by demographic questions. The Mini Z Burnout survey assessed 3 main outcomes: stress, burnout, and work satisfaction. The percentage of subgroups experiencing burnout were presented and comparisons made with odds ratios from logistic regression modeling. RESULTS Of the 592 ophthalmologists responding to the survey, 37.8% (224) self-reported symptoms of burnout with a low of 30.8% (12/39) for vitreoretinal specialists to a high of 45.4% (30/66) for uveitis specialists. Most of those reporting burnout were categorized as mild (65.2% [146/224]), followed by moderate (29.5% [66/224]) and severe (5.4% [12/224]). Women had almost twice the odds of reporting burnout (odds ratio [OR] = 1.9 [95% CI: 1.3-2.7]; P = .0005). Physicians employed in academic (OR = 2.0 [95% CI: 1.2-3.2]; P = 0.007) and hospital facilities (OR = 2.4 [95% CI: 1.3-4.6]; P = .008) reported higher rates of burnout compared with those in large private groups. Burnout was associated with self-reported low work control, insufficient time for documentation, and misalignment with departmental leaders (P < .0001). CONCLUSIONS Ophthalmologists exhibited a high degree of self-reported burnout in the U.S. This study highlights sex, employment autonomy, and practice type as major factors associated with burnout.
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Affiliation(s)
- Jessica A Sedhom
- From the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana (Sedhom); Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado (Patnaik); Department of Ophthalmology, University of Colorado, Aurora, Colorado (McCourt, Liao, Subramanian, Davidson, Palestine, Kahook, Patnaik, Seibold)
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Kostic M, Subramanian PS, Falcone SF, El-Swaify ST, Sur S, Spasic S, Miller NR, Morcos JJ, Lam BL. Cavernous Malformation of the Optic Nerve and Chiasm: Prompt Suspicion and Surgery Matter. J Neuroophthalmol 2022; 42:108-114. [PMID: 34001730 DOI: 10.1097/wno.0000000000001238] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cavernous malformations (CMs) of the optic nerve and chiasm are extremely rare, accounting for less than 1% of all intracranial CMs. Acute, subacute, or progressive visual loss from CM may occur with or without hemorrhage. Prompt surgical excision of the CM offers the best hope to improve or stabilize vision. Given its rarity, optic nerve and chiasm CMs may not be readily suspected. We provide 3 cases of optic nerve and chiasm CM, highlighting key neuroimaging features and the importance of expedited intervention. METHODS Case records of the neuro-ophthalmology clinics of the Bascom Palmer Eye Institute and the University of Colorado, and literature review of reported cases of optic CM. RESULTS A 49-year-old woman reported acute progressive painless vision loss in the right eye. MRI showed a suprasellar mass with heterogeneity in signal involving the right prechiasmatic optic nerve. Surgical excision of the CM 5 days after onset of visual loss improved vision from 20/300 to 20/30. A 29-year-old woman with acute painless blurred vision in the right eye had anterior chiasmal junctional visual field defects corresponding to a heterogeneously minimally enhancing mass with blood products enlarging the optic chiasm and proximal right optic nerve. Surgical excision of the CM 8 weeks after onset of visual loss improved vision from 20/40 to 20/15 with improved visual fields. A 33-year-old woman with a history of familial multiple CMs, diagnosed at age 18, reported new-onset severe headache followed by blurred vision. MRI showed a hemorrhagic lesion of the optic chiasm and right optic tract. She was 20/20 in each eye with a reported left superior homonymous hemianopia. No intervention was recommended. Vision of the right eye worsened to 20/400 2 months later. The patient was followed over 13 years, and the MRI and visual function remained unchanged. Literature review yielded 87 optic CM cases occurring across gender and nearly all ages with visual loss and headache as the most common presenting symptoms. Optic chiasm is the most common site of involvement (79%). Nearly 95% of reported CM cases were treated with surgery with 81% with improved vision and 1% with worsened vision. CONCLUSION MRI features are critical to the diagnosis of optic nerve and chiasm CM and may mimic other lesions. A high index of suspicion by the neuro-ophthalmologist and neuroradiologist leads to early recognition and intervention. Given optic CM displaces and does not infiltrate neural tissue, expedited surgical resection by a neurosurgeon after consideration of other diagnostic possibilities improves visual function in most cases.
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Affiliation(s)
- Maja Kostic
- Bascom Palmer Eye Institute (MK, BLL), University of Miami, Miami, Florida; Sue Anschutz-Rodgers UCHealth Eye Center and Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), University of Colorado, Denver, Colorado; Departments of Radiology (SFF) and Neurological Surgery (STE, S. Sur, JJM), Pathology (S. Spasic), University of Miami, Miami, Florida; and Wilmer Eye Institute (NRM), Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
BACKGROUND Previous research suggests the number of neuro-ophthalmologists in the United States may be below a level that provides sufficient access to neuro-ophthalmic care in much of the United States. However, national estimates of the amount of clinical time spent on neuro-ophthalmology are lacking. METHODS The North American Neuro-Ophthalmology Society administered a survey on professional time allocation to its active members. Survey response was 95%. The survey characterized the hours each week each respondent allocated to overall work, clinical work, clinical work in ophthalmology/neurology, and clinical work in neuro-ophthalmology specifically. The survey additionally collected information regarding demographics, current wait times to be seen for new patients, and the difference in clinical time spent in neuro-ophthalmology spent between the current day compared with that shortly after completing clinical training. Linear regression was used to identify potential relationships between the above and average wait time. RESULTS On average, responding physicians spent 70% of their clinical time on neuro-ophthalmology. In 6 states, there were no reported practicing neuro-ophthalmologists, and in only 8 states was the clinical full-time equivalent to population ratio below the suggested threshold of 1 for every 1.2 million. The median wait time for a new patient was 6 weeks. This wait time was associated with the fraction of clinical time spent in neuro-ophthalmology (0.2 weeks longer wait for a 10 percentage point increase in the fraction of time spent in neuro-ophthalmology; P = 0.02), and suggestively associated with training (training in ophthalmology was associated with 1.0 week shorter wait time; P = 0.06). CONCLUSION The survey suggests that neuro-ophthalmologists are unable to see patients in a timely manner and a decreasing number of clinicians are entering the field. Future interventions should be considered to incentivize neuro-ophthalmology training in ophthalmology and neurology residents such that the United States population is able to appropriately access neuro-ophthalmic care.
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Affiliation(s)
- Adam DeBusk
- Department of Ophthalmology (AD), Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Departments of Ophthalmology, Neurology, and Neurosurgery (PSS), Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado; Institute for Minority Health Research (MSB), University of Illinois College of Medicine, Chicago, Illinois; Departments of Ophthalmology and Neurology (MLM), Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Neurology (PCC), Johns Hopkins School of Medicine, Baltimore, Maryland; and Departments of Ophthalmology and Neurosciences (LPF), Rutgers-New Jersey Medical School, Newark, New Jersey
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Douglas RS, Dailey R, Subramanian PS, Barbesino G, Ugradar S, Batten R, Qadeer RA, Cameron C. Proptosis and Diplopia Response With Teprotumumab and Placebo vs the Recommended Treatment Regimen With Intravenous Methylprednisolone in Moderate to Severe Thyroid Eye Disease: A Meta-analysis and Matching-Adjusted Indirect Comparison. JAMA Ophthalmol 2022; 140:328-335. [PMID: 35175308 PMCID: PMC8855315 DOI: 10.1001/jamaophthalmol.2021.6284] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Thyroid eye disease can be a debilitating autoimmune disorder characterized by progressive proptosis or diplopia. Teprotumumab has been compared with placebo in randomized clinical trials, but not with intravenous methylprednisolone (IVMP), which sometimes is used in clinical practice for this condition. Objective To conduct a matching-adjusted indirect comparison of teprotumumab vs IVMP vs placebo. Data Sources Deidentified patient-level data from teprotumumab trials and aggregate-level data from literature on the most recommended regimen of IVMP. Study Selection PubMed and Embase were searched for randomized/observational studies using key terms and controlled vocabulary. Full texts of eligible articles were reviewed and cataloged. Data Extraction and Synthesis Conducted by 1 reviewer (R.A.Q.) and 1 verifier (R.B.), including study characteristics, eligibility criteria, baseline characteristics, and outcomes. Main Outcomes and Measures Changes in proptosis by millimeter and diplopia response (percentage with ≥1 grade reduction) from baseline to week 12 in patients receiving IVMP and placebo, and to week 24 in patients receiving teprotumumab. Results The search identified 1019 records, and 6 through manual searches, alerts, and secondary references. After excluding duplicates and screening full-text records, 12 IVMP studies were included in the matching-adjusted indirect comparison (11 for proptosis change [n = 419], 4 for diplopia response [n = 125], and 2 teprotumumab [n = 79] and placebo [n = 83] comparator studies). Treatment with IVMP resulted in a proptosis difference of -0.16 mm (95% CI, -1.55 to 1.22 mm) from baseline to week 12 vs placebo. The proptosis treatment difference between IVMP and teprotumumab of -2.31 mm (95% CI, -3.45 to -1.17 mm) favored teprotumumab. Treatment with IVMP (odds ratio, 2.69; 95% CI, 0.94-7.70) was not favored over placebo in odds of diplopia response; however, teprotumumab was favored over IVMP (odds ratio, 2.32; 95% CI, 1.07-5.03). Conclusions and Relevance This meta-analysis suggests that use of IVMP is associated with a small, typically not clinically relevant, change from baseline in proptosis vs placebo, with modest changes in diplopia. While this nonrandomized comparison suggests that use of teprotumumab, compared with IVMP, is associated with greater improvements in proptosis and may be twice as likely to have a 1 grade or higher reduction in diplopia, randomized trials comparing these 2 treatments would be warranted to determine if 1 treatment is superior to the other to a clinically relevant degree.
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Affiliation(s)
| | | | | | | | - Shoaib Ugradar
- Jules Stein Eye Institute, University of California, Los Angeles
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Pedler MG, Petrash JM, Subramanian PS. Prostaglandin analog effects on cerebrospinal fluid reabsorption via nasal mucosa. PLoS One 2021; 16:e0248545. [PMID: 34971554 PMCID: PMC8719688 DOI: 10.1371/journal.pone.0248545] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) outflow has been demonstrated along nasal lymphatics via olfactory nerve projections; flow may be increased by stimulating lymphatic contractility using agents such as noradrenaline and the thromboxane A2 analog U46619. Lymphatics elsewhere in the body show increased contractility upon exposure to the prostaglandin F2alpha analog isoprostane-8-epi-prostaglandin. We investigated the ability of ophthalmic prostaglandin F2alpha analogs to increase CSF outflow when applied to the nasal mucosa by inhalation. METHODS Latanoprost (0.1, 0.5, or 1mg/ml), bimatoprost (0.3 or 3mg/ml), travoprost (0.04 or 0.4mg/ml), latanoprostene bunod (0.24 or 2.4mg/ml), tafluprost (0.25 or 2.5mg/ml), or control vehicle (10% DMSO) was administered to awake adult C57B/6 mice by nasal inhalation of 2μl droplets. Multiday dosing (daily for 3 days) of latanoprost also was evaluated. A total of 81 animals were studied including controls. General anesthesia was induced by injection, and fluorescent tracer (AlexaFluor647-labelled ovalbumin) was injected under stereotaxic guidance into the right lateral ventricle. Nasal turbinate tissue was harvested and homogenized after 1 hour for tracer detection by ELISA and fluorometric analysis. RESULTS Inhalation of latanoprost 0.5mg/ml and 1mg/ml led to a 11.5-fold increase in tracer recovery from nasal turbinate tissues compared to controls (3312 pg/ml vs 288 pg/ml, p<0.001 for 0.5mg/ml; 3355 pg/ml vs 288 pg/ml, p<0.001 for 1mg/ml), while latanoprost 0.1 mg/ml enhanced recovery 6-fold (1713 pg/ml vs 288 pg/ml, p<0.01). Tafluprost 0.25mg/ml and bimatoprost 0.3mg/ml showed a modest (1.4x, p<0.05) effect, and the remaining agents showed no significant effect on tracer recovery. After 3 days of daily latanoprost treatment and several hours after the last dose, a persistently increased recovery of tracer was found. CONCLUSIONS Prostaglandin F2alpha analogs delivered by nasal inhalation resulted in increased nasal recovery of a CSF fluorescent tracer, implying increased CSF outflow via the nasal lymphatics. The greatest effect, partially dose-dependent, was observed using latanoprost. Further studies are needed to determine the efficacy of these agents in reducing ICP in short and long-term applications.
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Affiliation(s)
- Michelle G. Pedler
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - J. Mark Petrash
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Prem S. Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
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Hoang TT, Nguyen CN, Nguyen AQ, Nguyen HL, Subramanian PS, Pham VT. Contralateral Ocular Manifestations of a Carotid Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery. J Neuroophthalmol 2021; 41:e803-e805. [PMID: 33449487 DOI: 10.1097/wno.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tung Thanh Hoang
- Ophthalmology Department (TTH, VTP), Hanoi Medical University, Vietnam; Ophthalmology Unit (TTH), Hanoi Medical University Hospital, Vietnam; Save Sight Institute (TTH), the University of Sydney School of Medicine, Australia ; Radiology Department (CNN), Hanoi Medical University Hospital, Vietnam; Oculoplastic and Cosmesis Surgery Department (AQN), Vietnam National Eye Hospital; Cardiology Center (HLN), Hanoi Medical University Hospital, Vietnam; and Ophthalmology Department (PSS), University of Colorado School of Medicine
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Sun MM, Seleme N, Chen JJ, Zekeridou A, Sechi E, Walsh RD, Beebe JD, Sabbagh O, Mejico LJ, Gratton S, Skidd PM, Bellows DA, Falardeau J, Fraser CL, Cappelen-Smith C, Haines SR, Hassanzadeh B, Seay MD, Subramanian PS, Williams Z, Gordon LK. Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade. J Neuroophthalmol 2021; 41:519-530. [PMID: 33136674 DOI: 10.1097/wno.0000000000001148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/26/2022]
Abstract
BACKGROUND In recent years, CTLA-4 and PD-1/PD-L1 checkpoint inhibitors have proven to be effective and have become increasingly popular treatment options for metastatic melanoma and other cancers. These agents work by enhancing autologous antitumor immune responses. Immune-related ophthalmologic complications have been reported in association with checkpoint inhibitor use but remain incompletely characterized. This study seeks to investigate and further characterize the neuro-ophthalmic and ocular complications of immune checkpoint blockade treatment. METHODS A survey was distributed through the secure electronic data collection tool REDCap to neuro-ophthalmology specialists in the North American Neuro-Ophthalmology Society listserv. The study received human subjects approval through the University of California at Los Angeles Institutional Review Board. The survey identified patients sent for neuro-ophthalmic consultation while receiving one or more of a PD-1 inhibitor (pembrolizumab, nivolumab, or cemiplimab); PD-L1 inhibitor (atezolizumab, avelumab, or durvalumab); or the CTLA-4 inhibitor ipilimumab. Thirty-one patients from 14 institutions were identified. Patient demographics, neuro-ophthalmic diagnosis, diagnostic testing, severity, treatment, clinical response, checkpoint inhibitor drug used, and cancer diagnosis was obtained. RESULTS The checkpoint inhibitors used in these patients included pembrolizumab (12/31), nivolumab (6/31), combined ipilimumab with nivolumab (7/31, one of whom also received pembrolizumab during their course of treatment), durvalumab (3/31), ipilimumab (2/31), and cemiplimab (1/31). Malignant melanoma (16/31) or nonsmall cell lung carcinoma (6/31) were the most common malignancies. The median time between first drug administration and the time of ophthalmological symptom onset was 14.5 weeks. Eleven patients had involvement of the optic nerve, 7 patients had inflammatory orbital or extraocular muscle involvement, 6 patients had ocular involvement from neuromuscular junction dysfunction, 4 patients had cranial nerve palsy, and 4 patients had non neuro-ophthalmic complications. Use of systemic corticosteroids with or without stopping the checkpoint inhibitor resulted in improvement of most patients with optic neuropathy, and variable improvement for the other ophthalmic conditions. CONCLUSION This study describes the variable neuro-ophthalmic adverse events associated with use of immune checkpoint inhibitors and contributes a more thorough understanding of their clinical presentations and treatment outcomes. We expect this will increase awareness of these drug complications and guide specialists in the care of these patients.
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Affiliation(s)
- Michel M Sun
- Department of Ophthalmology (MMS, NS, LKG), Jules Stein Eye Institute, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California; Department of Ophthalmology (JJC), Mayo Clinic, Rochester, Minnesota; Department of Neurology (JJC, AZ, ES), Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology & Visual Sciences (RDW), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Ophthalmology (JDB), Park Nicollet Health Services, Minneapolis, Minnesota; Department of Ophthalmology (OS), University of Kentucky/Retina Associates of Kentucky, Lexington, Kentucky; Department of Neurology (LJM), SUNY Upstate Medical University, Syracuse, New York; Department of Ophthalmology (LJM), SUNY Upstate Medical University, Syracuse, New York; Department of Neurology (SG), University of Missouri-Kansas City, Kansas City, Missouri; Department of Ophthalmology (PMS), University of Vermont Medical Center, Burlington, Vermont; The Medical Eye Center (DAB), Manchester, New Hampshire; Department of Ophthalmology (JF), Oregon Health & Science University, Portland, Oregon; Department of Ophthalmology (CLF), University of Sydney, Sydney, Australia ; Department of Neurology & Neurophysiology (CC-S), Liverpool Hospital, NSW, Australia ; Department of Neurology (SRH), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Neurology (BH), INI Eye Center, OSF Healthcare, University of Illinois College of Medicine, Peoria, Illinois; Department of Ophthalmology (MDS), University of Utah, Salt Lake City, Utah; Department of Ophthalmology (PSS), University of Colorado, Aurora, Colorado; and Department of Ophthalmology (ZW), University of Rochester Medical Center, Rochester, New York
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Aghsaei Fard M, Ghahvechian H, Subramanian PS. Follow-up of Nonarteritic Anterior Ischemic Optic Neuropathy With Optical Coherence Tomography Angiography. J Neuroophthalmol 2021; 41:e433-e439. [PMID: 34788242 DOI: 10.1097/wno.0000000000000997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/26/2022]
Abstract
BACKGROUND Peripapillary and macular microvasculature alterations after nonarteritic ischemic optic neuropathy (NAION) have been investigated in several studies. We aimed to explore the vascular changes from acute NAION (aNAION) to chronic NAION (cNAION). METHODS This prospective observational study composed of 16 eyes with aNAION and 40 healthy age-matched controls. Eyes with NAION were followed up for more than 6 months after acute event. Optical coherence tomography angiography (OCTA) was used to evaluate peripapillary and macular vessel densities (VDs). The customized software was used for calculating deep retinal VD to attenuate the large superficial vessel projection effect. RESULT The mean age of patients with NAION and controls was 56.13 ± 13.2 and 54.46 ± 15.5 years, respectively (P = 0.195). Radial peripapillary capillary density was significantly lower in both eyes with aNAION and eyes with cNAION than healthy eyes. Peripapillary capillary density decreased significantly from the acute to the chronic phase of NAION with values of 41.77 ± 4.05% and 34.35 ± 7.30%, respectively (P < 0.001). The mean superficial macular VD was 46.83 ± 3.47% in aNAION and 44.49 ± 4.50% in cNAION eyes with no significant difference between them (P = 0.252), but both were lower than control eyes. Deep macular VD was not affected in aNAION and cNAION eyes compared with control eyes. Correlation analysis in eyes with cNAION revealed that there were significant correlations between peripapillary nerve fiber layer and the capillary density (r = 0.772, P < 0.001) and between ganglion cell complex thickness and corresponding superficial macular VD. CONCLUSIONS Although a decrease in peripapillary capillary density in aNAION eyes with active disc edema progressed when evaluated in the cNAION state, progressive VD loss was not observed in the macular area, suggesting a nonprogressive nature of macular vessel involvement in NAION.
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Affiliation(s)
- Masoud Aghsaei Fard
- Department of Ophthalmology (MAF, HG), Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran ; and Department of Ophthalmology (PSS), University of Colorado, School of Medicine, Aurora, Colorado
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Hoang TT, Van Le T, Tran D, Ho TD, Thi Le NH, Subramanian PS. Acute Complete Oculomotor Nerve Palsy in a Young Male Due to a Skull Base Myofibroma. J Neuroophthalmol 2021; 41:e759-e760. [PMID: 33449492 DOI: 10.1097/wno.0000000000001177] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 25-year-old male patient visited the ophthalmology clinic because of upper eye lid ptosis in the right eye, binocular double vision, and light sensitivity. He was diagnosed with a complete third nerve palsy caused by a skull base myofibroma, a rare clinical entity that has not been described before in oculomotor nerve palsy.
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Affiliation(s)
- Tung Thanh Hoang
- Ophthalmology Department (TTH, NHTL), Hanoi Medical University, Hanoi, Vietnam; Ophthalmology Unit (TTH, NHTL), Hanoi Medical University Hospital, Hanoi, Vietnam; Save Sight Institute (TTH), the University of Sydney School of Medicine, Sydney, Australia ; Neurology Unit (TVL), Hanoi Medical University Hospital, Hanoi, Vietnam; Neurosurgery Department I (DT), Viet Duc Hospital, Hanoi, Vietnam; Pathology Department (TDH), Viet Duc Hospital, Hanoi, Vietnam; and Ophthalmology Department (PSS), University of Colorado School of Medicine, Aurora, Colorado
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Ng SMS, Low R, Hoskin AK, Rousselot A, Gunasekeran DV, Natarajan S, Sundar G, Chee CKL, Mishra C, Sen P, Pradhan E, Irawati Y, Kamalden TA, Shah M, Yan H, Woreta FA, Subramanian PS, Kuhn F, Watson SL, Agrawal R. The application of clinical registries in ophthalmic trauma-the International Globe and Adnexal Trauma Epidemiology Study (IGATES). Graefes Arch Clin Exp Ophthalmol 2021; 260:1055-1067. [PMID: 34812939 DOI: 10.1007/s00417-021-05493-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The prevalence of ophthalmic trauma varies considerably based on geographic location, socio-economic status, age groups, occupation, and cultural practices such as firework celebrations. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. However, there is currently a lack of a centralized international data repository for ophthalmic trauma. We draw lessons from past and existing clinical registries related to ophthalmology and propose a new suitable international multicenter clinical registry for ophthalmic trauma: the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES is hosted on a secure web-based platform which exhibits user-friendly smart features, an integrated Ocular Trauma Score (OTS) prognosis calculator, efficient data collection points, and schematic graphical software. IGATES currently has 37 participating centers globally. The data collected through IGATES will be primarily used to develop a more robust and improved ophthalmic trauma prognostic classification system, the Ocular Trauma Score-2 (OTS-2), which builds on previous systems such as the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Furthermore, IGATES will act as a springboard for further research into the epidemiology, diagnosis, and management of ophthalmic trauma. Ultimately, IGATES serves to advance the field of ophthalmic trauma and improve the care that patients with ophthalmic trauma receive.
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Affiliation(s)
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, 308433, Singapore
| | - Annette K Hoskin
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Andres Rousselot
- Consultorios Oftalmológicos Benisek Ascarza, Capital Federal, Argentina
| | | | | | - Gangadhara Sundar
- National University Hospital, National University of Singapore, Singapore, Singapore
| | - Caroline Ka Lin Chee
- National University Hospital, National University of Singapore, Singapore, Singapore
| | | | | | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | | | | | - Mehul Shah
- Drashti Netralaya Eye Hospital, Dahod, India
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, USA
- Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Singapore, Singapore.
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, 308433, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore.
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Hoang TT, Nguyen CN, Ha TTH, Subramanian PS. A Lesson Learnt from a Dural Carotid Cavernous Fistula-induced Superior Ophthalmic Vein Occlusion with Posterior Ischaemic Optic Neuropathy. Neuroophthalmology 2021; 46:199-202. [DOI: 10.1080/01658107.2021.2000622] [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: 10/19/2022] Open
Affiliation(s)
- Tung Thanh Hoang
- Ophthalmology Department, Hanoi Medical University, Hanoi, Vietnam
- Ophthalmology Unit, Hanoi Medical University Hospital, Hanoi, Vietnam
- Save Sight Institute, The University of Sydney School of Medicine, Camperdown, Australia
| | - Cuong Ngoc Nguyen
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Thanh Thien Huy Ha
- Oculoplastic and Cosmesis Surgery Department, Vietnam National Eye Hospital, Hanoi, Vietnam
| | - Prem S. Subramanian
- Ophthalmology Department, University of Colorado School of Medicine, Aurora, Colorado, USA
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Bubak AN, Mescher T, Mariani M, Frietze SE, Hassell JE, Niemeyer CS, Como CN, Burnet AM, Subramanian PS, Cohrs RJ, Mahalingam R, Nagel MA. Targeted RNA Sequencing of Formalin-Fixed, Paraffin-Embedded Temporal Arteries From Giant Cell Arteritis Cases Reveals Viral Signatures. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/6/e1078. [PMID: 34493606 PMCID: PMC8424492 DOI: 10.1212/nxi.0000000000001078] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Varicella zoster virus (VZV) antigen has been detected in temporal arteries (TAs) of individuals with giant cell arteritis (GCA), the most common systemic vasculitis in older adults. Thus, we explored the contribution of VZV to GCA pathogenesis. METHODS Formalin-fixed, paraffin-embedded TA sections from biopsy-positive GCA participants with VZV antigen (GCA/VZV-positive; n = 20) and without (GCA/VZV-negative, n = 20) and from normal participants with VZV antigen (control/VZV-positive, n = 11) and without (control/VZV-negative, n = 20) were analyzed by targeted RNA sequencing of the whole human transcriptome (BioSpyder TempO-Seq). Ingenuity pathway analysis and R-computational program were used to identify differentially expressed genes and pathways between groups. RESULTS Compared with control/VZV-negative TAs, GCA/VZV-negative and GCA/VZV-positive TAs were significantly enriched for human transcripts specific for pathways involved in viral infections, including viral entry, nuclear factor kappa B activation by viruses, and other pathogen-related immune activation pathways. Similarly, human gene sets supporting viral infection were found in control/VZV-positive TAs that showed no morphological signs of inflammation, suggesting that the enriched pathways were not nonspecific signatures of infiltrating immune cells. All GCA TAs and control/VZV-positive TAs showed enrichment of transcripts involved in vascular remodeling, including smooth muscle cell migration. DISCUSSION The detection of viral and immune activation pathways in GCA TAs supports a role for virus infection in GCA pathogenesis. In addition, the detection of viral pathways in control/VZV-positive TAs, along with vascular remodeling pathways, suggests that these samples may represent early infection with progression to clinical disease, depending on host and other environmental factors.
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Affiliation(s)
- Andrew N Bubak
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Teresa Mescher
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Michael Mariani
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Seth E Frietze
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - James E Hassell
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Christy S Niemeyer
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Christina N Como
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Anna M Burnet
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Prem S Subramanian
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Randall J Cohrs
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Ravi Mahalingam
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Maria A Nagel
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora.
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Liu TYA, Wei J, Zhu H, Subramanian PS, Myung D, Yi PH, Hui FK, Unberath M, Ting DSW, Miller NR. Detection of Optic Disc Abnormalities in Color Fundus Photographs Using Deep Learning. J Neuroophthalmol 2021; 41:368-374. [PMID: 34415271 PMCID: PMC10637344 DOI: 10.1097/wno.0000000000001358] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/18/2022]
Abstract
BACKGROUND To date, deep learning-based detection of optic disc abnormalities in color fundus photographs has mostly been limited to the field of glaucoma. However, many life-threatening systemic and neurological conditions can manifest as optic disc abnormalities. In this study, we aimed to extend the application of deep learning (DL) in optic disc analyses to detect a spectrum of nonglaucomatous optic neuropathies. METHODS Using transfer learning, we trained a ResNet-152 deep convolutional neural network (DCNN) to distinguish between normal and abnormal optic discs in color fundus photographs (CFPs). Our training data set included 944 deidentified CFPs (abnormal 364; normal 580). Our testing data set included 151 deidentified CFPs (abnormal 71; normal 80). Both the training and testing data sets contained a wide range of optic disc abnormalities, including but not limited to ischemic optic neuropathy, atrophy, compressive optic neuropathy, hereditary optic neuropathy, hypoplasia, papilledema, and toxic optic neuropathy. The standard measures of performance (sensitivity, specificity, and area under the curve of the receiver operating characteristic curve (AUC-ROC)) were used for evaluation. RESULTS During the 10-fold cross-validation test, our DCNN for distinguishing between normal and abnormal optic discs achieved the following mean performance: AUC-ROC 0.99 (95 CI: 0.98-0.99), sensitivity 94% (95 CI: 91%-97%), and specificity 96% (95 CI: 93%-99%). When evaluated against the external testing data set, our model achieved the following mean performance: AUC-ROC 0.87, sensitivity 90%, and specificity 69%. CONCLUSION In summary, we have developed a deep learning algorithm that is capable of detecting a spectrum of optic disc abnormalities in color fundus photographs, with a focus on neuro-ophthalmological etiologies. As the next step, we plan to validate our algorithm prospectively as a focused screening tool in the emergency department, which if successful could be beneficial because current practice pattern and training predict a shortage of neuro-ophthalmologists and ophthalmologists in general in the near future.
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Affiliation(s)
- T Y Alvin Liu
- Department of Ophthalmology (TYAL, NRM), Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering (JW), Johns Hopkins University, Baltimore, Maryland; Malone Center for Engineering in Healthcare (HZ, MU), Johns Hopkins University, Baltimore, Maryland; Department of Radiology (PHY, FKH), Johns Hopkins University, Baltimore, Maryland; Singapore Eye Research Institute (DSWT), Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore ; Department of Ophthalmology (PSS), University of Colorado School of Medicine, Aurora, Colorado; and Department of Ophthalmology (DM), Byers Eye Institute, Stanford University, Palo Alto, California
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44
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Subramanian PS. Protecting Patients from the Harm We Can Cause. Ophthalmology 2021; 128:1363-1364. [PMID: 34420596 DOI: 10.1016/j.ophtha.2021.06.005] [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] [Received: 05/30/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
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45
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Sears CM, Wang Y, Bailey LA, Turbin R, Subramanian PS, Douglas R, Cockerham K, Kossler AL. Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study. Am J Ophthalmol Case Rep 2021; 23:101111. [PMID: 34113737 PMCID: PMC8170359 DOI: 10.1016/j.ajoc.2021.101111] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To study post-interventional findings in patients with dysthyroid optic neuropathy (DON) treated with teprotumumab. Observations In this multicenter observational Case series, patients with DON were treated with teprotumumab, an insulin-like growth factor I receptor inhibitor (10 mg/kg for the first infusion then 20 mg/kg for subsequent infusions, every three weeks for a total 8 infusions). This study included patients with acute and chronic thyroid eye disease (TED) with DON who had failed conventional therapies and were not candidates for surgical decompression. Data collected included best corrected visual acuity (BCVA), color vision, RAPD when present, and orbital CT or MRI. Proptosis, clinical activity score (CAS), Gorman diplopia score (GDS), and Humphrey visual fields (HVF) were also evaluated. Ten patients (6 women, 4 men) with an average age 64 years old were included in this study. Mean follow up after completion of infusions was 15 weeks. Baseline visual acuity (VA) impairment ranged from hand motion (HM) to 20/25 in affected eyes. All patients had pre-treatment orbital CT or MRI that confirmed orbital apex compression. Seventy percent of patients had objective improvement in DON after 2 infusions of teprotumumab measured as significant improvement in visual acuity, resolution of RAPD, or both. After completion of treatment, affected eyes had a mean BCVA improvement of 0.87 logMAR (p=0.0207), proptosis reduction of 4.7 mm (p<0.00001), CAS improvement of 5.25 points (p<0.00001), and GDS improvement of 0.75 points (p=0.160). All 6 patients who presented with an RAPD had resolution or improvement of RAPD. All 7 patients who presented with color vision deficits had normalization or improvement of color vision. Conclusions and Importance Teprotumumab infusions resulted in medical decompression and objective resolution or improvement of dysthyroid optic neuropathy. Most patients had rapid improvement of visual acuity and reversal of RAPD. Post-infusion imaging demonstrated reduction in extraocular muscle size that correlated with improvement in visual dysfunction. However, patients who presented with longstanding severe visual loss had limited improvement. There was no recurrence of DON after completion of teprotumumab in our cohort. Teprotumumab is effective for the treatment of dysthyroid optic neuropathy. Most patients demonstrated rapid objective improvement after 2 infusions. Visual acuity improved and relative afferent pupillary defect resolved after treatment. Orbital imaging showed improvement of orbital apex crowding after treatment. Patients with longstanding severe vision loss had limited improvement in visual acuity.
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Affiliation(s)
- Connie M Sears
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yao Wang
- Private Practice, Beverly Hills, CA, USA
| | | | - Roger Turbin
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Prem S Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine and Sue Anschutz-Rodgers UC Health Eye Center, Aurora, CO, USA
| | | | - Kimberly Cockerham
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.,Central Valley Eye Medical Group; Stockton, CA, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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46
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Ifantides C, Christopher KL, Deitz GA, Smith JM, Patnaik JL, SooHoo JR, Subramanian PS. Ophthalmic Injuries by Less-Lethal Kinetic Weapons During the US George Floyd Protests in Spring 2020. JAMA Ophthalmol 2021; 139:242-244. [PMID: 33270094 DOI: 10.1001/jamaophthalmol.2020.5325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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)
- Cristos Ifantides
- Department of Ophthalmology, University of Colorado, Aurora.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado, Aurora.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Galia A Deitz
- Department of Ophthalmology, University of Colorado, Aurora
| | - Jesse M Smith
- Department of Ophthalmology, University of Colorado, Aurora.,Department of Surgery, Denver Health Medical Center, Denver, Colorado
| | | | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado, Aurora.,Department of Surgery, Denver Health Medical Center, Denver, Colorado
| | - Prem S Subramanian
- Department of Ophthalmology, University of Colorado, Aurora.,Department of Neurology, University of Colorado, Aurora.,Department of Neurosurgery, University of Colorado, Aurora
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Nguyen NT, Hoang TT, Subramanian PS. Ocular, Orbital, and Sinus Damage Induced by a Fierce Fishhook Trauma. Asia Pac J Ophthalmol (Phila) 2021; 10:226-227. [PMID: 33793444 DOI: 10.1097/apo.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Nam Thanh Nguyen
- Department of Oculoplastics and Neuro-Ophthalmology, Ho Chi Minh City Eye Hospital, Ho Chi Minh, Vietnam
| | - Tung Thanh Hoang
- Ophthalmology Department, Hanoi Medical University, Ha Noi, Vietnam
- Save Sight Institute, The University of Sydney School of Medicine, New South Wales, Australia
| | - Prem S Subramanian
- Ophthalmology Department, University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
Patients with meningiomas of the planum sphenoidale and tuberculum sella often present with insidious vision loss in one or both eyes as the only sign or symptom of their disease, although other sensory, oculomotor, and even endocrine abnormalities may be seen in a minority of cases. Incidentally discovered tumors also are common, as patients may undergo neuroimaging for unrelated symptoms or events. Depending on the size and orientation of the tumor, central vision loss from optic nerve compression may be a later sign, and loss of peripheral vision in one or both eyes may not be recognized until it has progressed to areas closer to fixation. A thorough neuroophthalmologic assessment including visual field testing will help to define the extent of optic pathway involvement. Both fundus examination and optical coherence tomography of the retinal nerve fiber layer and macular ganglion cell complex will aid in determining prognosis after treatment of the tumor. Orbital surgery rarely is indicated as primary therapy for meningiomas in this location, and surgical resection or debulking is usually pursued before consideration is given to radiation therapy. Because of the long-term risk of residual tumor growth or recurrence, neuroophthalmic surveillance along with serial neuroimaging is required for years after tumor resection and/or radiation therapy.
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Affiliation(s)
- Elizabeth L Echalier
- Department of Ophthalmology, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States.,Department of Neurology, and Neurosurgery, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Prem S Subramanian
- Department of Ophthalmology, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States.,Department of Neurology, and Neurosurgery, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States
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Abstract
PURPOSE OF REVIEW Recent studies have increased our understanding of the biochemical and structural bases of visual hallucinations in patients with a variety of underlying causes. RECENT FINDINGS Visual hallucinations may be related to disruption of functional connectivity networks, with underlying biochemical dysfunction such as decreased in cholinergic activity. Structural abnormalities in primary and higher order visual processing areas also have been found in patients with visual hallucinations. The occurrence of visual hallucinations after vision loss, the Charles Bonnet syndrome, may have more functional similarity to psychiatric and neurodegenerative causes than previously suspected despite retained insight into the unreal nature of the phenomena. SUMMARY Visual hallucinations are common, and patients may not report them if specific inquiries are not made. Presence or absence of hallucinations may be of diagnostic and therapeutic importance, especially in patients with neurodegenerative conditions that have overlapping features. Treatment of visual hallucinations remains challenging and must be tailored to each patient based on the underlying cause and comorbid conditions.
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Affiliation(s)
| | - Prem S Subramanian
- Department of Ophthalmology
- Department of Neurology
- Department of Neurosurgery, University of Colorado School of Medicine
- Sue Anschutz-Rodgers UCHealth Eye Center, Aurora, Colorado, USA
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50
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Sibony PA, Biousse V, Bursztyn L, Costello F, Digre K, Fraser JA, Fraser CL, Huna-Baron R, Katz B, Lawlor M, Malmqvist L, Newman NJ, Peragallo J, Petzold A, Subramanian PS, Warner JEA, Wegener M, Wong S, Hamann S. Comment on: Morphologic Features of Buried Optic Disc Drusen on En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 219:369-370. [PMID: 32546392 DOI: 10.1016/j.ajo.2020.03.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick A Sibony
- Department of Ophthalmology, State University of New York at Stony Brook, Health Sciences Center, Stony Brook, New York, USA
| | | | - Lulu Bursztyn
- Ivey Eye Institute, Western University, London, Ontario, Canada
| | - Fiona Costello
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Kathleen Digre
- University of Utah, Department of Ophthalmology, Moran Eye Center, Salt Lake City, Utah, USA
| | | | | | | | - Bradley Katz
- University of Utah, Department of Ophthalmology, Moran Eye Center, Salt Lake City, Utah, USA
| | | | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | | | - Jason Peragallo
- Department of Ophthalmology, State University of New York at Stony Brook, Health Sciences Center, Stony Brook, New York, USA
| | | | | | - Judith E A Warner
- University of Utah, Department of Ophthalmology, Moran Eye Center, Salt Lake City, Utah, USA
| | - Marianne Wegener
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Sui Wong
- Moorfields Eye Hospital, London, UK
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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