Ann Shue, MD

All Publications

• Risk factors for capsular phimosis following congenital cataract extraction. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Al-Lozi, A. M., McFadyen, J., Shue, A., Lambert, S. R. 2025: 104279

  Abstract

  BACKGROUND: Visual axis opacities are one of the most common complications following infantile cataract surgery. To date, most studies have focused on lens reproliferation and pupillary membranes rather than capsular phimosis. We evaluated risk factors for capsular phimosis after lensectomies in infants.METHODS: A retrospective chart and video review of patients seen at a single institution over a period of 4 years was performed. Exclusion criteria were follow-up of <7 months and poor video quality. Two independent examiners, masked to patient outcomes, calculated capsulotomy diameters from video stills. To analyze risk factors for capsular phimosis, the chi2 test was used for categorical variables; the independent t test for continuous variables. For bilateral cases, one eye was randomly included in capsulotomy analysis.RESULTS: A total of 20 eyes of 12 patients, aged 1.7 months (IQR, 1.25; range, 0.6-3.2) at time of surgery, were reviewed. Median follow-up was 1.7 years (IQR, 2.39; range, 0.5-3.9). Capsular phimosis developed in 7 eyes (35%) and required surgical intervention in 5 eyes (25%) a median of 2.3 months (IQR 1.49; range, 1.2-5.1) after primary surgery. Male sex (P = 0.03) and smaller anterior horizontal (4.31 vs 5.78 mm [P = 0.0039]), anterior vertical (4.67 vs 5.59 [P = 0.0131]), and posterior vertical (4.10 vs 5.08 mm [P = 0.00074]) capsulotomy diameters increased risk of phimosis.CONCLUSIONS: In our study cohort, capsular phimosis was a common complication following a lensectomy in infants. Smaller anterior and posterior capsulotomy diameters increase risk of capsular phimosis.

  View details for DOI 10.1016/j.jaapos.2025.104279

  View details for PubMedID 40754288

• Retinal racemose hemangioma presenting with a chorioretinal anastomosis. American journal of ophthalmology case reports Soetikno, B. T., Ghoraba, H., Brant, A., DeBoer, C., Guo, L., Shue, A., Hartnett, M. E. 2024; 36: 102188

  Abstract

  Purpose: To report a case of neovascular glaucoma in an 8-year-old male, secondary to a racemose hemangioma without associated intracranial arteriovenous malformation, highlighting the challenges in management and novel findings on optical coherence tomography angiography (OCTA).Observations: An 8-year-old male initially presented with pain, redness, and blurred vision in the right eye. The patient was diagnosed with secondary neovascular glaucoma due to a racemose hemangioma. Urgent interventions included intravitreal bevacizumab injection and tube shunt surgery for persistently high intraocular pressure. Pars plana vitrectomy and scatter laser photocoagulation were eventually performed to manage a tractional retinal detachment and peripheral ischemia, respectively. OCTA imaging revealed a racemose hemangioma with a unique chorioretinal anastomosis.Conclusions and Importance: We present a rare pediatric case of neovascular glaucoma secondary to a racemose hemangioma with significant peripheral ischemia and an unusual chorioretinal anastomosis. The discovery of a chorioretinal anastomosis on OCTA suggests a potentially severe variant of racemose hemangioma.

  View details for DOI 10.1016/j.ajoc.2024.102188

  View details for PubMedID 39502457

• Glaucoma Home Self-Testing Using VR Visual Fields and Rebound Tonometry Versus In-Clinic Perimetry and Goldmann Applanation Tonometry: A Pilot Study. Translational vision science & technology Berneshawi, A. R., Shue, A., Chang, R. T. 2024; 13 (8): 7

  Abstract

  This pilot study aimed to assess the feasibility, accuracy, and repeatability of unsupervised, at-home, multi-day glaucoma testing using the Olleyes VisuALL Virtual Reality Platform (VRP) and the iCare HOME handheld self-tonometer.Participants were trained to use two U.S. Food and Drug Administration-registered or approved devices before conducting self-tests at home over 3 consecutive days. The iCare HOME intraocular pressure (IOP) measurements were collected four times daily per eye, and VRP visual field tests were performed once daily. The results were compared with one in-clinic Humphrey Field Analyzer (HFA) visual field test performed on the day of device training, iCare HOME measurements by the trainer, and the last five Goldmann applanation tonometer (GAT) results.Of 15 enrolled participants, nine of them (60%) completed the study. The six excluded participants could not self-measure using iCare HOME. There was significant correlation between the average mean deviation (MD) values of the at-home VRP tests and in-clinic HFA test (r2 = 0.8793, P < 0.001). Additionally, the average of the sensitivities in five of six Garway-Heath sectors were significantly correlated. VRP test duration was also shorter than in-clinic HFA testing (P < 0.001). Finally, at-home tonometry yielded statistically similar values compared to trainer-obtained iCare HOME values. The mean and range of at-home tonometry were also statistically similar to those for in-clinic GAT, but at-home tonometry demonstrated higher maximum IOP values (P = 0.0429).Unsupervised, at-home, multi-day glaucoma testing using two devices resulted in the capture of higher maximum IOPs than in the clinic and good MD correlation of VRP with HFA. However, 40% of participants could not self-measure IOP using iCare HOME.The study findings suggest that at-home remote glaucoma monitoring correlates with in-office testing and could provide additional information for glaucoma management, although patients had more difficulty with the iCare HOME than the VRP.

  View details for DOI 10.1167/tvst.13.8.7

  View details for PubMedID 39102241

• Repeatability of a Virtual Reality Headset Perimeter in Glaucoma and Ocular Hypertensive Patients. Translational vision science & technology Nascimento E Silva, R., Kim, J. A., Li, Y., Chen, C., Chaudhry, A. F., Berneshawi, A. R., Zhang, M., Villarreal, A., Liu, J., Shue, A., Chang, D. S., Chang, R. T. 2024; 13 (6): 14

  Abstract

  The VisuALL S is an automated, static threshold, virtual reality-based perimeter for mobile evaluation of the visual field. We examined same-day and 3-month repeatability.Adult participants with a diagnosis of glaucoma or ocular hypertension underwent two VisuALL 24-2 Normal T- Full threshold strategy tests at baseline and one additional exam at 3 months for each eligible eye. Spearman, intraclass correlation coefficients (ICCs), and Bland-Altman plots were used to assess the correlation of individual point sensitivities and mean deviation (MD) among three tests.Eighty-eight eyes (44 participants) were included. Average age was 68.1 ± 14.3 years, and 60.7% were male. VisuALL MD was highly correlated between tests (intravisit: r = 0.89, intervisit: r = 0.82; P < 0.001 for both). Bland-Altman analysis showed an average difference in intravisit MD of -0.67 dB (95% confidence interval [CI], -6.04 to 4.71 dB) and -0.15 dB (95% CI, -8.04 to 7.73 dB) for intervisit exams. Eight-five percent of pointwise intravisit ICCs were above 0.75 (range, 0.63 to 0.93), and 65% of pointwise intervisit ICCs were above 0.75 (range, 0.55 to 0.91).VisuALL demonstrated high correlation of MD between tests and good repeatability for individual point sensitivities among three tests in 3 months, except at the points around the blind spot and superiorly.The preliminary reproducibility results for VisuALL are encouraging. Its portable design makes it a potentially useful tool for patients with glaucoma, enabling more frequent assessments both at home and in clinical settings.

  View details for DOI 10.1167/tvst.13.6.14

  View details for PubMedID 38899952

• Ocular features of NGLY1 deficiency from a prospective longitudinal cohort. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Frater, C. H., Ruzhnikov, M. R., Beres, S., Alcorn, D., Shue, A., Levy, R. J. 2024: 103925

  Abstract

  NGLY1 deficiency is a rare autosomal recessive disorder with core features of global developmental delay, liver enzyme abnormalities, movement disorder, polyneuropathy, and hypo- or alacrima. We characterized the full spectrum and evolution of the ocular phenotype in a prospective natural history of NGLY1 deficiency.We collected ophthalmological data on 29 individuals with NGLY1 deficiency in a natural history study. Medical records were reviewed to confirm caregiver-reported symptoms. Of the 29, 15 participants appeared for at least one ophthalmological examination.Caregivers reported at least one ocular sign or symptom in 90% of participants (26/29), most commonly decreased tears, refractive error, and chronic infection. Daily eye medication, including artificial tears, ophthalmic ointment, and topical antibiotics were used by 62%. Ophthalmological examination confirmed refractive errors in 93% (14/15) and corneal abnormalities in 73% (11/15).Given nearly universal hypolacrima and additional prominent ocular findings in NGLY1 deficiency, a targeted ocular history and ophthalmologic examination may facilitate prompt diagnosis and early initiation of preventive eye care, preserving vision and overall ocular health.

  View details for DOI 10.1016/j.jaapos.2024.103925

  View details for PubMedID 38697387

• Comparison of Ophthalmologist and Large Language Model Chatbot Responses to Online Patient Eye Care Questions. JAMA network open Bernstein, I. A., Zhang, Y. V., Govil, D., Majid, I., Chang, R. T., Sun, Y., Shue, A., Chou, J. C., Schehlein, E., Christopher, K. L., Groth, S. L., Ludwig, C., Wang, S. Y. 2023; 6 (8): e2330320

  Abstract

  Importance: Large language models (LLMs) like ChatGPT appear capable of performing a variety of tasks, including answering patient eye care questions, but have not yet been evaluated in direct comparison with ophthalmologists. It remains unclear whether LLM-generated advice is accurate, appropriate, and safe for eye patients.Objective: To evaluate the quality of ophthalmology advice generated by an LLM chatbot in comparison with ophthalmologist-written advice.Design, Setting, and Participants: This cross-sectional study used deidentified data from an online medical forum, in which patient questions received responses written by American Academy of Ophthalmology (AAO)-affiliated ophthalmologists. A masked panel of 8 board-certified ophthalmologists were asked to distinguish between answers generated by the ChatGPT chatbot and human answers. Posts were dated between 2007 and 2016; data were accessed January 2023 and analysis was performed between March and May 2023.Main Outcomes and Measures: Identification of chatbot and human answers on a 4-point scale (likely or definitely artificial intelligence [AI] vs likely or definitely human) and evaluation of responses for presence of incorrect information, alignment with perceived consensus in the medical community, likelihood to cause harm, and extent of harm.Results: A total of 200 pairs of user questions and answers by AAO-affiliated ophthalmologists were evaluated. The mean (SD) accuracy for distinguishing between AI and human responses was 61.3% (9.7%). Of 800 evaluations of chatbot-written answers, 168 answers (21.0%) were marked as human-written, while 517 of 800 human-written answers (64.6%) were marked as AI-written. Compared with human answers, chatbot answers were more frequently rated as probably or definitely written by AI (prevalence ratio [PR], 1.72; 95% CI, 1.52-1.93). The likelihood of chatbot answers containing incorrect or inappropriate material was comparable with human answers (PR, 0.92; 95% CI, 0.77-1.10), and did not differ from human answers in terms of likelihood of harm (PR, 0.84; 95% CI, 0.67-1.07) nor extent of harm (PR, 0.99; 95% CI, 0.80-1.22).Conclusions and Relevance: In this cross-sectional study of human-written and AI-generated responses to 200 eye care questions from an online advice forum, a chatbot appeared capable of responding to long user-written eye health posts and largely generated appropriate responses that did not differ significantly from ophthalmologist-written responses in terms of incorrect information, likelihood of harm, extent of harm, or deviation from ophthalmologist community standards. Additional research is needed to assess patient attitudes toward LLM-augmented ophthalmologists vs fully autonomous AI content generation, to evaluate clarity and acceptability of LLM-generated answers from the patient perspective, to test the performance of LLMs in a greater variety of clinical contexts, and to determine an optimal manner of utilizing LLMs that is ethical and minimizes harm.

  View details for DOI 10.1001/jamanetworkopen.2023.30320

  View details for PubMedID 37606922

• Anterior segment ischemia following strabismus surgery in a young adult using gender-affirming estrogen hormone therapy. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Al-Lozi, A., Koo, E. B., Lambert, S. R., Levin, M. H., Velez, F., Do, D. V., Shue, A. 2023

  Abstract

  Well-known risk factors for anterior segment ischemia (ASI) following strabismus surgery include ipsilateral surgery on three or more rectus muscles, older age, and vasculopathy. ASI is rarely reported in young patients following uneventful strabismus surgery on two ipsilateral rectus muscles. We report a 30-year-old transgender female on long-term estrogen therapy who underwent strabismus surgery involving recessions of both lateral rectus muscles, the right inferior rectus muscle, and the left superior rectus muscle. The left eye developed severe ASI with hypotony maculopathy that was resistant to topical medications, oral steroids, anterior chamber reformation, and intravitreal steroid injection. Following phacoemulsification with intraocular lens and capsular tension ring insertion 1 year later, intraocular pressure and hypotony maculopathy improved.

  View details for DOI 10.1016/j.jaapos.2023.05.004

  View details for PubMedID 37355012

• 2021 U.S. Virgin Islands Zika health brigade: Providing recommended pediatric health screenings for children born to mothers with laboratory evidence of possible Zika virus infection during pregnancy. Birth defects research de Wilde, L. H., Harrison, C. J., Ceesay, B. E., Mayers, C. S., Ferrol-Hawley, J., Canton, J., Godfred-Cato, S., Reynolds, M. R., Brown-Shuler, L., Randhawa, S., Schoelles, D., Hillman, B., Carlos, M. P., Ambrose, T., Bitner, D., Holgado, S., Jones, C., Lattin, D. J., Mulkey, S. B., Nguyen, A., Payne, M., Prakalapakorn, S. G., Shue, A., Ellis, E. M. 2022

  Abstract

  The United States Virgin Islands (USVI) Department of Health (DOH) conducted a second Zika health brigade (ZHB) in 2021 to provide recommended Zika-related pediatric health screenings, including vision, hearing, neurologic, and developmental screenings, for children in the USVI. This was replicated after the success of the first ZHB in 2018, which provided recommended Zika-related pediatric health screenings to 88 infants and children exposed to Zika virus (ZIKV) during pregnancy.Ten specialty pediatric care providers were recruited and traveled to the USVI to conduct the screenings. USVI DOH scheduled appointments for children included in CDC's U.S. Zika Pregnancy and Infant Registry (USZPIR). During the ZHB, participants were examined by pediatric ophthalmologists, pediatric audiologists, and pediatric neurologists. We report the percentage of participants who were referred for additional follow-up care or given follow-up recommendations in the 2021 ZHB and compare these referrals and recommendations to those given in the 2018 ZHB.Thirty-three children born to mothers with laboratory evidence of ZIKV infection during pregnancy completed screenings at the 2021 ZHB, of which 15 (45%) children were referred for additional follow-up care. Ophthalmological screenings resulted in the highest number of new referrals for a specialty provider among ZHB participants, with 6 (18%) children receiving referrals for that specialty. Speech therapy was the most common therapy referral, with 10 (30%) children referred, of which 9 (90%) were among those who attended the 2018 ZHB.Thirty-three children in a jurisdiction with reduced access to healthcare specialists received recommended Zika-related pediatric health screenings at the ZHB. New and continuing medical and developmental concerns were identified and appropriate referrals for follow-up care and services were provided. The ZHB model was successful in creating connections to health services not previously received by the participants.

  View details for DOI 10.1002/bdr2.2143

  View details for PubMedID 36574736

• Strabismus and Nystagmus in Patients with Pediatric Cataracts: Study using Insurance Claims Data. American journal of ophthalmology Kim, S. J., Slinger, K., Lambert, S. R., Koo, E., Shue, A., Roberts, T. L. 2022

  Abstract

  To describe the characteristics and prevalence of strabismus and nystagmus in children diagnosed with cataracts using a national insurance claims database.Population-based retrospective cohort study METHODS: Patients <13 years diagnosed with cataracts (traumatic cataracts excluded) and enrolled continuously in their healthcare program for ≥5 years after their first cataract diagnosis were identified in a retrospective review of 66 million charts in Optum's de-identified Clinformatics Data Mart Database between 2003 and 2015. Patients were categorized based on age of their first diagnosed cataract, and if cataract surgery was performed. Clinical and demographic factors associated with the occurrence of strabismus and nystagmus were evaluated.Of 1,636 children diagnosed with cataract, 434 (26.5%) and 109 (6.7%) were diagnosed with strabismus and nystagmus, respectively. Both strabismus and nystagmus were more common in those who underwent cataract surgery (P <0.001) and in patients diagnosed with cataract ≤ 12 months of age (P <0.001). Survival analysis demonstrated that strabismus and nystagmus may be diagnosed 8 years following the initial cataract diagnosis. Cox proportional hazard regression analyses revealed strabismus was associated with cataract surgery, nystagmus, and the diagnosis with cataract ≤ 12 months and cataract surgery > 12 months.As strabismus and nystagmus occur more frequently in children diagnosed with cataracts necessitating cataract surgery, regular long-term follow-up is crucial for these children to monitor for the development of strabismus and nystagmus.

  View details for DOI 10.1016/j.ajo.2022.11.014

  View details for PubMedID 36410473

• Axenfeld-Rieger syndrome: more than meets the eye. Journal of medical genetics Reis, L. M., Maheshwari, M., Capasso, J., Atilla, H., Dudakova, L., Thompson, S., Zitano, L., Lay-Son, G., Lowry, R. B., Black, J., Lee, J., Shue, A., Kremlikova Pourova, R., Vaneckova, M., Skalicka, P., Jedlickova, J., Trkova, M., Williams, B., Richard, G., Bachman, K., Seeley, A. H., Costakos, D., Glaser, T. M., Levin, A. V., Liskova, P., Murray, J. C., Semina, E. V. 2022

  Abstract

  Axenfeld-Rieger syndrome (ARS) is characterised by typical anterior segment anomalies, with or without systemic features. The discovery of causative genes identified ARS subtypes with distinct phenotypes, but our understanding is incomplete, complicated by the rarity of the condition.Genetic and phenotypic characterisation of the largest reported ARS cohort through comprehensive genetic and clinical data analyses.128 individuals with causative variants in PITX2 or FOXC1, including 81 new cases, were investigated. Ocular anomalies showed significant overlap but with broader variability and earlier onset of glaucoma for FOXC1-related ARS. Systemic anomalies were seen in all individuals with PITX2-related ARS and the majority of those with FOXC1-related ARS. PITX2-related ARS demonstrated typical umbilical anomalies and dental microdontia/hypodontia/oligodontia, along with a novel high rate of Meckel diverticulum. FOXC1-related ARS exhibited characteristic hearing loss and congenital heart defects as well as previously unrecognised phenotypes of dental enamel hypoplasia and/or crowding, a range of skeletal and joint anomalies, hypotonia/early delay and feeding disorders with structural oesophageal anomalies in some. Brain imaging revealed highly penetrant white matter hyperintensities, colpocephaly/ventriculomegaly and frequent arachnoid cysts. The expanded phenotype of FOXC1-related ARS identified here was found to fully overlap features of De Hauwere syndrome. The results were used to generate gene-specific management plans for the two types of ARS.Since clinical features of ARS vary significantly based on the affected gene, it is critical that families are provided with a gene-specific diagnosis, PITX2-related ARS or FOXC1-related ARS. De Hauwere syndrome is proposed to be a FOXC1opathy.

  View details for DOI 10.1136/jmg-2022-108646

  View details for PubMedID 35882526

• Repeatability and correlation of a virtual reality perimeter with standard automated perimetry in glaucoma patients Chaudhry, A., Berneshawi, A., Liu, J., Shue, A., Chang, D., Kim, J., Chang, R. T. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401303262

• Feasibility of Glaucoma Home Self Testing Using a Virtual Reality Visual Field Test Combined with Home Tonometry Berneshawi, A., Shue, A., Chang, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401303264

• Anterior and temporal transposition of the superior oblique for treatment of exotropia in oculomotor nerve palsy. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Bonafede, L., Law, M., Scott, A. B., Shue, A., Velez, F. G. 2022

  View details for DOI 10.1016/j.jaapos.2021.10.007

  View details for PubMedID 35091084

• Rare Complications of Selective Laser Trabeculoplasty - Corneal Edema, Thinning and Hyperopic Shift: Incidences in the Optum Data Set Shue, A., Villegas, N. C., Wang, S. Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761400742

• The Ophthalmology Mini-Elective Gives Vision to Preclinical Medical Students. MedEdPORTAL : the journal of teaching and learning resources Mortensen, P., Enzor, R., Keppel, K., Williamson, R., Jones, P., Nkrumah, G., Safiullah, Z., Michelson, S., Nadimpalli, S., Shue, A., Waxman, E. 2020; 16: 11024

  Abstract

  Introduction: Ophthalmology education during medical school is often very limited. To provide exposure to areas beyond its standard curriculum, the University of Pittsburgh School of Medicine offers mini-elective courses in various disciplines. We developed such a course to provide instruction in the basics of clinical ophthalmology to interested preclinical medical students.Methods: First- and second-year medical students electively enrolled in our course (mean number of students per year = 12), which included four sessions combining didactics and hands-on learning. Additionally, each student individually spent time with an ophthalmologist in the operating room. Our course was held each year from 2015 to 2019.Results: Participants completed pre- (n = 25) and postsurveys (n = 20), reflecting increased comfort with the ophthalmologic history and physical examination. In 2019, participants also completed pre- and posttests, demonstrating increased knowledge of ophthalmology.Discussion: The Ophthalmology Mini-Elective is a unique educational tool that introduces the principles of ophthalmology to preclinical medical students, addressing an area of medicine that is generally minimally included in the required curriculum.

  View details for DOI 10.15766/mep_2374-8265.11024

  View details for PubMedID 33274290

• Oculocerebrorenal syndrome of Lowe: Survey of ophthalmic presentations and management. European journal of ophthalmology Ma, X. n., Ning, K. n., Jabbehdari, S. n., Prosseda, P. P., Hu, Y. n., Shue, A. n., Lambert, S. R., Sun, Y. n. 2020: 1120672120920544

  View details for DOI 10.1177/1120672120920544

  View details for PubMedID 32340490