Residency: Stanford University Ophthalmology Residency (2022) CA
Internship: Alameda County Highland Hospital Internal Medicine Residency (2019) CA
Medical Education: Emory University Medical School (2018) GA
BS, The Johns Hopkins University, Biomedical Engineering (2008)
MSE, The Johns Hopkins University, Biomedical Engineering (2009)
PhD, Georgia Institute of Technology, Biomedical Engineering (2016)
MD, Emory University School of Medicine (2018)
A protocol to inject ocular drug implants into mouse eyes.
2022; 3 (1): 101143
Ocular drug implants (ODIs) are beneficial for treating ocular diseases. However, the lack of a robust injection approach for small-eyed model organisms has been a major technical limitation in developing ODIs. Here, we present a cost-effective, minimally invasive protocol to deliver ODIs into the mouse vitreous called Mouse Implant Intravitreal Injection (MI3). MI3 provides two alternative surgical approaches (air-pressure or plunger) to deliver micro-scaled ODIs into milli-scaled eyes, and expands the preclinical platforms to determine ODIs' efficacy, toxicity, and pharmacokinetics. For complete details on the use and execution of this protocol, please refer to Sun etal. (2021).
View details for DOI 10.1016/j.xpro.2022.101143
View details for PubMedID 35141566
Teleophthalmology and Inequities in Diabetic Eye Disease at Safety Net Hospitals.
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Introduction: Teleophthalmology has emerged as a convenient and cost-effective intervention to increase access to screening for diabetic retinopathy (DR), a disease that disproportionately affects socially disadvantaged communities. However, a few studies have directly compared the detection of eye disease by teleophthalmology between socially and geographically diverse communities. This study compared the rates and severity of diabetic eye disease, as detected by teleophthalmology, between safety net and non-Safety Net Hospitals (non-SNHs). Methods: Retrospective chart review of patients screened for DR at county Safety Net Hospitals (SNHs) and non-SNHs in 150 cities and 30 states. The rates of DR, macular edema, suspected cataract, suspected glaucoma, and suspected age-related macular degeneration were compared. Relative risk and severity of disease in the county SNH population were calculated. Images were graded by the same group of IRIS readers, who used at least one image per eye with a 45° field centered between the optic disc and the macula. Participants with ungradable screening images were excluded. Results: Ninety-four thousand three hundred twenty-nine participants were screened for eye disease from September 1, 2016 to August 31, 2017. Among the screened participants (54% female; mean [SD] age, 58.7 [12.9] years), overall disease detection was 31% in the county SNH population and 23.6% in the non-SNH population. Compared with the non-SNH population, the county SNH population was twice as likely to screen positive for three or more concurrent eye conditions (1.2% vs. 0.7%) and had increased prevalence of DR (20.2% vs. 16.2%), macular edema (4.9% vs. 3.4%), suspected glaucoma (9.1% vs. 4.3%), suspected cataract (9.6% vs. 4.8%), and proliferative DR (2.1% vs. 1.0%). Conclusions: Increased diabetic eye disease prevalence and severity among people seen at SNHs highlights the need for continued resources to screen, treat, and manage disease. Teleophthalmology continues to be an important tool in efforts to mitigate health inequities and address barriers faced by underserved communities.
View details for DOI 10.1089/tmj.2021.0329
View details for PubMedID 34978959
An intravitreal implant injection method for sustained drug delivery into mouse eyes.
Cell reports methods
2021; 1 (8)
Using small molecule drugs to treat eye diseases carries benefits of specificity, scalability, and transportability, but their efficacy is significantly limited by a fast intraocular clearance rate. Ocular drug implants (ODIs) present a compelling means for the slow and sustained release of small molecule drugs inside the eye. However, methods are needed to inject small molecule ODIs into animals with small eyes, such as mice, which are the primary genetic models for most human ocular diseases. Consequently, it has not been possible to fully investigate efficacy and ocular pharmacokinetics of ODIs. Here, we present a robust, cost-effective, and minimally invasive method called "mouse implant intravitreal injection" (MI3) to deliver ODIs into mouse eyes. This method will expand ODI research to cover the breadth of human eye diseases modeled in mice.
View details for DOI 10.1016/j.crmeth.2021.100125
View details for PubMedID 35128514
Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided Laser in Situ Keratomileusis (WFG-LASIK) and Small Incision Lenticule Extraction (SMILE) refractive surgeries.
American journal of ophthalmology
PURPOSE: Wave-front guided laser in situ keratomileusis (WFG-LASIK) and small incision lenticule extraction (SMILE) are keratorefractive surgeries that can improve uncorrected visual acuity in myopic patients. Comparison of visual outcomes in myopic patients treated with LASIK and SMILE are needed.DESIGN: Prospective, randomized contralateral eye-controlled trial METHODS: We performed a single-center prospective, randomized, contralateral eye comparison of WFG-LASIK and SMILE (NCT03067077). Myopic patients with low levels of astigmatism were treated with WFG-LASIK in one eye and SMILE in the fellow eye from March 2017 to March 2021. Treatments were randomized by ocular dominance. WFG-LASIK and SMILE were performed. Postoperative evaluation at 1 day consisted of UDVA, wavefront aberrometry, and a slit lamp examination. On subsequent postoperative visits at 1-mo, 3-mo, 6-mo, and 12-mo, UDVA, manifest refraction, 5% and 25% low-contrast visual acuity, wavefront aberrometry, and slit lamp examination were performed.MAIN OUTCOME MEASURE: The primary outcome measure was uncorrected distance visual acuity at twelve months RESULTS: Eighty-eight (88) eyes of 44 patients with myopia were enrolled in the study. Seventy-four eyes of 37 patients had successful treatments and ccompleted 12 months of follow-up. At postoperative month 12, there was significantly higher proportion of WFG-LASIK eyes who had >= 20/20 uncorrected distance visual acuity compared with SMILE eyes (94% vs 83%, p<0.05). There was no difference between spherical equivalent between WFG-LASIK eyes and SMILE eyes (-0.17±0.25 vs -0.29±0.38, p>0.05); there was no difference in higher order aberrations, including coma, trefoil, and spherical aberrations (p>0.05); and there was significantly higher proportion of WFG-LASIK eyes who had improved 5% and 25% low contrast visual acuity compared with SMILE eyes (p<0.05) CONCLUSIONS: WFG-LASIK and SMILE both offered significant improvements in corrected distance visual acuity and excellent predictability in both eyes. Compared with SMILE, WFG-LASIK resulted in faster visual recovery, better low contrast visual acuity, and greater gains in uncorrected visual acuity.
View details for DOI 10.1016/j.ajo.2021.11.013
View details for PubMedID 34788593
Contamination of multiuse eyedrop bottles by exhaled air from patients wearing face masks during the COVID-19 pandemic: Schlieren imaging analysis.
Journal of cataract and refractive surgery
2021; 47 (9): 1167-1174
PURPOSE: To determine whether mask-induced redirected exhaled air through the superior mask gap contacts multiuse eyedrop bottles during drop administration and the efficacy of interventions to reduce such exposure.SETTING: Academic ophthalmology center.DESIGN: Interventional analysis.METHODS: Schlieren airflow imaging was taken of an examinee wearing frequently used face masks and enacting common clinical scenarios-with and without manual occlusion of the superior mask gap and/or neck extension-and maximum visible vertical breath plume height was quantified. Bottle height during eyedrop administration was measured for 4 ophthalmologists during instillation to 8 eyes of 4 subjects.RESULTS: Breath plume height (mean ± SD 275.5 ± 16.3 mm) was significantly greater than mean bottle height (13.9 ± 4.7 mm; P < .01). Plume height was reduced with manual mask occlusion vs without (P < .01) and was also lower than mean bottle height with manual mask occlusion (P < .01) but not in the absence of occlusion (P < .01). Neck extension alone did not adequately redirect liberated breath to prevent contact with a bottle.CONCLUSIONS: Exhaled air liberated from commonly worn patient face masks was able to contact multiuse eyedrop bottles during eyedrop administration. These findings have important patient safety implications during the coronavirus disease 2019 pandemic and with other respiratory pathogens because these multiuse bottles could potentially serve as vectors of disease. Occlusion of the superior mask gap significantly reduces breath contamination and should be strongly considered by eyecare providers during drop administration in eye clinics.
View details for DOI 10.1097/j.jcrs.0000000000000590
View details for PubMedID 34468454
Enhancing Risk Assessment in Patients with Diabetic Retinopathy by Combining Measures of Retinal Function and Structure.
Translational vision science & technology
2020; 9 (9): 40
To determine whether combining measures of retinal structure and function predicts need for intervention for diabetic retinopathy (DR) better than either modality alone.The study sample consisted of 279 diabetic patients who participated in an earlier cross-sectional study. Patients were excluded if they were previously treated for macular edema or proliferative DR or if they had other retinopathies. Medical records were reviewed for ocular interventions including vitrectomy, intravitreal injection, and laser treatment. Need for intervention was analyzed using Kaplan-Meier analyses and Cox proportional hazards. Baseline electroretinograms and fundus photographs were obtained. Two definitions of structural positive findings were as follows: 1. Early Treatment of Diabetic Retinopathy Study diabetic retinopathy severity scale (ETDRS-DR) severity ≥ level 53 (ETDRS-DR+) and 2. ETDRS-DR+ or clinically significant macular edema (VTDR+). A positive function finding corresponded to a RETeval DR Score >23.5 (RETeval+).For patients with VTDR+ the incidence of intervention was 19%, 31%, and 53% after 1, 2, and 3 years of follow-up. In these patients, intervention incidence increased to 34%, 54%, and 74% the subsequent 1, 2, and 3 years if function was above criterion (RETeval+), whereas RETeval- results reduced the risk to 3%, 4%, and 29%, respectively, reducing risk to similar levels seen for patients with VTDR- results at baseline.Prediction of subsequent intervention was best when combining structural and functional information.This study demonstrates that clinical management of diabetic retinopathy is improved by adding electroretinography to fundus photographic information in assessing the risk of the need for intervention.
View details for DOI 10.1167/tvst.9.9.40
View details for PubMedID 32908803
View details for PubMedCentralID PMC7453041