Gayathri Srinivasan OD, MS

All Publications

• 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

• 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