Bio


Jennifer Rose-Nussbaumer is a board-certified ophthalmologist and fellowship-trained cornea specialist at the Byers Eye Institute at Stanford University. Her clinical practice focuses on lamellar keratoplasty such as Descemet Membrane Endothelial Keratoplasty (DMEK), Ultrathin-Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK), and Deep Anterior Lamellar Keratoplasty (DALK), as well as cataract surgery. After completing her fellowship in corneal transplantation at the University of California, San Francisco, she stayed on faculty and remained there until she transitioned to Stanford in 2021.

In addition to her clinical work, Dr. Rose-Nussbaumer is an NIH-funded researcher who focuses on randomized clinical trials in ophthalmology. She is the PI on a UG1 grant, Descemet Endothelial Thickness Comparison Trial (DETECT), a randomized clinical trial comparing UT-DSAEK to DMEK and ripasudil versus placebo in patients with endothelial disease such as Fuchs Endothelial Dystrophy. She is also the PI on a UG1 grant, the Steroids and Cross-linking for Ulcer Treatment Trial (SCUT II), a randomized clinical trial in collaboration with Aravind Eye hospital in India looking at the benefit of adjunctive topical steroids, corneal crosslinking or rose bengal photodynamic therapy in the treatment of infectious ulcers.

As a native of Northern California, she loves spending time with her husband, three sons and Bernese Mountain Dog, Kenji, exploring California's natural beauty through hiking and camping.

Clinical Focus


  • Ophthalmology

Academic Appointments


Boards, Advisory Committees, Professional Organizations


  • Member, AAO, Annual Program Committee (2019 - Present)
  • President, Cordes Society, UCSF Ophthalmology Alumni Association (2021 - Present)
  • Associate Editor, Eye and Contact Lens (2018 - Present)
  • Associate Editor, Cornea (2021 - Present)
  • Managing Editor, JAMA Ophthalmology (2021 - Present)
  • Methodologist, AAO, OTAC Refractive Panel (2018 - Present)

Professional Education


  • Board Certification: American Board of Ophthalmology, Ophthalmology (2014)
  • Fellowship: UCSF Cornea Fellowship (2013) CA
  • Residency: OHSU Casey Eye Institute (2012) OR
  • Cornea Fellowship, F.I. Proctor Foundation, University of California, San Francisco (2013)
  • Internship: Legacy Emanuel Hospital and Health Center (2009) OR
  • Ophthalmology, Casey Eye Institute, Oregon Health & Science University (2012)
  • Medical Education: University of California at San Francisco School of Medicine (2008) CA
  • MD, University of California, San Francisco, Medicine (2008)

Clinical Trials


  • Cross-linking for Corneal Ulcers Treatment Trial Recruiting

    The primary purpose of this study is to determine if patients randomized to corneal collagen cross-linking plus medical therapy will have a lower prevalence of positive bacterial or fungal cultures immediately after the procedure than patients who received medical therapy alone. The secondary purpose of this study is to determine if patients randomized to corneal collagen cross-linking will have a better visual acuity at 3 and 12 months than patients who receive medical therapy alone.

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  • Descemet Endothelial Thickness Comparison Trial Not Recruiting

    The purpose of this study is to compare visual acuity outcomes of two types of endothelial keratoplasty: 1) Ultrathin Descemet's Stripping Endothelial Keratoplasty (DSAEK) or 2) Descemet's Membrane Endothelial Keratoplasty (DMEK). Half of the participants will be randomized to have DSAEK and the other half will have DMEK.

    Stanford is currently not accepting patients for this trial.

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  • Descemet Endothelial Thickness Comparison Trial I Not Recruiting

    Descemet Endothelial Thickness Comparison Trial (DETECT) I is a multi-center, outcome assessor-masked, placebo-controlled clinical trial randomizing 160 patients in a 2x2 factorial design. The purpose of this study is to determine differences in visual outcomes between two types of corneal transplant surgeries, ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), and to determine the effect of rho-kinase inhibitors on endothelial cell loss.

    Stanford is currently not accepting patients for this trial. For more information, please contact Nicole Varnado, MPH, (480) 298 - 1310.

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  • Descemet Endothelial Thickness Comparison Trial II Not Recruiting

    Descemet Endothelial Thickness Comparison Trial (DETECT) II is a multi-center, outcome assessor-masked, placebo-controlled clinical trial randomizing 60 patients with Fuchs endothelial dystrophy to DMEK versus Descemet Stripping Only (DSO) with adjunctive Ripasudil.

    Stanford is currently not accepting patients for this trial. For more information, please contact Nicole Varnado, MPH, (480) 298 - 1310.

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  • Rose Bengal Electromagnetic Activation With Green Light for Infection Reduction Not Recruiting

    Rose Bengal Electromagnetic Activation with Green light for Infection Reduction (REAGIR ) is an international, randomized, doubled masked, clinical trial. The purpose of this study is to determine differences in 6-month visual acuity between medical antimicrobial treatments alone versus antimicrobial treatment plus cross-linking with rose Bengal (RB-PDT). Patients presenting to one of the Aravind Eye Hospitals in India with either smear or culture positive fungal or acanthamoeba keratitis or smear and culture negative corneal ulcers and moderate to severe vision loss, defined as Snellen visual acuity of 20/40 or worse, will be eligible for inclusion. Those who agree to participate will be randomized to one of two treatment groups: Group 4, Sham RB-PDT: topical chlorhexidine gluconate 0.02% (acanthamoeba), moxifloxacin 0.5% (smear/culture negative) or natamycin 5% (fungal keratitis) plus sham RB-PDT Group 5, RB-PDT: topical chlorhexidine gluconate 0.02% (acanthamoeba), moxifloxacin 0.5% (smear/culture negative) or natamycin 5% (fungal keratitis) plus RB-PDT.

    Stanford is currently not accepting patients for this trial.

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All Publications


  • Changes in Corneal Power up to Two Years after Endothelial Keratoplasty: Results from the Randomized Controlled DETECT Trial. American journal of ophthalmology Chamberlain, W., Shen, E., Werner, S., Lin, C., Rose-Nussbaumer, J. 2022

    Abstract

    PURPOSE: To compare changes in corneal power measurements after Descemet membrane endothelial keratoplasty (DMEK) vs. ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK).SETTING: Hospital centers DESIGN: : Post-hoc sub-analysis of the randomized controlled DETECT Trial METHODS: : 50 eyes (38 patients) with endothelial dysfunction from Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy were randomized to DMEK or UT-DSAEK 1 to 2 days prior to surgery. Total Corneal Refractive Power (TCRP) and anterior/posterior simulated keratometry were obtained using Scheimpflug imaging preoperatively (baseline) and postoperatively at 3, 6, 12, and 24 months. Spectacle refractions were performed at 6, 12, and 24 months after surgery.RESULTS: Mean hyperopic shift of TCRP from baseline to 12 months was 0.80±1.1 (p=0.002) in the DMEK group and 0.69±0.84 (p<0.001) in the UT-DSAEK group. Posterior corneal curvature (Km) steepened (more negative dioptric power) by 0.42±0.10 (p<0.001) in DMEK and 0.54±0.09 (p<0.001) in UT-DSAEK. Mean change in TCRP and posterior corneal curvature did not differ between DMEK and UT-DSAEK (TCRP, p=0.71; posterior Km, p=0.36).CONCLUSIONS: Sustained steepening in posterior corneal curvature with loss in total corneal power contributes to hyperopic shifts after endothelial keratoplasty. Changes in corneal measurements do not differ between DMEK and UT-DSAEK.

    View details for DOI 10.1016/j.ajo.2022.07.009

    View details for PubMedID 35870491

  • Femtosecond Laser-Assisted Cataract Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology Lin, C. C., Rose-Nussbaumer, J. R., Al-Mohtaseb, Z. N., Pantanelli, S. M., Steigleman, W. A., Hatch, K. M., Santhiago, M. R., Kim, S. J., Schallhorn, J. M. 2022

    Abstract

    PURPOSE: To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS).METHODS: A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies.RESULTS: No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS.CONCLUSIONS: Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.

    View details for DOI 10.1016/j.ophtha.2022.04.003

    View details for PubMedID 35570159

  • Clinical Trial Design-The Best Approach Is Often the Simple One. JAMA ophthalmology Ma, K. K., Rose-Nussbaumer, J. 2022

    View details for DOI 10.1001/jamaophthalmol.2022.0054

    View details for PubMedID 35238898

  • Patterns of Antifungal Resistance in Adult Patients With Fungal Keratitis in South India: A Post Hoc Analysis of 3 Randomized Clinical Trials. JAMA ophthalmology Prajna, N. V., Lalitha, P., Krishnan, T., Rajaraman, R., Radnakrishnan, N., Srinivasan, M., Devi, L., Das, M., Liu, Z., Zegans, M. E., Acharya, N. R., Porco, T. C., Lietman, T. M., Rose-Nussbaumer, J. 1800

    Abstract

    Importance: Antifungal resistance has been shown to impact treatment success, but research analyzing antifungal resistance is scarce.Objective: To evaluate changes in antifungal resistance over time.Design, Setting, and Participants: Ad hoc analysis of 3 randomized clinical trials including consecutive patients 18 years and older presenting with smear-positive fungal ulcers to Aravind Eye Hospitals in Madurai, Coimbatore, Pondicherry, and Tirunelveli in South India who participated in 1 of 3 clinical trials: the Mycotic Ulcer Treatment Trials (MUTT) I (2010 to 2011) or II (2010 to 2015) or the Cross-Linking Assisted Infection Reduction (CLAIR) trial (2016 to 2018). This post hoc analysis was designed in March 2021 and data were analyzed in May and November 2021.Interventions: Minimum inhibitory concentration (MIC) of natamycin and voriconazole was determined from corneal cultures obtained using standardized methods outlined in the Clinical and Laboratory Standards Institute.Main Outcomes and Measures: The primary outcome of this post hoc analysis was MIC of natamycin and voriconazole.Results: A total of 890 fungal isolates were obtained from 651 patients (mean [SD] age, 49.6 [13.0]; 191 [43.3%] female) from 2010 to 2018. MICs were available for 522 samples in 446 patients. Fungal isolates overall demonstrated a 1.02-fold increase per year in voriconazole resistance as measured by MICs (95% CI, 1.00-1.04; P=.06). In subgroup analyses, Fusarium species demonstrated a 1.04-fold increase in voriconazole resistance per year (95% CI, 1.00-1.06; P=.01). Fungal isolates showed a 1.06-fold increase in natamycin resistance per year overall (95% CI, 1.03-1.09; P<.001). Fusarium species had a 1.06-fold increase in natamycin resistance (95% CI, 1.05-1.08; P<.001), Aspergillus had a 1.09-fold increase in resistance (95% CI, 1.05-1.15; P<.001), and other filamentous fungi had a 1.07-fold increase in resistance to natamycin per year (95% CI, 1.04-1.10; P<.001).Conclusions and Relevance: This post hoc analysis suggests that susceptibility to both natamycin and voriconazole may be decreasing over the last decade in South India. While a trend of increasing resistance could impact treatment of mycoses in general and infectious fungal keratitis in particular, further study is needed to confirm these findings and determine their generalizability to other regions of the world.Trial Registration: ClinicalTrials.gov Identifiers: NCT00996736 and NCT02570321.

    View details for DOI 10.1001/jamaophthalmol.2021.5765

    View details for PubMedID 35024776

  • Survey of the American Glaucoma Society Membership on Current Glaucoma Drainage Device Placement and Postoperative Corticosteroid Use. Clinical ophthalmology (Auckland, N.Z.) Yonamine, S., Ton, L., Rose-Nussbaumer, J., Ying, G., Ahmed, I. I., Chen, T. C., Weiner, A., Gedde, S. J., Han, Y. 2022; 16: 2305-2310

    Abstract

    Purpose: To assess practice patterns and opinions of glaucoma specialists regarding glaucoma drainage device tube shunt placement and post-operative anti-inflammatory medication use. We also assess the perceived need for a randomized control trial to compare them.Patients and Methods: An online survey was distributed to a group of glaucoma specialists from the American Glaucoma Society via the American Glaucoma Society forum from April to August 2021.Results: One hundred and twenty-eight responses were included. Ninety percent placed tubes in the anterior chamber. Sixty-one percent reported that evidence suggested the superiority of sulcus tube placement over the anterior chamber, whereas 34% reported there was not enough evidence to suggest superiority of either in preventing endothelial cell loss. Comparing these techniques for intraocular pressure control, 49% reported evidence suggested sulcus tube placement superiority whereas 46% reported there was not enough evidence. Over 40% of respondents reported that they were either unfamiliar with literature or that there was not enough evidence to support the superiority of difluprednate 0.05% over prednisolone 1% for post-operative use in preventing endothelial cell loss and for intraocular pressure control. Ninety percent and 81% of respondents respectively would benefit from randomized control trials comparing outcomes of anterior chamber vs sulcus tube placement and post-operative corticosteroid usage.Conclusion: Most glaucoma specialists surveyed place glaucoma drainage device tube in the anterior chamber over the sulcus. A randomized control trial to determine optimal tube placement and post-operative anti-inflammatory medication use for preventing endothelial cell loss would change current glaucoma drainage device practice patterns.

    View details for DOI 10.2147/OPTH.S369673

    View details for PubMedID 35903751

  • Double-masked, sham and placebo-controlled trial of corneal cross-linking and topical difluprednate in the treatment of bacterial keratitis: Steroids and Cross-linking for Ulcer Treatment Trial (SCUT II) study protocol. BMJ open ophthalmology Radhakrishnan, N., Prajna, V. N., Prajna, L. S., Venugopal, A., Narayana, S., Rajaraman, R., Amescua, G., Porco, T. C., Lietman, T. M., Rose-Nussbaumer, J. 2021; 6 (1): e000811

    Abstract

    Although antibiotics are successful at achieving microbiological cure in infectious keratitis, outcomes are often poor due to corneal scarring. Ideal treatment of corneal ulcers would address both the infection and the inflammation. Adjunctive topical steroid treatment may improve outcomes by reducing inflammation. Corneal cross-linking (CXL) is a novel prospective therapy that may simultaneously reduce both inflammatory cells and bacterial pathogens. The purpose of this study is to determine differences in 6-month visual acuity between standard medical therapy with antibiotics versus antibiotics with adjunctive early topical steroid therapy versus antibiotic treatment plus CXL and early topical steroids.This international, randomised, sham and placebo-controlled, three-arm clinical trial randomises patients with smear positive bacterial ulcers in a 1:1:1 fashion to one of three treatment arms: (1) topical 0.5% moxifloxacin plus topical placebo plus sham CXL; (2) topical 0.5% moxifloxacin plus difluprednate 0.05% plus sham CXL; or (3) the CXL group: topical 0.5% moxifloxacin plus difluprednate 0.05% plus CXL.We anticipate that both adjunctive topical steroids and CXL will improved best spectacle corrected visual acuity and also reduce complications such as corneal perforation and the need for therapeutic penetrating keratoplasty. This study will comply with the NIH Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. Our results will be disseminated via ClinicalTrials.gov website, meetings and journal publications. Our data will also be available on reasonable request.NCT04097730.

    View details for DOI 10.1136/bmjophth-2021-000811

    View details for PubMedID 34901464

    View details for PubMedCentralID PMC8634009

  • Double-masked, sham and placebo-controlled trial of corneal cross-linking and topical difluprednate in the treatment of bacterial keratitis: Steroids and Cross-linking for Ulcer Treatment Trial (SCUT II) study protocol BMJ OPEN OPHTHALMOLOGY Radhakrishnan, N., Prajna, V. N., Prajna, L. S., Venugopal, A., Narayana, S., Rajaraman, R., Amescua, G., Porco, T. C., Lietman, T. M., Rose-Nussbaumer, J. 2021; 6 (1)
  • Descemet Endothelial Thickness Comparison Trial: Two-Year Results from a Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty with Descemet Membrane Endothelial Keratoplasty OPHTHALMOLOGY Rose-Nussbaumer, J., Lin, C. C., Austin, A., Liu, Z., Clover, J., McLeod, S. D., Porco, T. C., Lietman, T. M., Dresner, S. M., Benetz, B., Lass, J. H., Chamberlain, W. D. 2021; 128 (8): 1238-1240
  • Predictors of Vision-Related Quality of Life After Endothelial Keratoplasty in the Descemet Endothelial Thickness Comparison Trials. Cornea Pickel, J., Chamberlain, W. D., Lin, C. C., Austin, A., Clover, J., Lietman, T. M., Rose-Nussbaumer, J. 2021; 40 (4): 449–52

    Abstract

    PURPOSE: To determine which baseline characteristics are associated with vision-related quality of life (QOL) after endothelial keratoplasty.METHODS: A patient- and outcome-masked randomized clinical trial. Consecutive patients presenting with isolated endothelial disease requiring endothelial keratoplasty at Oregon Health Sciences University and Stanford University. Study eyes randomized to one of the 2 types of endothelial keratoplasty were given the national eye institute vision function questionnaire 25 at baseline and 12 months. In this prespecified secondary outcome, we assessed the role of recipient and donor characteristics as predictors of the 12-month national eye institute vision function questionnaire 25 change score.RESULTS: The mean vision function questionnaire (VFQ) score was 74 (SD 14) at baseline and increased to 82 (SD 12) at 3 months and 87 (SD 10) at 12 months. We were unable to find a difference in vision-related QOL in study participants who underwent Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping endothelial keratoplasty [coef -0.98, 95% confidence interval (CI) -9.27 to 7.31; P = 0.82]. In multivariable analysis, patients who underwent endothelial keratoplasty in 2 eyes had approximately 8 points higher VFQ at 12 months after the second eye than those who had only one eye enrolled (95% CI 0.10-15.72; P = 0.047). Posterior densitometry produced an approximately 1-point increase each in the VFQ change score for each 1 grayscale unit increase at baseline (95% CI 0.26-1.81; P = 0.009). Although the sample size was small, a diagnosis of pseudophakic bullous keratopathy had approximately 19-points more improvement on average compared with Fuchs (95% CI 7.68-30.00; P = 0.001).CONCLUSIONS: Bilateral endothelial keratoplasty resulted in higher vision-related QOL compared with unilateral. Baseline densitometry, objective measure of corneal haze that predicts vision-related QOL, may play a role in monitoring disease progression.

    View details for DOI 10.1097/ICO.0000000000002431

    View details for PubMedID 33881810

  • Intraocular Lens Power Calculation in Eyes with Previous Excimer Laser Surgery for Myopia: A Report by the American Academy of Ophthalmology. Ophthalmology Pantanelli, S. M., Lin, C. C., Al-Mohtaseb, Z. n., Rose-Nussbaumer, J. R., Santhiago, M. R., Steigleman, W. A., Schallhorn, J. M. 2021

    Abstract

    To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK).Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist.When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72-1.9 diopters [D] and 0.65-1.73 D, respectively), and a low (8%-40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42-0.94 D) and MedAEs (0.30-0.81 D) and higher (30%-68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31-0.35 D) and highest (66%-68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it.Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.

    View details for DOI 10.1016/j.ophtha.2020.10.031

    View details for PubMedID 33500124

  • Multifocal and Accommodating Intraocular Lenses for the Treatment of Presbyopia: A Report by the American Academy of Ophthalmology. Ophthalmology Schallhorn, J. M., Pantanelli, S. M., Lin, C. C., Al-Mohtaseb, Z. N., Steigleman, W. A., Santhiago, M. R., Olsen, T. W., Kim, S. J., Waite, A. M., Rose-Nussbaumer, J. R. 2021

    Abstract

    To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal.Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II.Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses.Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.

    View details for DOI 10.1016/j.ophtha.2021.03.013

    View details for PubMedID 33741376

  • Descemet Endothelial Thickness Comparison Trial: Two-year Results from a Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty to Descemet Membrane Endothelial Keratoplasty. Ophthalmology Rose-Nussbaumer, J., Lin, C. C., Austin, A., Liu, Z., Clover, J., McLeod, S. D., Porco, T. C., Lietman, T. M., Dresner, S. M., Benetz, B. A., Lass, J. H., Chamberlain, W. 2020

    View details for DOI 10.1016/j.ophtha.2020.12.021

    View details for PubMedID 33359556

  • The Prognostic Value of Persistent Culture Positivity in Fungal Keratitis in the Mycotic Antimicrobial Localized Injection Trial AMERICAN JOURNAL OF OPHTHALMOLOGY Pickel, J., Narayana, S., Krishnan, T., Ramakrishnan, S., Samantaray, P., Porco, T. C., Redd, T., Lietman, T. M., Rose-Nussbaumer, J. 2020; 215: 1-7

    Abstract

    To evaluate the utility of repeat cultures at days 3 and 7 after starting antifungal medications for predicting outcomes in fungal keratitis.Prespecified secondary analysis of the randomized clinical Mycotic Antimicrobial Localized Injection trial.Patients presenting to Aravind Eye Hospital, Pondicherry, India, with fungal keratitis and visual acuity worse than 20/70 received topical natamycin and were randomized to either receive intrastromal injection of voriconazole or topical therapy alone. All subjects received corneal cultures at date of presentation, day 3, and day 7. Outcome measures included 3-week and 3-month visual acuity and scar size, corneal perforation, and/or the need for therapeutic penetrating keratoplasty (TPK). Visual acuity and scar size were analyzed with multiple linear regression controlling for baseline measures. Survival analysis was used to analyze the risk of corneal perforation and/or need for TPK.Of the 70 study subjects with fungal keratitis, 25 of 69 (36%) remained culture positive at day 3, and 20 of 62 (32%) were culture positive at day 7. Culture positivity at day 3 conferred a hazard ratio of 2.8 for requiring TPK (P = .03) but was not a statistically significant predictor of perforation, scar size, or final visual acuity. Culture positivity at day 7 had a hazard ratio of 3.5 for requiring TPK (P = .003). Those with positive cultures at day 7 had on average 3 logMAR lines worse visual acuity at 3 months (95% confidence interval 0.9 to 5.2 logMAR lines, P = .006) and 1.1 mm larger scar size at 3 months after controlling for baseline measures (95% confidence interval 0.1 to 2.2 mm; P = .03).While not as predictive as day 7 cultures, culture positivity at day 3 after starting treatment is a significant predictor of the need for TPK in patients with moderate-to-severe filamentous fungal keratitis. This has applications for risk stratification, and may facilitate earlier consideration of TPK in high-risk patients.

    View details for DOI 10.1016/j.ajo.2020.02.021

    View details for Web of Science ID 000542119700001

    View details for PubMedID 32171765

  • Change in Central and Peripheral Corneal Thickness in UT-DSAEK and DMEK in the Descemet Endothelial Thickness Comparison Trial Gutowski, M., Rose-Nussbaumer, J., Lin, C., Austin, A., Labadzinzki, P., Clover, J., Chamberlain, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Corneal Light Scatter After Ultrathin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty in Descemet Endothelial Thickness Comparison Trial: A Randomized Controlled Trial. Cornea Hirabayashi, K. E., Chamberlain, W., Rose-Nussbaumer, J., Austin, A., Stell, L., Lin, C. C. 2020

    Abstract

    PURPOSE: To compare the degree of corneal light scatter as measured by densitometry in ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) in the Descemet endothelial thickness comparison trial.METHODS: This was a prespecified secondary analysis of the Descemet endothelial thickness comparison trial, which was a prospective, randomized controlled trial. Subjects with isolated endothelial dysfunction were enrolled and were randomized to either UT-DSAEK or DMEK. Corneal opacity was quantitatively measured by Pentacam densitometry (OCULUS) at 3, 6, and 12 months.RESULTS: Fifty eyes of 38 patients were enrolled at the Casey Eye Institute at Oregon Health & Science University and the Byers Eye Institute at Stanford University. Corneal densitometry for the anterior and posterior layers improved in both UT-DSAEK and DMEK after surgery. The decrease was more pronounced in the posterior layer for both groups. However, there was no difference in the degree of corneal light scatter between UT-DSAEK and DMEK at postoperative month 12, and no difference in change in densitometry was observed between the 2 arms from baseline to month 12.CONCLUSIONS: Both UT-DSAEK and DMEK experience an improvement in the degree of corneal light scatter after surgery. However, there was no difference in densitometry between the 2 groups at month 12. Therefore, other factors such as higher order aberrations in the posterior cornea rather than stromal-stromal interface haze mediate the superior visual outcomes in DMEK compared with UT-DSAEK.

    View details for DOI 10.1097/ICO.0000000000002256

    View details for PubMedID 31939923

  • Corneal Higher-Order Aberrations in Descemet Membrane Endothelial Keratoplasty versus Ultrathin DSAEK in the Descemet Endothelial Thickness Comparison Trial A Randomized Clinical Trial OPHTHALMOLOGY Duggan, M. J., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Labadzinzki, P. C., Chamberlain, W. D. 2019; 126 (7): 946–57
  • Changes in Anterior and Posterior Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty: Results from the Randomized Controlled DETECT Trial Werner, S., Rose-Nussbaumer, J., Lin, C., Austin, A., Chamberlain, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Effect of Unilateral Endothelial Keratoplasty on Vision-Related Quality-of-Life Outcomes in the Descemet Endothelial Thickness Comparison Trial (DETECT): A Secondary Analysis of a Randomized Clinical Trial JAMA OPHTHALMOLOGY Ang, M. J., Chamberlain, W., Lin, C. C., Pickel, J., Austin, A., Rose-Nussbaumer, J. 2019; 137 (7): 747–54
  • Corneal Higher-Order Aberrations in DMEK versus UT-DSAEK in DETECT: A Randomized Clinical Trial. Ophthalmology Duggan, M. J., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Labadzinzki, P. C., Chamberlain, W. D. 2019

    Abstract

    PURPOSE: To compare corneal higher-order aberrations (HOA) following ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).DESIGN: Patient and outcome-masked, randomized controlled clinical trial.PARTICIPANTS: Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were considered good candidates for DMEK or UT-DSAEK.METHODS: Corneal anterior and posterior surface HOA were measured with Scheimpflug imaging before surgery and at 3, 6, and 12 months post-operatively. Zernike orders 3-8 were calculated at 4.0- and 6.0-mm-diameter optical zones (OZ). HOA after UT-DSAEK and DMEK were compared and correlation was performed between best spectacle-corrected visual acuity (BSCVA) and HOA at each time point.MAIN OUTCOME MEASURES: Higher-order aberrations of the anterior and posterior cornea, expressed as the root mean square deviation from a best fit sphere reference surface.RESULTS: At 3, 6, and 12 months after surgery, the posterior corneal surface had significantly less coma (P≤0.003) and total HOA (P≤0.001) in DMEK compared to UT-DSAEK (4.0- and 6.0-mm OZ). Posterior trefoil (P≤0.034), secondary astigmatism (P≤0.042), and tetrafoil (P≤0.045) were lower in DMEK than UT-DSAEK at 3, 6, or 12 months (either 4.0- or 6.0-mm OZ). There were no significant differences in anterior surface HOA between DMEK and UT-DSAEK at any time point. Compared to baseline, total posterior HOA was significantly increased (P≤0.036) in UT-DSAEK at 3, 6, and 12 months, in contrast to DMEK where it was significantly decreased (P≤0.044) at 6 and 12 months (4.0- and/or 6.0-mm OZ). At 6 and 12 months, posterior corneal total HOA correlated moderately with BSCVA (rho≤0.635, P≤0.001) (4.0- and 6.0-mm OZ). There were no moderate or strong correlations between anterior or combined corneal surface HOA at any time point after surgery.CONCLUSIONS: DMEK results in less posterior corneal HOA compared to UT-DSAEK. DMEK decreases and UT-DSAEK increases posterior corneal HOA compared to pre-surgical values. Total posterior corneal HOA correlates moderately with 6- and 12-month post-operative visual acuity and may partially account for the better visual acuity observed after DMEK.

    View details for PubMedID 30776384

  • Descemet Endothelial Thickness Comparison Trial A Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty with Descemet Membrane Endothelial Keratoplasty OPHTHALMOLOGY Chamberlain, W., Lin, C. C., Austin, A., Schubach, N., Clover, J., McLeod, S. D., Porco, T. C., Lietman, T. M., Rose-Nussbaumer, J. 2019; 126 (1): 19–26

    Abstract

    To compare clinical outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the treatment of corneal endothelial dysfunction.Patient and outcome-masked, randomized controlled clinical trial.Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were considered good candidates for DMEK or UT-DSAEK.Study eyes were randomized by the eye bank to UT-DSAEK or DMEK 1 to 2 days before surgery.The primary outcome of the trial was best spectacle-corrected visual acuity (BSCVA) at 6 months. Secondary outcomes included 3- and 12-month BSCVA; 3-, 6-, and 12-month endothelial cell counts; intraoperative and postoperative complications; and change in pachymetry.A total of 216 patients with endothelial dysfunction were screened, and 50 eyes of 38 patients were enrolled by 2 surgeons at Casey Eye Institute at Oregon Health & Science University in Portland, Oregon, and at Byers Eye Institute at Stanford University in Palo Alto, California. Overall, we found DMEK to have better visual acuity outcomes compared with UT-DSAEK after correcting for baseline visual acuity: compared with UT-DSAEK, those randomized to DMEK had 1.5 lines better BSCVA at 3 months (95% confidence interval [CI], 2.5-0.6 lines better; P = 0.002), 1.8 lines better BSCVA at 6 months (95% CI, 2.8-1.0 lines better; P < 0.001), and 1.4 lines better BSCVA at 12 months (95% CI, 2.2-0.7 lines better; P < 0.001). Average endothelial cell counts were 1963 cells/mm2 in DMEK and 2113 cells/mm2 in UT-DSAEK at 6 months (P = 0.17) and 1855 cells/mm2 in DMEK and 2070 cells/mm2 in UT-DSAEK at 12 months (P = 0.051). Intraoperative and postoperative complication rates were similar between groups.Descemet membrane endothelial keratoplasty had superior visual acuity results compared with UT-DSAEK at 3, 6, and 12 months in patients with isolated endothelial dysfunction with similar complication rates.

    View details for PubMedID 29945801

  • Effect of Unilateral Endothelial Keratoplasty on Vision-Related Quality-of-Life Outcomes in the Descemet Endothelial Thickness Comparison Trial (DETECT): A Secondary Analysis of a Randomized Clinical Trial. JAMA ophthalmology Ang, M. J., Chamberlain, W. n., Lin, C. C., Pickel, J. n., Austin, A. n., Rose-Nussbaumer, J. n. 2019

    Abstract

    Vision-related quality of life can be a valuable outcome for some interventions in ophthalmology. In the primary Descemet Endothelial Thickness Comparison Trial (DETECT), Descemet membrane endothelial keratoplasty (DMEK) had superior postoperative visual acuity compared with ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). It is of interest to determine whether this trend extends to quality of life.To determine the effect of UT-DSAEK and DMEK on vision-related quality of life.A prespecified secondary analysis of a 2-surgeon patient- and outcome-masked randomized clinical trial was conducted at the Casey Eye Institute in Portland, Oregon, and Byers Eye Institute in Palo Alto, California. The study was conducted between January 20, 2015, and April 26, 2017. DETECT enrolled 38 individuals and included 50 eyes with isolated endothelial dysfunction; for this analysis, the second eye from a single participant was excluded along with any questionnaires in the first eye after second eye surgery for evaluation of 38 eyes at baseline and 3 months and 26 eyes at 12 months. Mean (SD) baseline visual acuity was 0.35 (0.31) logMAR in the DMEK arm and 0.28 (0.22) logMAR in the UT-DSAEK arm. Each arm consisted of 19 participants: 18 individuals with Fuchs dystrophy and 1 participant with pseudophakic bullous keratopathy.Study eyes were randomized to receive either UT-DSAEK or DMEK.Responses to the National Eye Institute (NEI) Visual Function Questionnaire-39 (VFQ-39) administered at baseline and 3 and 12 months postoperatively were analyzed using the NEI-defined traditional subscales and composite score on a 100-point scale and with a Rasch-refined analysis.There were more women in both arms of the study (UT-DSAEK, 12 [63%]; DMEK, 11 [58%]); mean (SD) age was 68 (11) years in the UT-DSAEK arm and 68 (4) years in the DMEK arm. Overall, study participants experienced a 9.1-point improvement in NEI VFQ-39 composite score at 3 months compared with baseline (N = 38; 95% CI, 4.9-13.3; P < .001), and an 11.6-point improvement at 12 months compared with baseline (n = 26; 95% CI, 6.8-16.4; P < .001). Eyes randomized to DMEK had 0.9 points more improvement in NEI VFQ-39 composite score at 3 months compared with UT-DSAEK after controlling for baseline NEI VFQ-39 (95% CI, -6.2 to 8.0; P = .80).Improvement in vision-related quality of life was not shown to be greater with DMEK compared with UT-DSAEK.ClinicalTrials.gov identifier: NCT02373137.

    View details for PubMedID 31046075

  • Therapeutic Penetrating Keratoplasty Button Cultures in The Mycotic Ulcer Treatment Trial II: A Randomized Trial Comparing Oral Voriconazole Versus Placebo AMERICAN JOURNAL OF OPHTHALMOLOGY Cho, J., Prajna, N., Lalitha, P., Rajaraman, R., Krishnan, T., Lin, Y., Ray, K. J., Lietman, T. M., Rose-Nussbaumer, J., Mycotic Ulcer Treatment Trial Grp 2018; 192: 142-145

    Abstract

    To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis.Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial.Study Participants: Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK).Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops.TPK button culture positivity.A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fungal culture positivity (95% confidence interval [CI] 0.90-0.98, P = .005). Those randomized to oral voriconazole had 1.26-fold increased odds of TPK button culture positivity after controlling for time to TPK and baseline organism, but this was not statistically significant (95% CI 0.32-4.87; P = .74). Those who underwent TPK for lack of response to medical therapy were 10.64-fold more likely to be culture positive than if the indication for surgery was perforation and this was statistically significant (95% CI 2.16-51.70; P = .003).There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. Infection rather than inflammation appears to be the reason for the worsening clinical picture in many of these patients.

    View details for DOI 10.1016/j.ajo.2018.05.007

    View details for Web of Science ID 000441226900021

    View details for PubMedID 29758184

    View details for PubMedCentralID PMC6584760

  • DMEK results in significantly less higher-order aberration than UT-DSAEK: Results from the DETECT trial. Duggan, M., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Chamberlain, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Effect of Donor Characteristics on Visual Outcomes and Endothelial Cell Count in the Descemet Endothelial Thickness Comparison Trial Lin, Y., Chamberlain, W., Lin, C. C., Austin, A., Shubach, N., Clover, J., Mcleod, S., Porco, T., Lietman, T., Rose-Nussbaumer, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Inter-grader Agreement of the Ocular Staining Score in the Sjogren's. International Clinical Collaborative Alliance (SICCA) Registry AMERICAN JOURNAL OF OPHTHALMOLOGY Rose-Nussbaumer, J., Lietman, T. M., Shiboski, C. H., Shiboski, S. C., Bunya, V. Y., Akpek, E. K., Srinivasan, M., Mascarenhas, J., Massaro-Giordano, G., Mcnamara, N. A., Whitcher, J. P., Gaynor, B. D., Sjogren's Int Collaborative Clinic 2015; 160 (6): 1150-1153

    Abstract

    To determine the intra-observer and inter-observer reliability of a novel ocular staining score among trained ophthalmologists.Reliability analysis within a prospective, observational, multicenter cohort study.Those enrolled in the National Institutes of Health-funded Sjögren's International Collaborative Clinical Alliance (SICCA) who presented for follow-up at the University of California San Francisco, Aravind Eye Hospital, Johns Hopkins University, and the University of Pennsylvania were included. Study participants were graded using the ocular staining score by at least 2 masked SICCA-trained ophthalmologists. The primary outcome for this study was the intraclass correlation coefficient (ICC) for the total ocular staining score. ICCs were also calculated for tear break-up time (TBUT) and conjunctival and corneal staining.Total ocular staining score had an ICC of 0.91 for the right eye (95% confidence interval [CI] 0.85-0.96) and 0.90 for the left eye (95% CI 0.83-0.97). Corneal staining (right eye 0.86, 95% CI 0.76-0.93, left eye 0.90, 95% CI 0.81-0.95) and conjunctival staining (right eye 0.87, 95% CI 0.80-0.93, left eye 0.85, 95% CI 0.75-0.93) demonstrated excellent agreement. The ICC for TBUT was slightly lower (right eye 0.77, 95% CI 0.64-0.89; left eye 0.81, 95% CI 0.68-0.90).Previous studies have shown that the ocular staining score is correlated with other diagnostic components of Sjögren syndrome. In this study, we demonstrate high reliability in grading among trained ophthalmologists, completing the validation of this test.

    View details for DOI 10.1016/j.ajo.2015.08.021

    View details for Web of Science ID 000365243400009

    View details for PubMedID 26302236

    View details for PubMedCentralID PMC4651820