Visiting Instructor/Lecturer, Ophthalmology
Boards, Advisory Committees, Professional Organizations
Member, The Association for Research in Vision and Ophthalmology (2023 - Present)
Member, Women in Ophthalmology (2023 - Present)
Doctor of Medicine, Universidad De Nuevo Leon (2019)
MD, Universidad Autonoma de Nuevo Leon Facultad de Medicina, Medicine (2019)
Heather Moss, Postdoctoral Faculty Sponsor
Visual Outcomes Following Plasma Exchange for Optic Neuritis: An International Multicenter Retrospective Analysis of 395 Optic Neuritis Attacks.
American journal of ophthalmology
To evaluate the effectiveness of plasma exchange (PLEX) for optic neuritis (ON).We conducted an international multicenter retrospective study evaluating the outcomes of ON following PLEX. Outcomes were compared to raw data from the Optic Neuritis Treatment Trial (ONTT) using a matched subset.A total of 395 ON attack treated with PLEX from 317 patients were evaluated. The median age was 37 years (range 9 to 75) and 71% were female. Causes of ON included: multiple sclerosis (108), myelin-oligodendrocyte-glycoprotein-antibody-associated-disease (MOGAD) (92), aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD) (75), seronegative-NMOSD (34), idiopathic (83), and other (3). Median time from onset of vision loss to PLEX was 2.6 weeks (IQR, 1.4-4.0). Median visual acuity (VA) at time of PLEX was count fingers (IQR, 20/200-hand motion) and median final VA was 20/25 (IQR, 20/20-20/60) with no differences among etiologies except MOGAD-ON which had better outcomes. In 81 (20.5%) ON attacks, the final VA was 20/200 or worse. Patients with poor outcomes were older (p=0.002), had worse VA at time of PLEX (p<0.001), and longer delay to PLEX (p<0.001). In comparison with the ONTT subset with severe corticosteroid-unresponsive ON, a final VA of worse than 20/40 occurred in 6/50 (12%) PLEX-treated ON versus 6/18 (33%) from the ONTT treated with intravenous methylprednisolone without PLEX (p=0.04).Most ON attacks improved with PLEX, and outcomes were better than attacks with similar severity in the ONTT. The presence of severe vision loss at nadir, older age, and longer delay to PLEX predicted a worse outcome while MOGAD-ON had a more favorable prognosis.
View details for DOI 10.1016/j.ajo.2023.02.013
View details for PubMedID 36822570
Accuracy of International Classification of Diseases Codes for Identifying Acute Optic Neuritis.
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
The accuracy of International Classification of Diseases (ICD) codes for identifying cases of acute optic neuritis (aON) is not known. A prior study reported 61% accuracy for ICD code plus MRI consistent with aON within 2 months. This study determined accuracy for ICD code plus MRI within 2 months regardless of results.Retrospective chart review was conducted using a medical record research repository of a tertiary care institution from 1998 to 2019. Subjects with ICD-9/10 codes for ON and an MRI brain and/or orbits within 2 months of earliest (initial) ICD code were included. MRI was classified as positive or negative for aON based on report noting gadolinium-contrast enhancement. Clinical diagnosis at the time of initial code was classified as aON, prior ON, considered ON, alternative diagnosis, or unknown based on review of physician authored clinical notes within 7 days of the initial code. Accuracy of ICD code for aON, acute or prior ON, and acute, prior, or considered ON were calculated for all subjects and stratified based on MRI result.Two hundred fifty-one subjects had MRI results within 2 months of their initial ON ICD code (49 positive MRI [previously reported]; 202 negative MRI). Among those with negative MRI, 32 (16%) had aON, 40 (20%) had prior ON, 19 (9%) considered ON as a diagnosis, 92 (46%) had other confirmed diagnoses, and 19 (9%) had unknown diagnosis at time of code. Considering all subjects, accuracy for ICD code was 25% for acute ON, 41% for acute or prior ON, and 48% for acute, prior, or considered ON. Positive MRI, increased number of ON ICD codes, a code given by an ophthalmologist or neurologist within 2 months, and the presence of a neurology encounter within 2 months were associated with an increased accuracy for clinical aON diagnosis.In the setting of an MRI within 2 months, ICD codes for ON have low accuracy for acute ON and only slightly better accuracy for acute or prior ON. Accuracy is higher for cases with a positive MRI than those with a negative MRI, suggesting positive MRI in conjunction with ICD codes may help more accurately identify cases. Reliance on ICD and Current Procedural Terminology codes alone to identify aON cases may introduce substantial misclassification bias in claims-based research.
View details for DOI 10.1097/WNO.0000000000001805
View details for PubMedID 36696226
Secondary Rhinoplasty Using Autologous Rib Cartilage
Journal of Otolaryngology and Rhinology
View details for DOI 10.23937/2572-4193.1510073
- Sudden Sensorineural Hearing Loss: An Updated Review American Journal of Otolaryngology and Head and Neck Surgery 2019