Assistant Professor Edward H. Wood, MD is a board certified and fellowship trained vitreoretinal surgeon in the department of ophthalmology at the Byers Eye Institute, Stanford University School of Medicine.
Dr. Wood’s clinical practice focuses on both adult and pediatric vitreoretinal disease. His approach to patients with retinal disorders is to ensure that every patient and their family are treated with respect and compassion. Dr. Wood takes a team approach in creating a treatment plan tailored to each patient’s individual needs with the goal of achieving a lifetime of useful and high quality vision.
In addition to medical and surgical care for retina patients, Dr. Wood engages in translational research with the goal of developing new therapies and approaches for patients without viable treatment options. He does so through leveraging the technologies of patient derived stem cells, optogenetics, and phenotypic drug screening in conjunction with active clinical research and surgical device development. Dr. Wood has filed numerous patents and founded several healthcare startups with the goal of improving patients’ quality of life. Areas of interest include age-related macular degeneration, diabetic retinopathy, retinal vascular disease, retinal detachment, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital x-linked retinoschisis, stickler syndrome, surgery for the macula (such as treatment of epiretinal membranes and macular holes), and correction of aphakia and dislocated intraocular lenses. His research interests are significantly inspired by his patients, and he is driven towards not only delivering the highest quality of care currently available, but also in developing the future standard of care in the field of medical retina and vitreoretinal surgery.
Dr. Wood received his BS in Neuroscience from Vanderbilt University graduating Magna cum laude with Honors, and was elected to Phi Beta Kappa honor society. He then returned to his home state to complete medical school at the University of Kentucky where he served as Class President and was elected to the Alpha Omega Alpha Honor Society. Following this, he completed his ophthalmology residency at Stanford University where he served as chief resident and was awarded the Heed Fellowship, the most prestigious national award for ophthalmology residents in the country. He underwent fellowship training in adult and pediatric vitreoretinal surgery at Associated Retinal Consultants of William Beaumont Hospital, under the mentorship of distinguished retina faculty such as Dr. Michael Trese, Dr. George Williams, Dr. Antonio Capone, Dr. Tamer Mahmoud, and others. In 2018, he received the Ronald G. Michels Fellowship Award, the highest honor for a vitreoretinal surgery fellow in the United States. Following fellowship, Dr. Wood returned to Stanford University's School of Medicine as an Assistant Professor of Vitreoretinal Surgery in the Department of Ophthalmology.
He has published over 40 peer-reviewed scientific manuscripts and book chapters, and presents regularly at national and international symposia. He is a member of the American Academy of Ophthalmology, the Association for Research in Vision and Ophthalmology, and the American Society of Retina Specialists.
Honors & Awards
Ronald G. Michels Fellow, Ronald G. Michels Fellowship Foundation (2018)
Best Consulting Department of the Year Award, Stanford Hospitals and Clinics / Kaiser Emergency Medicine Residency (2017)
Chief Resident in Ophthalmology, Stanford University School of Medicine (2017)
Heed Fellow, Heed Ophthalmic Foundation and Society of Heed Fellows (2017)
Heed Ophthalmic Foundation Residents Retreat, Heed Ophthalmic Foundation (2016)
Stanford Society of Physician Scholars and Stanford MedScholars, Stanford University School of Medicine (2015)
Patient Advocate Honor, University Medical Center Brackenridge, Transitional Year Program (2014)
Francis Massie Award from the Department of Surgery, University of Kentucky College of Medicine (2013)
Alpha Omega Alpha Honor Medical Society, University of Kentucky College of Medicine (2012)
Elected Medical School Class President, University of Kentucky College of Medicine (2011-2013)
Best Research Poster out of over 1,000 submissions, American Society of Retinal Specialists (ASRS) Annual Meeting (2011)
Graduated Magna Cum Laude with Distinction, Vanderbilt University (2008)
Phi Beta Kappa, Phi Beta Kappa at Vanderbilt University (2008)
Vanderbilt College Scholars Program, Vanderbilt University (2005)
Board Certification, American Board of Ophthalmology (2019)
Vitreoretinal Fellowship, Associated Retinal Consultants of William Beaumont Hospital, Medical and Surgical Retina; Ronald G. Michels Fellow (2019)
Ophthalmology Residency, Stanford University School of Medicine, Ophthalmology; Chief Resident, Heed Fellow (2017)
Medical Internship, Dell Medical School at University of Texas Austin, Medicine and Surgery; Patient Advocate Honor (2014)
MD, University of Kentucky College of Medicine, Medicine; Elected Class President (2013)
BS, Vanderbilt University, Neuroscience with Distinction; Magna Cum Laude, Phi Beta Kappa (2008)
Current Research and Scholarly Interests
Edward H. Wood, MD is an assistant professor of ophthalmology practicing adult and pediatric vitreoretinal surgery at Stanford University School of Medicine. Dr. Wood engages in translational research with the goal of developing new therapies and approaches for patients without viable treatment options. He does so through leveraging the technologies of patient derived stem cells, optogenetics, and phenotypic drug screening in conjunction with active clinical research and surgical device development. Dr. Wood has filed numerous patents and founded several healthcare startups with the goal of improving patients’ quality of life. His research interests include regenerative medicine, drug discovery, and pediatric retinal disease with the ultimate goal of pursuing basic science discoveries with potential for impactful clinical translation. His research interests are significantly inspired by his patients, and he is driven towards not only delivering the highest quality of care currently available, but also in developing the future standard of care in the field of medical retina and vitreoretinal surgery.
RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES
2020; 40 (8): E37
View details for Web of Science ID 000559752400006
Morning glory optic nerve in Aicardi syndrome: Report of a case with fluorescein angiography.
European journal of ophthalmology
BACKGROUND: Aicardi syndrome is an X-linked condition that is associated with multiple ophthalmic malformations. Here, we report the first published fluorescein angiography (FA) study of a morning glory optic nerve in a patient with Aicardi syndrome and contralateral persistent fetal vasculature (PFV).CASE DESCRIPTION: A 12-day old full-term baby girl with a normal neurological exam was referred for evaluation of microphthalmia. The posterior segment of the right eye demonstrated chorioretinal lacunae typical of Aicardi syndrome and microphthalmos with a stalk consistent with PFV. The right eye imaging could not be captured due to the severe microphthalmos and cataract, however, fluorescein angioscopy was performed. The left eye demonstrated a morning glory appearing optic disc with peripapillary chorioretinal lacunae. Fluorescein angiography of the eye showed and late staining in the areas of ellipsoid chorioretinal lacunae emanating from the optic nerve and extensive peripapillary staining and late leakage of the optic nerve.CONCLUSION: Patients with Aicardi syndrome can have morning glory optic nerve anomaly and PFV. Using FA under anesthesia to detect these abnormalities help in estimating the extend of the disease and its complications, which allows for better management of the complications.
View details for DOI 10.1177/1120672120942702
View details for PubMedID 32674592
ORCA: Opsins Restoring Cellular Aerobics
ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
View details for Web of Science ID 000554528302308
The retina revolution: signaling pathway therapies, genetic therapies, mitochondrial therapies, artificial intelligence.
Current opinion in ophthalmology
PURPOSE OF REVIEW: The aim of this article is to review and discuss the history, current state, and future implications of promising biomedical offerings in the field of retina.RECENT FINDINGS: The technologies discussed are some of the more recent promising biomedical developments within the field of retina. There is a US Food and Drug Administration-approved gene therapy product and artificial intelligence device for retina, with many other offerings in the pipeline.SUMMARY: Signaling pathway therapies, genetic therapies, mitochondrial therapies, and artificial intelligence have shaped retina care as we know it and are poised to further impact the future of retina care. Retina specialists have the privilege and responsibility of shaping this future for the visual health of current and future generations.
View details for DOI 10.1097/ICU.0000000000000656
View details for PubMedID 32205471
- Reply. Retina (Philadelphia, Pa.) 2020
- A renaissance of teleophthalmology through artificial intelligence EYE 2019; 33 (6): 861–63
- STEM CELL THERAPIES, GENE-BASED THERAPIES, OPTOGENETICS, AND RETINAL PROSTHETICS: CURRENT STATE AND IMPLICATIONS FOR THE FUTURE RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES 2019; 39 (5): 820–35
The Impact of Prefilled Syringes on Endophthalmitis Following Intravitreal Injection of Ranibizumab
AMERICAN JOURNAL OF OPHTHALMOLOGY
2019; 199: 200–208
To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation.Multicenter retrospective cohort study.All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum.A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred (0.013%; 1 in 7516 injections). In the prefilled ranibizumab group, 12 cases of suspected endophthalmitis occurred (0.015%; 1 in 6534 injections) and 2 cases of culture-positive endophthalmitis occurred (0.0026%; 1 in 39 204 injections). Prefilled syringes were associated with a trend toward decreased risk of suspected endophthalmitis (odds ratio 0.59; 95% confidence interval 0.31-1.12; P = .10) and a statistically significant decreased risk of culture-positive endophthalmitis (odds ratio 0.19; 95% confidence interval 0.045-0.82; P = .025). Average logMAR vision loss at final follow-up was significantly worse for eyes that developed endophthalmitis from the conventional ranibizumab preparation compared to the prefilled syringe group (4.45 lines lost from baseline acuity vs 0.38 lines lost; P = .0062). Oral-associated flora was found in 27.3% (6/22) of conventional ranibizumab culture-positive endophthalmitis cases (3 cases of Streptococcus viridans, 3 cases of Enterococcus faecalis) compared to 0 cases in the prefilled ranibizumab group.In a large, multicenter, retrospective study the use of prefilled syringes during intravitreal injection of ranibizumab was associated with a reduced rate of culture-positive endophthalmitis, including from oral flora, as well as with improved visual acuity outcomes.
View details for DOI 10.1016/j.ajo.2018.11.023
View details for Web of Science ID 000460997100023
View details for PubMedID 30552891
Preventing Progression in Nonexudative Age-Related Macular Degeneration With Subthreshold Laser Therapy: A Systematic Review
OPHTHALMIC SURGERY LASERS & IMAGING RETINA
2019; 50 (3): E61–E70
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among the elderly in developed countries. Subthreshold retinal laser therapy is a new technique that targets drusen - a marker of nonexudative AMD - without causing incidental retinal damage associated with conventional laser photocoagulation. This review summarizes published literature on subthreshold retinal laser therapy as prophylactic treatment of nonexudative AMD.A literature search of the PubMed, Medline, and Embase databases was conducted from January 1997 to April 2018. Studies were analyzed based upon study design, laser parameters, drusen reduction, changes in visual acuity (VA), and the development of choroidal neovascularization (CNV) and/or geographic atrophy (GA).Twelve studies involving 2,481 eyes treated with subthreshold retinal laser therapy were included in this review. Treatment led to increased drusen reduction, and studies with significant VA improvement were associated with significant drusen reduction. There was no significant change in the risk of developing CNV or GA.Subthreshold retinal laser therapy is effective for reducing drusen and potentially improving vision in patients with nonexudative AMD. This therapy does not show benefits in reducing development of CNV or GA. Thus, its long-term efficacy to prevent progression to advanced AMD cannot yet be recommended. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e61-e70.].
View details for DOI 10.3928/23258160-20190301-13
View details for Web of Science ID 000462056800003
View details for PubMedID 30893458
STEM CELL THERAPIES, GENE-BASED THERAPIES, OPTOGENETICS, AND RETINAL PROSTHETICS: CURRENT STATE AND IMPLICATIONS FOR THE FUTURE.
Retina (Philadelphia, Pa.)
PURPOSE: To review and discuss current innovations and future implications of promising biotechnology and biomedical offerings in the field of retina. We focus on therapies that have already emerged as clinical offerings or are poised to do so.METHODS: Literature review and commentary focusing on stem cell therapies, gene-based therapies, optogenetic therapies, and retinal prosthetic devices.RESULTS: The technologies discussed herein are some of the more recent promising biotechnology and biomedical developments within the field of retina. Retinal prosthetic devices and gene-based therapies both have an FDA-approved product for ophthalmology, and many other offerings (including optogenetics) are in the pipeline. Stem cell therapies offer personalized medicine through novel regenerative mechanisms but entail complex ethical and reimbursement challenges.CONCLUSION: Stem cell therapies, gene-based therapies, optogenetics, and retinal prosthetic devices represent a new era of biotechnological and biomedical progress. These bring new ethical, regulatory, care delivery, and reimbursement challenges. By addressing these issues proactively, we may accelerate delivery of care to patients in a safe, efficient, and value-based manner.
View details for PubMedID 30664120
ETIOLOGY AND CLINICAL CHARACTERISTICS OF MACULAR EDEMA IN PATIENTS WITH FAMILIAL EXUDATIVE VITREORETINOPATHY.
Retina (Philadelphia, Pa.)
To describe the etiology and clinical characteristics of macular edema (ME) in patients with familial exudative vitreoretinopathy.Observational, retrospective case series of 30 patients (34 eyes) with ME and familial exudative vitreoretinopathy who underwent spectral-domain optical coherence tomography imaging between 2009 and 2016. Baseline and follow-up optical coherence tomographies were correlated with color fundus photography and fluorescein angiography.The average age was 20.6 years (6.6-68.7). Eighteen eyes exhibited cystoid ME (52.9%), 14 noncystoid ME (41.2%), and 2 eyes (5.9%) with both. Macular edema was foveal in 52.9% (n = 18). Eighteen of 24 eyes (64.3%) with an available fluorescein angiography showed leakage from ME. The most common structural feature was posterior hyaloidal organization/contraction (n = 15). Sixteen eyes were treated with topical or intravitreal steroids (n = 6), intravitreal anti-vascular endothelial growth factor (n = 3), or pars plana vitrectomy with membrane stripping (n = 7). There was no difference between mean preoperative and postoperative LogMAR visual acuity (0.63 [20/85] vs. 0.87 [20/148], P = 0.35) after vitrectomy despite a statistical improvement in the mean central foveal thickness (596 mm vs. 303 mm, P = 0.04).Macular edema in familial exudative vitreoretinopathy occurs most commonly because of traction. Vitrectomy is effective for relieving tractional forces with anatomical improvement.
View details for DOI 10.1097/IAE.0000000000002623
View details for PubMedID 31404032
Adult Coats' Disease, Dubin-Johnson Syndrome, and the Search for Targeted Therapies.
Ophthalmic surgery, lasers & imaging retina
2019; 50 (5): 318–21
Coats' disease is nonhereditary retinal vascular disorder characterized by telangiectatic retinal vessels with prominent aneurysmal changes and exudation. A conclusive etiology has not yet been determined. In this retrospective case report and literature review, a 64-year-old male with Dubin-Johnson syndrome presented with unilateral retinal vascular changes and exudation consistent with a diagnosis of adult Coats' disease. The authors conclude that patients with Dubin-Johnson syndrome carry mutations in a multidrug resistance associated protein (MRP). MRPs are also expressed in the retina, retinal pigment epithelium, and vascular endothelium, where they export toxins and metabolites, and may serve as a therapeutic target. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:318-321.].
View details for DOI 10.3928/23258160-20190503-10
View details for PubMedID 31100164
Surgical Management of Suprachoroidal Hemorrhage in Younger Patients.
Ophthalmic surgery, lasers & imaging retina
2019; 50 (7): 454–58
Suprachoroidal hemorrhage (SCH) is a rare but serious complication that may accompany nearly any ocular surgery. In contrast to SCH in adults, the incidence and management of SCH in the pediatric population is poorly defined. Herein, the authors describe their experience managing SCH in patients of a younger age group, characterize this rare complication using multimodal imaging, and review the current literature on the subject. In this retrospective case series, two patients developed intraoperative SCH during cataract extraction once rendered aphakic. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:454-458.].
View details for DOI 10.3928/23258160-20190703-08
View details for PubMedID 31344246
Late re-activation of Coats disease.
American journal of ophthalmology case reports
2019; 15: 100458
To report case of Coats disease with the longest known interval of disease quiescence prior to first reactivation (17 years).A 25-year-old male was regularly followed for Coats disease since age 4. After initial treatment with cryoablation, disease quiescence was achieved at age 8. The disease activity was well controlled for 17 years after which he developed decreased vision in the right eye at age 25. Late reactivation of Coats disease was diagnosed and multiple treatments ensued. Despite aggressive therapy, the patient experienced progressive exudation warranting surgical management and eventually developed neovascular glaucoma.Once diagnosed with Coats disease, lifelong monitoring is essential to early detection and treatment of potential disease reactivation. The interval between disease quiescence and reactivation is variable, with this case representing the longest known interval of disease quiescence prior to first reactivation (17 years).
View details for DOI 10.1016/j.ajoc.2019.100458
View details for PubMedID 31193172
View details for PubMedCentralID PMC6518316
Correlating Changes in the Macular Microvasculature and Capillary Network to Peripheral Vascular Pathologic Features in Familial Exudative Vitreoretinopathy.
2019; 3 (7): 597–606
To evaluate the macular microvasculature in patients with familial exudative vitreoretinopathy (FEVR) using OCT angiography (OCTA) and to assess for peripheral vascular changes using widefield fluorescein angiography (WFA).Multicenter, retrospective, comparative, observational case series.We identified 411 patients with FEVR, examined between September 2014 and June 2018. Fifty-seven patients with FEVR and 60 healthy controls had OCTA images of sufficient quality for analysis.Custom software was used to assess for layer-specific, quantitative changes in vascular density and morphologic features on OCTA by way of vessel density (VD), skeletal density (SD), fractal dimension (FD), vessel diameter index (VDI), and foveal avascular zone (FAZ). Widefield fluorescein angiography images were reviewed for peripheral vascular changes including capillary dropout, late-phase angiographic posterior and peripheral vascular leakage (LAPPEL), vascular dragging, venous-venous shunts, and arteriovenous shunts.Macular microvascular parameters on OCTA and peripheral angiographic findings on WFA.OCT angiography analysis of 117 patients (187 eyes; 92 FEVR patients and 95 control participants) demonstrated significantly reduced VD, SD, and FD and greater VDI in patients with FEVR compared with controls in the nonsegmented retina, superficial retinal layer (SRL), and deep retinal layer (DRL). The FAZ was larger compared with that in control eyes in the DRL (P < 0.0001), but not the SRL (P = 0.52). Subanalysis by FEVR stage showed the same microvascular changes compared with controls for all parameters. Widefield fluorescein angiography analysis of 95 eyes (53 patients) with FEVR demonstrated capillary nonperfusion in all eyes: 47 eyes (49.5%) showed LAPPEL, 32 eyes (33.7%) showed vascular dragging, 30 eyes (31.6%) had venous-venous shunts, and 33 eyes (34.7%) had arteriovenous shunts. Decreasing macular VD on OCTA correlated with increasing peripheral capillary nonperfusion on WFA. Decreasing fractal dimension on OCTA correlated with increasing LAPPEL severity on WFA.Patients with FEVR demonstrated abnormalities in the macular microvasculature and capillary network, in addition to the peripheral retina. The macular microvascular parameters on OCTA may serve as biomarkers of changes in the retinal periphery on WFA.
View details for DOI 10.1016/j.oret.2019.02.013
View details for PubMedID 31277801
- Diagnosis and Management of Familial Exudative Vitreoretinopathy: A Lifelong, Progressive, and Often Asymmetric Disease. JAMA ophthalmology 2019
The Natural History of Congenital X-Linked Retinoschisis and Conversion between Phenotypes over Time.
2019; 3 (1): 77–82
To evaluate the natural history of congenital X-linked retinoschisis (CXLRS) and to assess disease stability or progression over time.Retrospective case series at a single-center, tertiary care, pediatric retina practice.One hundred two eyes of 51 patients with CXLRS.The clinical examinations, fundus photographs, and OCT images of all patients with CXLRS were assessed. Eyes that initially demonstrated combined retinoschisis-retinal detachments and those with large, centrally overhanging schisis cavities were excluded from the analysis (n = 49) because they underwent surgery, which precluded observation of the natural disease course.Stability or conversion of CXLRS phenotype over time.Fifty-three eyes met inclusion criteria for observation of natural disease history over time. At the time of diagnosis, 7.5% of eyes showed type 1 disease (n = 4), 17% showed type 2 disease (n = 9), 66% showed type 3 disease (n = 35), and 9.5% showed type 4 disease (n = 5). Mean length of follow-up was 7.4 years. A total of 7.5% of eyes demonstrated a combined retinoschisis-retinal detachment requiring surgery (n = 4), whereas 1.8% demonstrated a large, centrally overhanging schisis cavity requiring surgery (n = 1). Overall, 83% of eyes (n = 44) remained the same type without conversion or development of a complication requiring surgery. The remaining 17% of eyes (n = 9) experienced some type of change from their baseline diagnosis, with 7.5% (n = 4) converting between phenotypes and 9.5% (n = 5) demonstrating a complication requiring surgery; 3.75% of eyes (n = 2) converted from type 2 to 3 and 7.5% of eyes (n = 4) converted from type 3 to a combined retinoschisis-retinal detachment with mean time to conversion of 4.07 years.This longitudinal study conveyed the natural history of CXLRS. Congenital X-linked retinoschisis displayed long-term stability in 83% of eyes with conversion or progression of the disease to a more severe phenotype in the remaining cases. Type 3 CXLRS was a risk factor for the development of a combined retinoschisis-retinal detachment and may benefit from closer follow-up.
View details for DOI 10.1016/j.oret.2018.08.006
View details for PubMedID 30935660
Considerations for ophthalmic applications of optogenetics
2018; 96 (8): E1037
View details for PubMedID 29855158
Orbital, eyelid, and nasopharyngeal silicone oil granuloma presenting as ptosis & pseudo-xanthelasma.
American journal of ophthalmology case reports
2018; 11: 45–48
Purpose: To highlight the presentation and management of a patient with eyelid, orbital and nasopharyngeal silicone oil migration through a glaucoma drainage implant presenting as pseudo-xanthelasma and ptosis.Observations: A 68-year male presented with unilateral ptosis and presumed xanthelasma. He had a history of glaucoma drainage implant surgery, pseudophakia, and multiple retinal detachment repairs with silicone oil. During ptosis repair it was discovered that his presumed xanthelasma was in fact an eyelid silicone granuloma. Additional work up revealed silicone infiltration of the eyelids, orbits, and nasopharynx, resulting from emulsified silicone oil leakage through his glaucoma valve implant.Conclusions and Importance: Silicone oil may emulsify with time, with potential egress via a glaucoma filtration device. Clinicians should be alert for eyelid, orbital and sinonasal findings that may indicate occult migration.
View details for PubMedID 29978139
A new mitochondrial disease: MICHRED "'Mitochondrial disorder with Intracranial Calcification, REnal disease, REtinopathy, and Deafness."
ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
View details for Web of Science ID 000442932807181
Retina (Philadelphia, Pa.)
2018; 38 (5): e36–e37
View details for PubMedID 29547455
- Genetic Testing for Retina Specialists OPHTHALMIC SURGERY LASERS & IMAGING RETINA 2018; 49 (5): 292–95
Fellow Eye Anti-VEGF 'Crunch' Effect in Retinopathy of Prematurity.
Ophthalmic surgery, lasers & imaging retina
2018; 49 (9): e102–e104
Anti-vascular endothelial growth factor (VEGF) therapy is increasing in popularity for treatment of retinopathy of prematurity (ROP). Despite many technical benefits, issues remain prompting further investigation.Retrospective case report and literature review.A 42-week-old postmenstrual age female with gestational age of 28 weeks and birth weight of 990 g presented with prominent progression of peripapillary purely tractional atypical stage 4A ROP in both eyes following intravitreal bevacizumab therapy in the right eye only.The authors present the first reported case, to their knowledge, of a "crunch" phenomenon tractional retinal detachment from fellow eye administration of bevacizumab. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e102-e104.].
View details for DOI 10.3928/23258160-20180907-16
View details for PubMedID 30222828
PRN Ranibizumab in the Treatment of Choroidal Neovascularization Secondary to Ocular Histoplasmosis
OPHTHALMIC SURGERY LASERS & IMAGING RETINA
2018; 49 (1): 20–26
Ranibizumab (Lucentis; Genentech, South San Francisco, CA) is used off-label for the treatment of choroidal neovascularization secondary to ocular histoplasmosis syndrome (OHS). This study prospectively evaluates the safety and efficacy of two treatment paradigms utilizing ranibizumab 0.5 mg: one or three initial injections followed by monthly visits with PRN treatment through Month 12.In this prospective, open-label study, 21 subjects were evaluated monthly and retreated during the pro re nata treatment phase if specific criteria were met, including loss of vision, increase in subretinal fluid, or hemorrhage. Adverse events, best-corrected visual acuity (BCVA), and central subfield retinal thickness (CST) were evaluated.No adverse events were observed. Mean BCVA improved in both groups by approximately 2 lines, and mean CST decreased by approximately 100 μm at month 12. The number of injections was the same (5.7 and 5.8 injections).Results suggest that ranibizumab is safe and efficacious for treatment of CNV secondary to OHS. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:20-26.].
View details for DOI 10.3928/23258160-20171215-03
View details for Web of Science ID 000419990200003
View details for PubMedID 29304262
Spontaneous Globe Rupture Due to Rapidly Evolving Endogenous Hypermucoid Klebsiella Pneumoniae Endophthalmitis
OPHTHALMIC SURGERY LASERS & IMAGING RETINA
2017; 48 (7): 600–601
In this retrospective report, the authors describe a rare case of spontaneous globe rupture from Klebsiella pneumoniae endophthalmitis in a middle-aged man with poorly controlled type 2 diabetes mellitus. There have been only four previously reported cases of spontaneous globe rupture from endophthalmitis. Out of the now five reported cases, all have been due to endogenous endophthalmitis, four have been due to gram-negative bacteria, and three have been due to K. pneumoniae. K. pneumoniae, especially the hypermucoid variant with a protective polysaccharide capsule, is an emerging pathogen with remarkable virulence. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:600-601.].
View details for DOI 10.3928/23258160-20170630-14
View details for Web of Science ID 000409080200015
View details for PubMedID 28728189
- Regarding 'Advances of optical coherence tomography in myopia and pathologic myopia'. Eye (London, England) 2017
Bilateral frosted branch angiitis as the presenting sign of antiphospholipid antibody syndrome.
Journal of ophthalmic inflammation and infection
2016; 6 (1): 20-?
"Frosted branch retinal angiitis" is an encompassing term for a rare, typically bilateral diffuse retinal periphlebitis that may occur in a number of varying conditions. To our knowledge, we report the first case of frosted branch angiitis as the presenting sign of antiphospholipid antibody syndrome in a 28-year-old woman.This study is a retrospective case report and literature review. Serial fundus photos, fluorescein angiogram, and ocular coherence tomography taken were before and after treatment, showing resolution of diffuse retinal perivascular sheathing and macular edema along with marked improvement in visual acuity 4 months after the treatment with corticosteroids.Frosted branch angiitis can be seen in association with antiphospholipid antibody syndrome. Prompt recognition and treatment with corticosteroids may result in good visual prognosis, and long-term immunosuppression and additional anticoagulation may be beneficial to prevent recurrence.
View details for DOI 10.1186/s12348-016-0089-9
View details for PubMedID 27287993
NONDAMAGING RETINAL LASER THERAPY FOR TREATMENT OF CENTRAL SEROUS CHORIORETINOPATHY: What is the Evidence?
Retina (Philadelphia, Pa.)
To summarize the literature addressing subthreshold or nondamaging retinal laser therapy (NRT) for central serous chorioretinopathy (CSCR) and to discuss results and trends that provoke further investigation.Analysis of current literature evaluating NRT with micropulse or continuous wave lasers for CSCR.Sixteen studies including 398 patients consisted of retrospective case series, prospective nonrandomized interventional case series, and prospective randomized clinical trials. All studies but one evaluated chronic CSCR, and laser parameters varied greatly between studies. Mean central macular thickness decreased, on average, by ∼80 μm by 3 months. Mean best-corrected visual acuity increased, on average, by about 9 letters by 3 months, and no study reported a decrease in acuity below presentation. No retinal complications were observed with the various forms of NRT used, but six patients in two studies with micropulse laser experienced pigmentary changes in the retinal pigment epithelium attributed to excessive laser settings.Based on the current evidence, NRT demonstrates efficacy and safety in 12-month follow-up in patients with chronic and possibly acute CSCR. The NRT would benefit from better standardization of the laser settings and understanding of mechanisms of action, as well as further prospective randomized clinical trials.
View details for PubMedID 27841848
Intraocular pressure measurement in the emergency department is inconsistently documented and significantly varies from ophthalmologist IOP
ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016
View details for Web of Science ID 000394210603161
Evaluation of Visunex Medical's PanoCam(TM) LT and PanoCam(TM) Pro wide-field imaging systems for the screening of ROP in newborn infants.
Expert review of medical devices
2016; 13 (8): 705-712
Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness. The incidence of ROP is rising, placing greater demands on the healthcare providers that serve these patients and their families. Telemedicine remote digital fundus imaging (TM-RDFI) plays a pivotal role in ROP management, and has allowed for the expansion of ROP care into previously underserved areas.A broad literature review through the pubmed index was undertaken with the goal of summarizing the current state of ROP and guidelines for its screening . Furthermore, all currently used telemedicine remote digital fundus imaging devices were analyzed both via the literature and the companies' websites/brochures. Finally, the PanoCam LT™ and PanoCam™ Pro created by Visunex Medical were analyzed via the company website/brochures. Expert commentary: The PanoCam LT™ and PanoCam™ Pro have recently been approved for use within the USA and CE marked for international commercialization in European Union and other countries requiring CE mark. These wide-field imaging systems have the intended use of ophthalmic imaging of all newborn babies and meet the requirements for ROP screening, thereby serving as competition within the ROP screening market previously dominated by one camera imaging system.
View details for DOI 10.1080/17434440.2016.1208560
View details for PubMedID 27424884
- Comment on: 'Effectiveness of a smartphone application for testing near visual acuity' EYE 2016; 30 (7): 1028
Visual acuity measured with a smartphone app is more accurate than Snellen testing by emergency department providers
GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
2016; 254 (6): 1175-1180
To assess the accuracy of best-corrected visual acuity (BCVA) measured by non-ophthalmic emergency department (ED) staff with a standard Snellen chart versus an automated application (app) on a handheld smartphone (Paxos Checkup, San Francisco, CA, USA).The study included 128 subjects who presented to the Stanford Hospital ED for whom the ED requested an ophthalmology consultation. We conducted the study in two phases. During phase 1 of the study, ED staff tested patient BCVA using a standard Snellen test at 20 feet. During phase 2 of the study, ED staff tested patient near BCVA using the app. During both phases, ophthalmologists measured BCVA with a Rosenbaum near chart, which was treated as the gold standard. ED BCVA measurements were benchmarked prospectively against ophthalmologists' measurements and converted to logMAR.ED logMAR BCVA was 0.21 ± 0.35 (approximately 2 Snellen lines difference ± 3 Snellen lines) higher than that of ophthalmologists when ED staff used a Snellen chart (p = .0.00003). ED BCVA was 0.06 ± 0.40 (less than 1 Snellen line ± 4 Snellen lines) higher when ED staff used the app (p = 0.246). Inter-observer difference was therefore smaller by more than 1 line (0.15 logMAR) with the app (p = 0.046).BCVA measured by non-ophthalmic ED staff with an app was more accurate than with a Snellen chart. Automated apps may provide a means to standardize and improve the efficiency of ED ophthalmologic care.
View details for DOI 10.1007/s00417-016-3291-4
View details for PubMedID 26931323
Multi-Modal Longitudinal Evaluation of Subthreshold Laser Lesions in Human Retina, Including Scanning Laser Ophthalmoscope-Adaptive Optics Imaging.
Ophthalmic surgery, lasers & imaging retina
2016; 47 (3): 268-275
Subthreshold retinal laser therapy is efficacious for a variety of retinovascular disorders. Currently, it is unknown which laser parameters can ensure no detectable damage to human retina tissue.One informed physician participant with a normal retina was treated with three levels (75%, 50%, and 25%) of subthreshold 577-nm laser (PASCAL; Topcon, Santa Clara, CA) at 20-millisecond (ms) duration and 100 µm spot size. Several high-resolution retinal imaging modalities, including spectral-domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscope-adaptive optics (SLO-AO), were used to longitudinally image retinal laser lesions during a 9-month period.SLO-AO and SD-OCT imaging of subthreshold laser therapy in human retina showed no cone cell or RPE damage at all time points during a 9-month period using the 25% threshold power 577-nm laser in the human retina.It is likely that subthreshold laser therapy with 577-nm laser at 20-ms duration in the human retina is safe at the 25% of threshold power level. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:268-275.].
View details for DOI 10.3928/23258160-20160229-10
View details for PubMedID 26985801
Short-Term Outcomes of Aflibercept Therapy for Diabetic Macular Edema in Patients With Incomplete Response to Ranibizumab and/or Bevacizumab.
Ophthalmic surgery, lasers & imaging retina
2015; 46 (9): 950-954
Aflibercept is a vascular endothelial growth factor (VEGF) inhibitor recently approved by the U.S. Food and Drug Administration for the treatment of diabetic macular edema (DME). Currently, the effect of switching to aflibercept from other anti-VEGF agents for DME is unknown.In this prospective, interventional case series, DME patients with persistent retinal fluid despite regular (every 4 to 6 weeks) intravitreal injection (IVI) with ranibizumab 0.3 mg, and/or bevacizumab 1.25 mg were switched to IVI aflibercept 2 mg. Collected data included visual acuity, central subfield foveal thickness (CSFT), and the area of thickest edema on registered spectral-domain optical coherence tomography (SD-OCT).At 1 month after the first aflibercept IVI, 79% (11 of 14 eyes) showed anatomic improvement with a 23% decrease in average CSFT from 421 µm to 325 µm (P < .0132).A majority of patients with DME with persistent fluid on SD-OCT despite regular ranibizumab 0.3 mg and/or bevacizumab 1.25 mg IVIs showed a positive anatomic response to IVI aflibercept 2 mg. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:950-954.].
View details for DOI 10.3928/23258160-20151008-08
View details for PubMedID 26469235
Analysis of Varicella-Zoster Virus in Temporal Arteries Biopsy Positive and Negative for Giant Cell Arteritis.
2015; 72 (11): 1281–87
Giant cell arteritis (GCA) is the most common systemic vasculitis in elderly individuals. Diagnosis is confirmed by temporal artery (TA) biopsy, although biopsy results are often negative. Despite the use of corticosteroids, disease may progress. Identification of causal agents will improve outcomes. Biopsy-positive GCA is associated with TA infection by varicella-zoster virus (VZV).To analyze VZV infection in TAs of patients with clinically suspected GCA whose TAs were histopathologically negative and in normal TAs removed post mortem from age-matched individuals.A cross-sectional study for VZV antigen was performed from January 2013 to March 2015 using archived, deidentified, formalin-fixed, paraffin-embedded GCA-negative, GCA-positive, and normal TAs (50 sections/TA) collected during the past 30 years. Regions adjacent to those containing VZV were examined by hematoxylin-eosin staining. Immunohistochemistry identified inflammatory cells and cell types around nerve bundles containing VZV. A combination of 17 tertiary referral centers and private practices worldwide contributed archived TAs from individuals older than 50 years.Presence and distribution of VZV antigen in TAs and histopathological changes in sections adjacent to those containing VZV were confirmed by 2 independent readers.Varicella-zoster virus antigen was found in 45 of 70 GCA-negative TAs (64%), compared with 11 of 49 normal TAs (22%) (relative risk [RR] = 2.86; 95% CI, 1.75-5.31; P < .001). Extension of our earlier study revealed VZV antigen in 68 of 93 GCA-positive TAs (73%), compared with 11 of 49 normal TAs (22%) (RR = 3.26; 95% CI, 2.03-5.98; P < .001). Compared with normal TAs, VZV antigen was more likely to be present in the adventitia of both GCA-negative TAs (RR = 2.43; 95% CI, 1.82-3.41; P < .001) and GCA-positive TAs (RR = 2.03; 95% CI, 1.52-2.86; P < .001). Varicella-zoster virus antigen was frequently found in perineurial cells expressing claudin-1 around nerve bundles. Of 45 GCA-negative participants whose TAs contained VZV antigen, 1 had histopathological features characteristic of GCA, and 16 (36%) showed adventitial inflammation adjacent to viral antigen; no inflammation was seen in normal TAs.In patients with clinically suspected GCA, prevalence of VZV in their TAs is similar independent of whether biopsy results are negative or positive pathologically. Antiviral treatment may confer additional benefit to patients with biopsy-negative GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.
View details for DOI 10.1001/jamaneurol.2015.2101
View details for PubMedID 26349037
View details for PubMedCentralID PMC5110206
Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis.
2015; 84 (19): 1948–55
Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes giant cell arteritis (GCA).Formalin-fixed, paraffin-embedded GCA-positive temporal artery (TA) biopsies (50 sections/TA) including adjacent skeletal muscle and normal TAs obtained postmortem from subjects >50 years of age were examined by immunohistochemistry for presence and distribution of VZV antigen and by ultrastructural examination for virions. Adjacent regions were examined by hematoxylin & eosin staining. VZV antigen-positive slides were analyzed by PCR for VZV DNA.VZV antigen was found in 61/82 (74%) GCA-positive TAs compared with 1/13 (8%) normal TAs (p < 0.0001, relative risk 9.67, 95% confidence interval 1.46, 63.69). Most GCA-positive TAs contained viral antigen in skip areas. VZV antigen was present mostly in adventitia, followed by media and intima. VZV antigen was found in 12/32 (38%) skeletal muscles adjacent to VZV antigen-positive TAs. Despite formalin fixation, VZV DNA was detected in 18/45 (40%) GCA-positive VZV antigen-positive TAs, in 6/10 (60%) VZV antigen-positive skeletal muscles, and in one VZV antigen-positive normal TA. Varicella-zoster virions were found in a GCA-positive TA. In sections adjacent to those containing VZV, GCA pathology was seen in 89% of GCA-positive TAs but in none of 18 adjacent sections from normal TAs.Most GCA-positive TAs contained VZV in skip areas that correlated with adjacent GCA pathology, supporting the hypothesis that VZV triggers GCA immunopathology. Antiviral treatment may confer additional benefit to patients with GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.
View details for DOI 10.1212/WNL.0000000000001409
View details for PubMedID 25695965
View details for PubMedCentralID PMC4433460
Neovascular AMD with marked macular fluid and rapid response to anti-VEGF therapy.
Ophthalmic surgery, lasers & imaging retina
2014; 45 (2): 175–78
The authors describe the clinical management and spectral-domain optical coherence tomography (SD-OCT) findings of three unusual cases of neovascular age-related macular degeneration (AMD). Each patient presented with decreased vision and a diagnosis of neovascular AMD, with SD-OCT findings of marked macular fluid. Macular fluid was noted to be subretinal fluid, pigment epithelial detachment, or both. In each case, visual acuity improved and the fluid resolved rapidly with monthly anti-vascular endothelial growth factor therapy.
View details for DOI 10.3928/23258160-20140205-02
View details for PubMedID 24512809
A pharmacogenetics study to predict outcome in patients receiving anti-VEGF therapy in age related macular degeneration.
Clinical ophthalmology (Auckland, N.Z.)
2013; 7: 1987–93
To ascertain whether single nucleotide polymorphisms (SNPs) in the Vascular Endothelial Growth factor (VEGFA), Complement Factor H (CFH), and LOC387715 genes could predict outcome to anti-VEGF therapy for patients with age related macular degeneration (AMD).Patients with "wet" AMD were identified by chart review. Baseline optical coherence tomography (OCT) and visual acuity (VA) data, and at least 6 months of clinical follow up after 3 initial monthly injections of bevacizumab or ranibizumab were required for inclusion. Based on OCT and VA, patients were categorized into two possible clinical outcomes: (a) responders and (b) non-responders. DNA was extracted from saliva and genotyped for candidate SNPs in the VEGFA, LOC387715, and CFH genes. Clinical outcomes were statistically compared to patient genotypes.101 patients were recruited, and one eye from each patient was included in the analysis. 97% of samples were successfully genotyped for all SNPs. We found a statistically significant association between the LOC387715 A69S TT genotype and outcome based on OCT.Genetic variation may be associated with outcome in patients receiving anti-VEGF therapy.
View details for DOI 10.2147/OPTH.S39635
View details for PubMedID 24143065
View details for PubMedCentralID PMC3797648