Gayathri Srinivasan OD, MS

All Publications

• Long-term test and retest reliability of clinical vergence testing. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Scheiman, M., Raghuram, A., Master, C., Robich, M. L., Toole, A., Shelton, E. R., Srinivasan, G., Marusic, S., Meiyeppen, S., Jordan, L. A., Roberts, T. L., EPICC Study Group, Roberts, T. L., Jordan, L. A., Dalton, K. N., Grant, G. A., Liao, Y. J., Porter, J., Purcell, L. K., Scheiman, M., Swanson, M. A., Viswanathan, S., Jordan, L. A., Sinnott, L. T., Robich, M. L., Shaw, K. J., Myers, J. A., Choi, S. S., Porter, J., Patel, N., Koutures, C., Platt, J., Raghuram, A., O'Brien, M., Vyas, N., Wiecek, E., Marusic, S., Ghosh, D., Wu, C., Master, C., Calandra, L., Easby, K., Mozel, A., Podolak, O., Rownd, K., Godfrey, M., McGinnis, I., Ford, C., Stenger, K., Pollock, K., Housel, K., Chen, A., Han, S., Huang, K., Parker, S. M., Youngerman, J., Bansal, S., Breau, N., Wu, J., Burgher, A., Law, C. L., Posey, A., Sayani, A., Issac, L., Bennett, R., Green, K., Riaz, A., Scheiman, M., Meiyeppen, S., Roberts, T., Grant, G., Kraus, E., Beres, S., Moss, H., Wan, A., Slinger, K., Leonen, J., Hu, A., Srinivasan, G., Baah, C., Grieb, E. M., Lew, C., Vandiver, T., Clewes, K., Bansal, S., Lumba-Brown, A., Balaji, A., Viswanathan, S., Modica, P. A., Pothiadia-Irungovel, A. B., Vaughn, M., McDaniel, C., Morrison, A., Widmer, D., Buckland, M., Shelton, E., Toole, A. J., Stevens, N., Swanson, M. W., Gould, S., Montejo, J., Ferrill, L., Swanson-Kimani, E., Weise, K. K., Cardona, Z., Dalton, K. N., Purcell, L. K., Labreche, T., Shalhoub, J., Abuleil, D. 2025

  Abstract

  PURPOSE: To establish long-term reliability measures for vergence testing in a control population of adolescents.METHODS: Healthy participants between 12 and 17.5years with normal binocular vision were recruited from 10 clinical sites. Cover test, near point of convergence (NPC), positive and negative fusional vergences, vergence facility (12∆ base-out/3∆ base-in) and vergence jumps (using the Oculomotor Assessment Tool) were performed at the initial visit and repeated at 90days. The mean and standard deviation were calculated for the overall group for NPC, vergence facility and vergence jumps and by prism dioptre step value for PFV and NFV (1Delta or 2Delta if below 20∆ or 5Delta above 20∆). Agreement was assessed using Bland-Altman plots and 95% limits of agreement (LOA).RESULTS: Ninety-three participants (mean age 14.3±1.7years, 52% female) were enrolled and 91 (98%) completed the initial and 90-day outcome evaluation. The mean differences were significantly greater than zero for vergence facility (p<0.05) and the first and second 30s of vergence jumps (p<0.01). The 95% LOA were narrow for NPC (±2.5) and negative fusional vergence (±5.9), suggesting good repeatability. LOA were larger for positive fusional vergence (±17.8), vergence facility (±9.8) and vergence jumps (±16.2). Analysis of the positive fusional vergence data indicates that the different step sizes (1∆ or 2∆ vs. 5∆) in the horizontal prism bar contribute to considerably larger variability in these measures.CONCLUSIONS: In participants with normal binocular vision and no concussion history, good reliability yielded comparable results 90days apart for all vergence measures. The results provide values that can be used to interpret the effect of intervention for vergence disorders in clinical practice and research studies. An important outcome of this study is the understanding that 5∆ steps on the typical horizontal prism bar contribute to high variability in positive fusional vergence measures when findings are ≥20∆.

  View details for DOI 10.1111/opo.70022

  View details for PubMedID 41048201

• Post-concussion clinical findings of oculomotor function in paediatric patients with persisting symptoms compared to healthy controls. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Wu, C. H., Marusic, S., Haensel, J. X., Oke, I., Slinger, K. E., Vyas, N., Ameyaw Baah, C. A., Hu, A., Leonen, J., Lew, C. Y., Srinivasan, G., Norouzpour, A., Jenewein, E., Meiyeppen, S., Scheiman, M., Roberts, T. L., Raghuram, A. 2025

  Abstract

  Oculomotor deficits in vergence and accommodation can arise in paediatric patients with persistent concussion symptoms, although the profile is not well established. This study aimed to describe the frequency of these deficits in persistently symptomatic concussed paediatric patients and identify effective screening tools.This was a prospective cohort study conducted at three clinical sites across the United States. Participants aged 8-18 years with diagnosed concussion were recruited within 9 months of injury through concussion clinics or referral to a vision provider. Participants without concussion were recruited through the local community and eye clinics. Clinical measures of ocular alignment, vergence and accommodation were collected. Group comparisons were assessed using Welch's t-test, Mann-Whitney U test and Fisher's exact test with Bonferroni correction. The diagnostic value of near point of convergence (NPC) and accommodative amplitude (AA) for identifying persistently symptomatic concussed participants was evaluated using logistic regression and receiver operating characteristic curve analysis.Seventy-one participants were recruited, including 34 concussed participants (mean age 14.3 [SD 2.4] years; 74% female, 26% male; median time since concussion 107 [IQR 80-118] days) and 32 controls (mean age, 12.7 [SD 2.1] years; 56% female, 44% male). Concussed participants scored significantly worse or had higher failure rates than controls on all vergence and accommodative tests (p < 0.05) except ocular alignment and monocular accommodative facility. Concussed participants had a higher frequency of diagnoses (vergence: 62% vs. 3%; accommodation: 76% vs. 3%; p < 0.001). NPC and AA were significant predictors for concussion in individual models (NPC: OR = 2.16 [95% CI: 1.52-3.61], p < 0.001, mean AUC [SD] = 0.88 [0.13]; AA: OR = 0.46 [95% CI: 0.29-0.64], p < 0.001, mean AUC [SD] = 0.88 [0.15]).The oculomotor profile of persistently symptomatic concussed paediatric participants shows a high frequency of vergence and accommodative deficits, for which NPC and AA are effective screening tools. Further investigation should examine oculomotor deficits in acutely concussed paediatric patients.

  View details for DOI 10.1111/opo.70010

  View details for PubMedID 40905935

• Optical correction of hyperopia in school-aged children: a scoping review protocol. BMJ open Srinivasan, G., Kerber, K. L., Liu, S. H., Manh, V. M., Huang, K., Williamson, A., Sadhu, S., Ollinger, M. C., Tajbakhsh, Z., Fisher, J. H., Cheung, N. L., Junge, J., Chan, K. C., Hussaindeen, J. R., Simard, P., Trast, K. R., Morettin, C. E., Krueger, S., Nti, A. N., Lee Chen, D. M., Roberts, T. L. 2025; 15 (8): e103546

  Abstract

  Prescribing patterns for hyperopia in children vary widely among eye care providers worldwide. This scoping review aims to identify and map the current literature on optical correction and catalogue outcomes reported, particularly in the domains of vision, vision-related functional outcomes and quality of life (QoL) in school-aged children with hyperopia.This protocol was developed in accordance with the Joanna Briggs Institute's Manual for Evidence Synthesis. We will include studies involving school-aged children with hyperopia without restrictions on sex, gender, race, ethnicity, type of optical correction, length of intervention, publication date or country of origin. We will include studies with internal or external comparison groups. We will exclude studies associated with myopia control treatments, ocular and visual pathway pathologies affecting vision or visual function. We will search Cochrane CENTRAL, Embase.com and PubMed. Examples of data to be extracted include population demographics, visual acuity, study-specific definitions for refractive error, treatment regimens for optical correction, vision and vision-related functional outcomes and QoL (general or vision-related) as quantified by validated instruments.Informed consent and Institutional Review Board approval will not be required, as this scoping review will only use published data. The results from the scoping review will be disseminated by publication in a peer-reviewed scientific journal and at professional conferences.

  View details for DOI 10.1136/bmjopen-2025-103546

  View details for PubMedID 40819922

• In-Office Visual Acuity Measurement in Children Using a Custom iPhone® Application Roberts, T. L., Bothun, E. D., Zhu, Y., Kraker, R., Leske, D., Cotter, S. A., Holmes, J. M., Beaulieu, W. T., Hatt, S. R., Raghuram, A., Titelbaum, J., Crouch, E., Youngerman, J., Srinivasan, G., Colburn, J. D., Qayum, J. N., Esposito, C. A., Zeto, V., Manh, V., Bhakta, R. B., Lorenzana, I., McDowell, P., Pineles, S. L., Weise, K. K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001559761700029

• Accommodative responses in amblyopic and fellow eyes of anisometropic and strabismic/combined amblyopia Haensel, J. X., Baah, C., Hu, A., Leonen, J. A., Vandiver, T. J., Vyas, N., Wu, C., Iyer, T., Srinivasan, G., Norouzpour, A., Lew, C. Y., Raghuram, A., Roberts, T. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001560025300039

• Accommodative Response in Adolescents with Concussion under Binocular and Monocular Viewing of Static Near Stimuli Norouzpour, A., Haensel, J. X., Marusic, S., Slinger, K., Wu, C., Vyas, N., Baah, C., Hu, A., Leonen, J. A., Lew, C. Y., Srinivasan, G., Jenewein, E., Meiyeppen, S., Scheiman, M., Raghuram, A., Roberts, T. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558845400047

• Accommodative and Vergence Responses to a Moving Stimulus in Concussion. Investigative ophthalmology & visual science Haensel, J. X., Marusic, S., Slinger, K. E., Wu, C. H., Vyas, N., Ameyaw Baah, C. A., Hu, A., Leonen, J., Lew, C. Y., Srinivasan, G., Norouzpour, A., Jenewein, E., Meiyeppen, S., Scheiman, M., Raghuram, A., Roberts, T. L. 2024; 65 (12): 45

  Abstract

  Concussed adolescents often report visual symptoms, especially for moving targets, but the mechanisms resulting in oculomotor deficits remain unclear. We objectively measured accommodative and vergence responses to a moving target in concussed adolescents and controls.Thirty-two symptomatic concussed participants (mean age, 14.4 ± 2.6 years; mean days since concussion, 107 days; range, 36-273 days) and 32 healthy controls (mean age, 12.7 ± 2.1 years) viewed a movie binocularly (closed-loop) and monocularly (vergence open-loop), as well as a Difference of Gaussians (DoG) target binocularly (accommodation open-loop). The movie or DoG target sinusoidally moved toward and away from participants at a 0.1-hertz (Hz) frequency at four separate stimulus amplitudes (1.50 diopters [D], 1.00 D, 0.50 D, 0.25 D) around a 2.50-D midpoint. Accommodation and vergence were continuously measured at 50 Hz using the PowerRef 3. Fourier analysis was used to assess the response amplitudes at the 0.1-Hz frequency. A 2 × 3 analysis of variance with the factors group (concussed, control) and viewing condition (binocular, monocular, DoG) was conducted on response amplitudes.Across groups, accommodative and vergence responses were significantly higher in binocular than monocular conditions (P < 0.001), but not DoG conditions. Compared to controls, concussed participants had significantly reduced monocular accommodative responses (P < 0.012; e.g., at 1.50 D, controls = 1.09 ± 0.47 D and concussed = 0.80 ± 0.36 D, P = 0.011). No group differences were observed for vergence responses in any viewing condition.Accommodative and vergence responses to the moving target were largely driven by disparity cues for both groups, with only minimal improvements in the presence of additional blur cues. Concussed participants showed reduced accommodative responses to a 0.1-Hz stimulus in monocular conditions, indicating mild accommodative deficits in the absence of disparity cues.

  View details for DOI 10.1167/iovs.65.12.45

  View details for PubMedID 39475939

• Do looming tasks provoke eye symptoms following concussion? Wu, C. H., Marusic, S., Haensel, J. X., Slinger, K., Vyas, N., Baah, C., Hu, A., Leonen, J., Lew, C. Y., Srinivasan, G., Norouzpour, A., Jenewein, E., Meiyeppen, S., Scheiman, M., Roberts, T. L., Raghuram, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227703143

• Accommodation and Vergence Responses to a Moving Stimulus in Concussion Haensel, J. X., Marusic, S., Slinger, K., Wu, C., Vyas, N., Baah, C., Hu, A., Leonen, J., Lew, C. Y., Srinivasan, G., Norouzpour, A., Jenewein, E., Meiyeppen, S., Scheiman, M., Raghuram, A., Roberts, T. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227703129

• Utility of Eye-Symptom Provocation in Assessment of Adolescent Concussion Raghuram, A., Haensel, J. X., Wu, C., Marusic, S., Slinger, K., Vyas, N., Baah, C., Hu, A., Leonen, J., Lew, C. Y., Srinivasan, G., Norouzpour, A., Jenewein, E., Meiyeppen, S., Scheiman, M., Roberts, T. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227703141

• Prescribing Patterns for Children with Astigmatism Kulp, M. T., Ciner, E., Mitchell, G., Ying, G., Morrison, A., Granet, D., Roberts, T. L., Peterseim, M., Candy, T., Allison, C., Block, S. S., Moore, B., Orel-Bixler, D., Robbins, S., Srinivasan, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316205143

• Prescribing patterns for paediatric hyperopia among paediatric eye care providers. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Morrison, A. M., Kulp, M. T., Ciner, E. B., Mitchell, G. L., McDaniel, C. E., Hertle, R. W., Candy, T. R., Roberts, T. L., Peterseim, M. M., Granet, D. B., Robbins, S. L., Srinivasan, G., Allison, C. L., Ying, G. S., Orel-Bixler, D., Block, S. S., Moore, B. R. 2023

  Abstract

  To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia.Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test.Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years.Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

  View details for DOI 10.1111/opo.13184

  View details for PubMedID 37334937

• Effect of Co-existing Clinical Signs on Prescribing Patterns for Pediatric Hyperopia Morrison, A., Kulp, M. T., Ciner, E. B., McDaniel, C., Mitchell, G., Allison, C. L., Block, S. S., Granet, D., Hertle, R. W., Moore, B., Orel-Bixler, D., Roberts, T. L., Robbins, S. L., Peterseim, M., Srinivasan, G., Ying, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758304080

• Pediatric Visual Acuity Testing. The Pediatric Eye Exam Quick Reference Guide: Office and Emergency Room Procedures Srinivasan, G. IGI Global. 2022: 44-66

  View details for DOI 10.4018/978-1-7998-8044-8

• Prescribing Patterns for Hyperopia Kulp, M., Ciner, E., Mitchell, G., Ying, G., Peterseim, M., Alex, A., Allison, C., Block, S., Candy, T., Granet, D., Hertle, R., Moore, B., Orel-Bixler, D., Roberts, T., Robbins, S., Srinivasan, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500138

• Detection of Amblyogenic Refractive Error Using the Spot Vision Screener in Children OPTOMETRY AND VISION SCIENCE Gaiser, H., Moore, B., Srinivasan, G., Solaka, N., He, R. 2020; 97 (5): 324-331

  Abstract

  Vision screenings are conducted to detect significant refractive errors, amblyopia, and ocular diseases. Vision screening devices are desired to have high testability, sensitivity, and specificity. Spot has demonstrated high testability, but previous reports suggest that the Spot has low sensitivity for detecting amblyogenic hyperopia and moderate sensitivity for amblyogenic astigmatism.This study assessed the concurrent validity of detecting amblyogenic refractive errors by the Spot (v.1.1.50; Welch Allyn Inc., Skaneateles Falls, NY) compared with cycloplegic retinoscopy.A total of 475 subjects (24 to 96 months) were screened by Spot and then received a masked comprehensive examination. Sensitivity and specificity, Bland-Altman plot, receiver operating characteristic area under the curve, and paired t test were evaluated by comparing the results of the Spot (v1.1.50) using the manufacturer referral criteria with the results of the comprehensive examination using the 2013 American Association for Pediatric Ophthalmology and Strabismus criteria.The Spot (v.1.1.50) referred 107 subjects (22.53%) for the following: 18.73% (89/475) astigmatism, 4.63% (22/475) myopia, 0.42% (2/475) hyperopia, and 2.11% (10/475) anisometropia. The sensitivity and specificity of the Spot vision screener for detecting amblyogenic risk factors were 86.08% (95% confidence interval [CI], 76.45 to 92.84%) and 90.15% (95% CI, 86.78 to 92.90%). Areas under the curve were 0.906 (95% CI, 0.836 to 0.976) for hyperopia, 0.887 (95% CI, 0.803 to 0.972) for spherical equivalent, and 0.914 (95% CI, 0.866 to 0.962) for astigmatism. A modified hyperopia criteria cutoff of greater than +1.06 D improved the sensitivity from 25 to 80% with 90% specificity. The current cutoff criterion, greater than -1.75 D, for astigmatism seemed optimal.This study shows that the Spot vision screener accurately detects low spherical refractive errors and astigmatism. Lowering the hyperopia cutoff criteria from the current Spot screener referral criteria improves the sensitivity with desired (high) specificity.

  View details for DOI 10.1097/OPX.0000000000001505

  View details for Web of Science ID 000535908800003

  View details for PubMedID 32413003

• Implementation of vision therapy using telehealth services in an academic practice. Vision Dev & Rehab Srinivasan, G., Schwartz, S., Williams, S., Bossie, T. 2020; 6 (2): 182-7
• Validity of the Spot Vision Screener in detecting vision disorders in children 6 months to 36 months of age JOURNAL OF AAPOS Srinivasan, G., Russo, D., Taylor, C., Guarino, A., Tattersall, P., Moore, B. 2019; 23 (5): 278-279

  Abstract

  To evaluate the Spot Vision Screener in detecting targeted vision disorders compared to cycloplegic retinoscopy in children <3 years of age.Children, ages 6 months to 36 months underwent vision screening using the Spot Vision Screener. Results were compared to results of comprehensive eye examinations. Validity of the Spot was evaluated by calculating the area under the curve (AUC); the receiver operating characteristics (ROC) were used to determine optimal sensitivity and specificity for detection of targeted vision disorders.A total of 249 children were included. The AUC for detecting targeted vision disorders as defined by the study specific criteria using the Spot was 0.790. Compared to cycloplegic retinoscopy, the Spot underestimated hyperopia by 1.02 D (95% CI, 0.86-1.17 D). For hyperopia ≥4.5 D spherical equivalent (n = 10), the mean difference between the Spot and cycloplegic retinoscopy was 3.46 D (95% CI, 1.95-4.98 D). In contrast, the Spot overestimated astigmatism compared to cycloplegic retinoscopy (-1.00 D vs -0.48 D; P < 0.001) by -0.52 D (95% CI, 0.43-0.62 D).The Spot Vision Screener showed good overall validity in detecting targeted vision disorders. It was within 0.5 D and 1 D of cycloplegic retinoscopy with regard to low hyperopia and astigmatism. Higher hyperopic spherical equivalent refractive errors showed larger differences in mean values between the Spot and cycloplegic retinoscopy.

  View details for DOI 10.1016/j.jaapos.2019.06.008

  View details for Web of Science ID 000499763000014

  View details for PubMedID 31521849

• Management of intermittent exotropia of the divergence excess type: A teaching case report. Optometric Education Srinivasan, G. 2017; 42 (2): 43-52
• Influence of Participation in an Elective Course in Enhancing Perceived Critical Thinking, Independent Learning and Residency Decision-Making. Optometric Education Srinivasan, G., Russo, D., Lyons, S. 2017; 42 (3): 15-19
• A flicker therapy for the treatment of amblyopia. Vis Dev Rehabil Vera-Diaz, F., Moore, B., Hussey, E., Srinivasan, G., Johnson, C. 2016; 2