Clinical Focus


  • Retina Specialist

Academic Appointments


  • Clinical Assistant Professor, Ophthalmology

Honors & Awards


  • Michels, Ronald G. Michels Fellowship Foundation (2019)
  • Hodson Trust Scholar, Johns Hopkins University (2004-2008)
  • Heed Ophthalmic Society Award, The Heed Ophthalmic Foundation (2018)
  • ESPN Academic All-American, NCAA - Volleyball (Nov 2008)

Professional Education


  • Board Certification: American Board of Ophthalmology, Ophthalmology (2021)
  • Fellowship: Stanford University Retina and Vitreous Fellowship (2020) CA
  • Residency: Bascom Palmer Eye Institute (2018) FL
  • Internship: Resurrection Medical Center (2015) IL
  • Medical Education: Stanford University School of Medicine (2014) CA

All Publications


  • Interim Results of the Phase III Portal Extension Trial of the Port Delivery System with Ranibizumab in Neovascular Age-Related Macular Degeneration. Ophthalmology. Retina Campochiaro, P. A., Eichenbaum, D., Chang, M. A., Clark, W. L., Graff, J. M., Le Pogam, S., Cavichini Cordeiro, M., Gune, S., Rabena, M., Singh, N., Lin, S., Callaway, N. 2024

    Abstract

    The Port Delivery System with ranibizumab (PDS) is approved in the United States for neovascular age-related macular degeneration (nAMD). Portal (NCT03683251) is evaluating long-term safety and tolerability of the PDS in patients with nAMD who completed the phase II Ladder (NCT02510794) or phase III Archway (NCT03677934) trials.Multicenter, nonrandomized, open-label, extension clinical trial.All-PDS safety population (N = 555) comprises patients enrolled in Portal who completed Ladder or Archway. Due to data availability, efficacy population comprises Ladder-to-Portal patients only: patients who previously received PDS 10, 40, or 100 mg/ml pro re nata (as-needed [PRN]; n = 58, 62, 59, respectively) or monthly intravitreal ranibizumab 0.5-mg injections (monthly ranibizumab; n = 41) in Ladder and subsequently enrolled in Portal.Ladder patients received PDS refill-exchanges PRN or monthly ranibizumab. Archway patients received PDS 100 mg/ml with fixed refill-exchanges every 24 weeks (PDS Q24W) or monthly ranibizumab. Once enrolled in Portal, all patients receive PDS Q24W from day 1.Ocular adverse events of special interest (AESIs); changes from baseline in best-corrected visual acuity (BCVA) and center point thickness (CPT); supplemental ranibizumab treatment between refill-exchange procedures; PDS Patient Preference Questionnaire results.In the All-PDS safety population (mean follow-up, 111 weeks), 137 (24.7%) patients had ≥ 1 ocular AESI; most common were cataract (11.4%), vitreous hemorrhage (6.1%), conjunctival thickening (bleb)/filtering bleb leak (6.3%). Endophthalmitis occurred in 11 of 555 (2.0%) patients. For Ladder-to-Portal patients previously treated with PDS 100 mg/ml or monthly ranibizumab, BCVA remained stable from baseline to month 48; mean (95% confidence interval) changes from baseline were 0.1 (-6.6, 6.8; n = 31) and 2.3 (-9.4, 14.1; n = 15) letters, respectively; CPT remained stable through month 48. Approximately 95% of patients did not need supplemental treatment before each refill-exchange for > 2 years since Portal enrollment. Of Ladder-to-Portal previous monthly ranibizumab patients, 92% preferred the PDS over injections.Interim results from Portal suggest 4-year maintenance of visual/anatomic outcomes with PDS 100 mg/ml, with the PDS preferred to monthly injections. Long-term safety profile of the PDS is well characterized.

    View details for DOI 10.1016/j.oret.2024.05.021

    View details for PubMedID 39209113

  • Endophthalmitis in Eyes Treated With the Port Delivery System With Ranibizumab: Summary of Cases During Clinical Trial Development. Ophthalmology. Retina Eichenbaum, D. A., Freeman, W. R., Chang, M. A., Brooks, L., Chaudhry, N., Dadgostar, H., McCannel, C. A., Michels, M., Mittra, R. A., Wolfe, J. D., Beindl, V. C., Jaycock, P., Bobbala, A., Gune, S., Spicer, G., Callaway, N. 2024

    Abstract

    The Port Delivery System with ranibizumab (PDS) is approved in the United States for neovascular age-related macular degeneration. The US Prescribing Information has a Boxed Warning for endophthalmitis and reports the incidence rate in patients developing endophthalmitis after receiving the PDS compared to monthly intravitreal ranibizumab. Endophthalmitis cases noted in the Boxed Warning, treatment outcomes, potential contributing factors, and potential mitigations are summarized.Retrospective review of endophthalmitis cases in PDS-treated patients in the phase 2 Ladder (NCT02510794) and phase 3 Archway (NCT03677934) and Portal (NCT03683251) trials.Endophthalmitis cases in the pooled all-PDS safety population (N = 555) including PDS patients in Ladder, Archway, or Portal.Ladder patients received PDS (10, 40, or 100 mg/mL) with pro re nata refill-exchanges. Archway patients received PDS 100 mg/mL with fixed refill-exchanges every 24 weeks (PDS Q24W). Portal patients received PDS Q24W from day 1.Clinical features, management, and visual outcomes were summarized. Cases were summarized by date of PDS implant and/or refill, other prior invasive procedures/refills, and preceding/concurrent conjunctival complications.Twelve endophthalmitis events were reported in 11 patients (11/555 [2.0%]) through March 12, 2021. All were cultured (3 were culture positive) and treated with intravitreal antibiotics. Two cases (2/555 [0.4%]) occurred in the immediate postoperative period (days 5 and 6). Nine cases occurred later (day range: 57-853), including 4 before the first refill-exchange (day range: 57-161). Five patients received between 1-11 refill-exchanges before the event (onset: 6-168 days after last refill-exchange). Seven cases (7/11 [63.6%]) had preceding/concurrent conjunctival complications. At last follow-up, 7 patients recovered vision to study baseline levels or ≥ 20/40; 4 patients experienced vision loss of ≥ 15 ETDRS letters.Endophthalmitis is a serious complication that can endanger vision after any ocular procedure, including PDS implantation. This limited series of endophthalmitis cases notes most, but not all, cases were late onset, associated with conjunctival breach, and recovered vision with treatment. Meticulous attention to PDS surgical techniques with vigilant monitoring of conjunctiva during follow-up may minimize risk of endophthalmitis. Prompt treatment is critical for optimizing patient outcomes.

    View details for DOI 10.1016/j.oret.2024.08.005

    View details for PubMedID 39154860

  • Macular Sensitivity Endpoints in Geographic Atrophy: Exploratory Analysis of Chroma and Spectri Clinical Trials. Ophthalmology science Chang, D. S., Callaway, N. F., Steffen, V., Csaky, K., Guymer, R. H., Birch, D. G., Patel, P. J., Ip, M., Gao, S. S., Briggs, J., Honigberg, L., Lai, P., Ferrara, D., Sepah, Y. J. 2024; 4 (1): 100351

    Abstract

    To assess different microperimetry (MP) macular sensitivity outcome measures capturing functional deterioration in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).Patients were included from 2 identically designed, phase III, double-masked, randomized controlled clinical trials, Chroma (NCT02247479) and Spectri (NCT02247531).Patients enrolled were aged ≥ 50 years with bilateral GA and no evidence of previous or active neovascular AMD.Patients were randomized 2:1:2:1 to receive through 96 weeks intravitreal lampalizumab 10 mg every 4 weeks (LQ4W), every 6 weeks (LQ6W), or corresponding sham procedures. For this study, mesopic macular sensitivity of the central 20° was assessed using MP-1 microperimeter at selected sites.Two exploratory endpoints were developed, namely perilesional sensitivity (average of points adjacent to absolute scotomatous points) and responding sensitivity (average of all nonscotomatous points; > 0 dB at baseline) by using customized masks for each patient. These were compared with conventional MP endpoints (mean macular sensitivity and number of absolute scotomatous points).Of 1881 Chroma and Spectri participants, 277 agreed to participate in the present study. Of these, 197 (LQ4W, n = 63; LQ6W, n = 68; pooled sham, n = 66) had reliable MP results. Enlargement of GA lesion area by approximately 2 mm2/year across treatment groups was accompanied by deterioration in all MP parameters. There was no difference in worsening of macular sensitivity or absolute scotomatous points among treatment groups. Perilesional and responding sensitivities showed greater decline over time than mean macular sensitivity. Change in GA lesion area at week 48 showed better correlation with perilesional sensitivity (r = -0.17) and responding sensitivity (r = -0.20) than mean macular sensitivity (r = -0.03), while the correlation was highest with the number of absolute scotomatous points (r = 0.37).Perilesional or responding macular sensitivity measured by MP should be considered more sensitive endpoints than mean macular sensitivity for monitoring functional decline over time in GA. Although perilesional, responding, and mean macular sensitivity had weak correlation with GA lesion area, the number of absolute scotomatous points may provide additional information on the anatomic/functional correlation.Proprietary or commercial disclosure may be found after the references.

    View details for DOI 10.1016/j.xops.2023.100351

    View details for PubMedID 37869030

    View details for PubMedCentralID PMC10587617

  • Neonatal Macular Hemorrhage in a Term Healthy Infant: 18-Year Follow-up OPHTHALMIC SURGERY LASERS & IMAGING RETINA Moshfeghi, H. P., Patel, N. A., Callaway, N. 2024; 55 (6): 354-357

    Abstract

    Unobstructed binocular vision is required during the critical period of vision development to obtain optimal visual acuity in each eye and binocular stereopsis. In this article, we report 18-year follow-up of a full-term, otherwise healthy infant noted to have dense premacular hemorrhage occluding the visual axis in the left eye on retinal imaging performed 48 hours after birth. Serial examinations by the retina service were performed weekly for 10 weeks as the hemorrhage resolved spontaneously. Shortly thereafter, visual acuity revealed fixation was present, but the mother noted intermittent left eye esodeviation. At 90 days of life, the infant was seen by pediatric ophthalmology and started on 1 to 2 hours patching of the right eye daily for the esotropia, which was maintained through 24 months. At 18 years of age, the patient had orthophoria alignment, no spectacle correction, vision of 20/20 in the right eye and 20/25 in the left eye, and normal binocularity and stereopsis. Intermittent esodeviation on the left eye was observed when the patient was fatigued. Early identification of a visual axis occlusion led to prompt referral for the esotropia and initiation of patching therapy. This patient ultimately achieved a very favorable visual functional outcome that may not have been possible without early detection and management. This case report describes the longest-term published follow-up of a neonatal macular hemorrhage. [Ophthalmic Surg Lasers Imaging Retina 2024;55:354-357.].

    View details for DOI 10.3928/23258160-20240222-01

    View details for Web of Science ID 001248010200011

    View details for PubMedID 38648427

  • Telemedicine retinopathy of prematurity severity score (TeleROP-SS) versus modified activity score (mROP-ActS) retrospective comparison in SUNDROP cohort. Scientific reports Xu, C. L., Adu-Brimpong, J., Moshfeghi, H. P., Rosenblatt, T. R., Yu, M. D., Ji, M. H., Wang, S. K., Zaidi, M., Ghoraba, H., Michalak, S., Callaway, N. F., Kumm, J., Nudleman, E., Wood, E. H., Patel, N. A., Stahl, A., Lepore, D., Moshfeghi, D. M. 2023; 13 (1): 15219

    Abstract

    Identifying and planning treatment for retinopathy of prematurity (ROP) using telemedicine is becoming increasingly ubiquitous, necessitating a grading system to help caretakers of at-risk infants gauge disease severity. The modified ROP Activity Scale (mROP-ActS) factors zone, stage, and plus disease into its scoring system, addressing the need for assessing ROP's totality of binocular burden via indirect ophthalmoscopy. However, there is an unmet need for an alternative score which could facilitate ROP identification and gauge disease improvement or deterioration specifically on photographic telemedicine exams. Here, we propose such a system (Telemedicine ROP Severity Score [TeleROP-SS]), which we have compared against the mROP-ActS. In our statistical analysis of 1568 exams, we saw that TeleROP-SS was able to return a score in all instances based on the gradings available from the retrospective SUNDROP cohort, while mROP-ActS obtained a score of 80.8% in right eyes and 81.1% in left eyes. For treatment-warranted ROP (TW-ROP), TeleROP-SS obtained a score of 100% and 95% in the right and left eyes respectively, while mROP-ActS obtained a score of 70% and 63% respectively. The TeleROP-SS score can identify disease improvement or deterioration on telemedicine exams, distinguish timepoints at which treatments can be given, and it has the adaptability to be modified as needed.

    View details for DOI 10.1038/s41598-023-42150-w

    View details for PubMedID 37709791

  • Exudation in Patients With Neovascular Age-Related Macular Degeneration Treated With the Port Delivery System or Monthly Injections. American journal of ophthalmology Akhlaq, A., Williams, D., Clark, W. L., Khan, H., Khanani, A. M., Walden, L., Awh, C., Graff, J. T., Graff, J. M., Wakabayashi, T., Regillo, C., Maass, K. F., Callaway, N. F., Gune, S., Campochiaro, P. A. 2023; 258: 158-172

    Abstract

    To evaluate for the presence, severity, and type of exudation at each study visit for a subgroup of patients with neovascular age-related macular degeneration from the Archway and Portal trials.Retrospective analysis of prospectively obtained data.Spectral-domain optical coherence tomography scans from each study visit of 44 patients from the Port Delivery System (PDS) arm and 32 patients from the monthly injection arm of Archway were evaluated, and composites of horizontal scans through the fovea were created. Each composite was graded for the presence, type, and severity of exudation and impact on best-corrected visual acuity.After PDS implantation, 20 of 44 eyes (45%) never showed any exudation in the fovea, 2 (5%) never showed exudation in the fovea but had several missed visits, whereas 15 (34%), 3 (7%), and 4 (9%) showed mild, moderate, or severe exudation at 1 or more study visits, respectively. When exudation was present, it was most commonly subretinal fluid (50%). Of 32 patients randomized to monthly injections, 15 (47%) had no exudation in the fovea during monthly injections or after PDS implantation. Fluctuation of exudation in the fovea over time was seen in some patients after PDS implantation or during monthly injections with little or no identifiable impact on best-corrected visual acuity. In the 7 eyes with moderate or severe exudation in the fovea after PDS implantation, final vision was good in 5 (20/25 in 3, 20/40 in 1, and 20/50 in 1) and 2 had reduced vision from submacular hemorrhage.The PDS provides excellent control of exudation in the fovea in patients with neovascular age-related macular degeneration, and when exudation occurs, it often resolves without a negative impact on vision.

    View details for DOI 10.1016/j.ajo.2023.07.003

    View details for PubMedID 37453472

  • Alternative career paths for ophthalmologists. Current opinion in ophthalmology Callaway, N. F., Cunningham, E. T. 2023

    Abstract

    Traditionally, ophthalmologists complete training and then choose a clinical care setting. The skills required to become an ophthalmologist can be applied to a variety of alternative career paths within and beyond healthcare. Not unexpectedly, therefore, there is a growing trend for ophthalmologists to explore alternative career paths in both healthcare and the life science industry more broadly. In this invited editorial, we summarize the more commonly considered 'alternative career paths,' and provide personal perspectives that have helped us and others when weighing such options.Prior to pursuing an alternative career path, it is important to reflect on one's motivations and goals. A number of alternative careers paths are available, and the choice of when and what to pursue is both personal and personalizable. While it can be difficult to know a priori whether and to what extent a given path will be both enjoyable and rewarding, insights and advice from those who have walked that path before you can be invaluable. We review the more common paths of administrative leadership, entrepreneurship and innovation, product development, healthcare policy, nonprofit organizations, and investing, noting that these are just examples of the many options currently available.Ophthalmologists should feel empowered to design a career that is both purposeful and personally meaningful, as this will result ultimately in the greatest happiness and fulfillment. There is a world of opportunity available to those who are willing to explore and create their own path.

    View details for DOI 10.1097/ICU.0000000000000975

    View details for PubMedID 37527203

  • Epidemiology of rhegmatogenous retinal detachment in commercially insured myopes in the United States. Scientific reports Ludwig, C. A., Vail, D., Al-Moujahed, A., Callaway, N. F., Saroj, N., Moshfeghi, A., Moshfeghi, D. M. 2023; 13 (1): 9430

    Abstract

    Myopia is a known risk factor for rhegmatogenous retinal detachment (RRD). Given global trends of increasing myopia, we aimed to determine the absolute risk (incidence rate) of RRD in non-myopes, myopes and high myopes in the United States over ten years. We performed a retrospective cohort study of 85,476,781 commercially insured patients enrolled in the Merative Marketscan Research Database. The incidence rate of RRD in phakic patients inthe United States was 39-fold higher in high myopes than non-myopes (868.83 per 100,000 person-years versus 22.44 per 100,000 person-years)and three-fold higher in myopes than non-myopes (67.51 per 100,000 person-yearsversus22.44 per 100,000 person-years). The incidence rate was significantly higher in males in each category (P<0.01). Combined, the incidence rate of RRD in phakic patients inthe United States from 2007 to 2016was 25.27 RRDs per 100,000 person-years, a rate higherthan those in prior published studies in North America, South America, Europe, Asia, and Australia.The absolute risk of myopia and high myopia increased from 2007 to 2016. Therisk of RRD in phakichigh myopes rosewith increasing age. Notably, the magnitude of increased risk of RRD in myopes varied substantially according to the minimum follow-up period in our models and should be accounted for when interpreting data analyses.

    View details for DOI 10.1038/s41598-023-35520-x

    View details for PubMedID 37296124

  • Validation of a Photographic Retinopathy of Prematurity Severity Score (ROP-SS) and Comparison to the Modified Activity Score (mROP-ActS) in a Retrospective SUNDROP Cohort Xu, C., Adu-Brimpong, J., Moshfeghi, H., Rosenblatt, T., Yu, M., Wang, S., Zaidi, M., Ghoraba, H., Michalak, S., Callaway, N., Wood, E., Stahl, A., Lepore, D., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Archway Phase 3 Trial of the Port Delivery System with Ranibizumab for Neovascular Age-Related Macular Degeneration 2-Year Results. Ophthalmology Regillo, C., Berger, B., Brooks, L., Clark, W. L., Mittra, R., Wykoff, C. C., Callaway, N. F., DeGraaf, S., Ding, H. T., Fung, A. E., Gune, S., Le Pogam, S., Smith, R., Willis, J. R., Barteselli, G. 2023

    Abstract

    To report 2-year results from the Archway clinical trial of the Port Delivery System with ranibizumab (PDS) for treatment of neovascular age-related macular degeneration (nAMD).Phase 3, randomized, multicenter, open-label, active-comparator trial.Patients with previously treated nAMD diagnosed within 9 months of screening and responsive to anti-vascular endothelial growth factor therapy.Patients were randomized 3:2 to PDS with ranibizumab 100 mg/ml with fixed refill-exchanges every 24 weeks (PDS Q24W) or intravitreal ranibizumab 0.5 mg injections every 4 weeks (monthly ranibizumab). Patients were followed through 4 complete refill-exchange intervals (∼2 years).Change in best-corrected visual acuity (BCVA) Early Treatment Diabetic Retinopathy Study (ETDRS) letter score from baseline averaged over weeks 60 and 64, and weeks 88 and 92 (noninferiority margin, -3.9 ETDRS letters).PDS Q24W was noninferior to monthly ranibizumab, with differences in adjusted mean change in BCVA score from baseline averaged over weeks 60/64 and 88/92 of +0.4 (95% confidence interval [CI], -1.4 to +2.1) and -0.6 ETDRS letters (95% CI, -2.5 to +1.3). Anatomic outcomes were generally comparable between arms through week 96. Through each of 4 PDS refill-exchange intervals, 98.4%, 94.6%, 94.8%, and 94.7% of PDS Q24W patients assessed did not receive supplemental ranibizumab treatment. PDS ocular safety profile was generally unchanged from primary analysis. Prespecified ocular adverse events (AEs) of special interest were reported in 59 (23.8%) PDS and 17 (10.2%) monthly ranibizumab patients. Most common AE of special interest reported in both arms was cataract (PDS Q24W, 22 [8.9%]; monthly ranibizumab, 10 [6.0%]). Events in the PDS Q24W arm included (patient incidence) 10 (4.0%) conjunctival erosions, 6 (2.4%) conjunctival retractions, 4 (1.6%) endophthalmitis cases, and 4 (1.6%) implant dislocations. Serum ranibizumab sampling showed that the PDS continuously released ranibizumab over the 24-week refill-exchange interval and ranibizumab serum concentrations were within the range experienced with monthly ranibizumab.PDS Q24W showed noninferior efficacy to monthly ranibizumab through approximately 2 years, with approximately 95% of PDS Q24W patients not receiving supplemental ranibizumab treatment in each refill-exchange interval. AEs were generally manageable, with learnings continually implemented to minimize PDS-related AEs.

    View details for DOI 10.1016/j.ophtha.2023.02.024

    View details for PubMedID 36870451

  • Archway phase 3 trial of the Port Delivery System with ranibizumab (PDS) for neovascular AMD: end-of-study results Mittra, R., Brooks, L., Wykoff, C., Callaway, N., DeGraaf, S., Fung, A., Gune, S., LePogam, S., Smith, R., Willis, J., Barteselli, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Anti-VEGF for diabetic retinopathy treatment: systematic review of randomized controlled trials Le, L., Latkany, P., Kothari, N., Scott, N., Rodriguez, M., Patel, N., Yannuzzi, N., Haskova, Z., Callaway, N. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Interim analysis of the Portal extension trial evaluating the long-term safety and efficacy of the Port Delivery System with ranibizumab (PDS) in neovascular age-related macular degeneration (nAMD) Haug, S., Callaway, N., DeGraaf, S., LePogam, S., Rabena, M., Smith, R., Barteselli, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Key clinical pearls for evaluating surgical candidates, and patient preference, for the Port Delivery System with ranibizumab (PDS) Holekamp, N. M., Bobbala, A., Callaway, N., DeGraaf, S., Menezes, A., Heinrich, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Management of Key Ocular Adverse Events in Patients Implanted with the Port Delivery System with Ranibizumab. Ophthalmology. Retina Awh, C. C., Barteselli, G., Makadia, S., Chang, R. T., Stewart, J. M., Wieland, M. R., Brassard, R., Callaway, N. F., Gune, S., Heatherton, P., Malhotra, V., Willis, J. R., Pieramici, D. J. 2022

    Abstract

    PURPOSE: To provide strategies for the management of key ocular adverse events (AEs) that may be encountered with the Port Delivery System with ranibizumab (PDS) in practice, and to provide recommendations that may mitigate such AEs based on clinical trial experience and considerations from experts in the field.DESIGN: Safety evaluation based on the phase 2 Ladder (NCT02510794) and phase 3 Archway (NCT03677934) trials of the PDS.METHODS: The PDS is a permanent, indwelling, and refillable ocular drug delivery system that requires standardized procedural steps, for its insertion and refill-exchange procedures, which have evolved during the PDS clinical program. We describe identified AEs that may arise after implant insertion or refill-exchange procedures, including conjunctival retraction, conjunctival erosion, endophthalmitis, implant dislocation, conjunctival bleb or conjunctival filtering bleb leak, wound leak, hypotony, choroidal detachment, vitreous hemorrhage, rhegmatogenous retinal detachment, cataract, and septum dislodgement.RESULTS: Adverse events related to the PDS were well understood, manageable by trial investigators, and did not prevent patients from achieving optimal outcomes in most cases.CONCLUSIONS: Surgeons using the PDS should be aware of potential ocular AEs and identify them early for optimal management. As with any new surgical procedure, it is important to provide surgeons with appropriate training, to ensure adherence to optimal surgical techniques, and to continually refine the procedure to mitigate complications and improve outcomes.

    View details for DOI 10.1016/j.oret.2022.05.011

    View details for PubMedID 35589078

  • Refill-Exchange Procedure of the Port Delivery System With Ranibizumab: Overview and Clinical Trial Experience OPHTHALMIC SURGERY LASERS & IMAGING RETINA Khanani, A. M., Graff, J. M., Marcus, D. M., Wykoff, C. C., Jhaveri, C. D., Barteselli, G., Malhotra, V. K., Menezes, A. R., Callaway, N. F. 2022; 53 (5): 257-265

    Abstract

    To describe the Port Delivery System with ranibizumab refill-exchange procedure.Procedure based on the clinical trial program in patients with retinal diseases.The refill-exchange procedure is performed under topical anesthesia and strict aseptic conditions. Supplemental task lighting and magnification are recommended throughout the procedure. Ranibizumab is aseptically transferred from the vial with the filter needle and air is removed from the syringe. The filter needle is then replaced with the refill needle; any remaining air is removed from the syringe and the plunger is advanced to the 0.1-mL mark. Targeting the implant septum center, the refill needle is inserted perpendicularly to the globe until the soft stop contacts the conjunctiva (perpendicular orientation and conjunctival contact are maintained throughout the procedure); a cotton-tipped applicator is recommended for globe stabilization. The entire syringe contents are slowly injected over 5-10 seconds while existing solution fills the fluid collection reservoir. Once completed, the needle is carefully withdrawn while maintaining perpendicularity. The procedure can be successfully performed in rare, specific cases, including subconjunctival thickening or fibrous capsule formation, fluid-filled bleb formation, and corneal patch grafts.The procedure is straightforward but distinct from intravitreal injections and requires adherence to standardized techniques. With appropriate preparation, the procedure can be performed in specific cases. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:257-265.].

    View details for DOI 10.3928/23258160-20220412-01

    View details for Web of Science ID 000800365300003

    View details for PubMedID 35575741

  • Modeling absolute zone size in retinopathy of prematurity in relation to axial length. Scientific reports Wang, S. K., Korot, E., Zaidi, M., Ji, M. H., Al-Moujahed, A., Callaway, N. F., Kumm, J., Moshfeghi, D. M. 2022; 12 (1): 4717

    Abstract

    Treatment outcomes in retinopathy of prematurity (ROP) are closely correlated with the location (i.e. zone) of disease, with more posterior zones having poorer outcomes. The most posterior zone, Zone I, is defined as a circle centered on the optic nerve with radius twice the distance from nerve to fovea, or subtending an angle of 30 degrees. Because the eye enlarges and undergoes refractive changes during the period of ROP screening, the absolute area of Zone I according to these definitions may likewise change. It is possible that these differences may confound accurate assessment of risk in patients with ROP. In this study, we estimated the area of Zone I in relation to different ocular parameters to determine how variability in the size and refractive power of the eye may affect zoning. Using Gaussian optics, a model was constructed to calculate the absolute area of Zone I as a function of corneal power, anterior chamber depth, lens power, lens thickness, and axial length (AL), with Zone I defined as a circle with radius set by a 30-degree visual angle. Our model predicted Zone I area to be most sensitive to changes in AL; for example, an increase of AL from 14.20 to 16.58mm at postmenstrual age 32weeks was calculated to expand the area of Zone I by up to 72%. These findings motivate several hypotheses which upon future testing may help optimize treatment decisions for ROP.

    View details for DOI 10.1038/s41598-022-08680-5

    View details for PubMedID 35304549

  • Telemedicine screening for syphilitic chorioretinitis in the SUNDROP cohort. Eye (London, England) Zaidi, M. H., Rosenblatt, T. R., Al-Moujahed, A., Vail, D., Callaway, N. F., Nguyen, Q. D., Moshfeghi, D. M. 2022

    View details for DOI 10.1038/s41433-022-01967-x

    View details for PubMedID 35217825

  • Referable Macular Hemorrhage-A Clinically Meaningful Screening Target in Newborn Infants. Position Statement of the Association of Pediatric Retina Surgeons OPHTHALMIC SURGERY LASERS & IMAGING RETINA Wood, E. H., Capone, A., Drenser, K. A., Berrocal, A., Hubbard, G., Callaway, N. F., Kychenthal, A., Ells, A., Harper, C. A., Besirli, C., Baumal, C. R., Vavvas, D. G., Chang, E. Y., Nudleman, E. D., Tsui, I., Sears, J., Vajzovic, L., Hartnett, M. E., Shapiro, M. J., Quiram, P. A., Ozdek, S., Kusaka, S., Wu, W., Trese, M. T. 2022; 53 (1): 3-6

    Abstract

    Universal newborn eye screening facilitates early diagnosis of ocular abnormalities and mitigates vision loss. "Referral warranted" eye disease is present at birth in about 5.5% of term infants, with "macular hemorrhage impinging on the fovea" representing about 50% of referral warranted disease. The Association of Pediatric Retina Surgeons held a symposium on February 9, 2021 that culminated in a position statement on "referable macular hemorrhage" (RMH) in newborn infants. RMH is meaningful in that in can cause amblyopia through deprivation, can be readily captured with wide-angle photography in a safe and efficient manner, and may lead to early intervention with mitigation of vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:3-6.].

    View details for DOI 10.3928/23258160-20211214-01

    View details for Web of Science ID 000756618700001

    View details for PubMedID 34981999

  • Intravitreal Fluocinolone Acetonide (Retisert) Implantation Using a Keratome Blade. Journal of vitreoretinal diseases Pasricha, M. V., Callaway, N. F., Mahajan, V. B. 2021; 5 (1): 66-67

    View details for DOI 10.1177/2474126420946911

    View details for PubMedID 37009587

    View details for PubMedCentralID PMC9976051

  • Serous retinal detachment as a presenting sign of acute lymphoblastic leukemia: A case report and literature review. American journal of ophthalmology case reports Veerappan Pasricha, M., Callaway, N. F., Nguyen, Q. D., Do, D. V. 2021; 23: 101142

    Abstract

    Purpose: To describe a unique case of unilateral serous retinal detachment as the presenting sign of B-cell acute lymphoblastic leukemia (ALL).Observations: A 74 year old woman presented with right eye blurry vision and was found to have an underlying serous retinal detachment, along with cotton wool spots, inner retinal hemorrhages, and retinal pigment epithelial changes throughout her bilateral fundi. Fluorescein angiography demonstrated bilateral vasculitis and ultrasonography revealed asymmetric thickening and enhancement of the affected eyes' choroid. This prompted a systemic lab workup and results were suspicious for an underlying hematologic malignancy. The patient was admitted to the hospital for bone marrow biopsy confirming B-cell ALL, underwent intensive intravenous and intrathecal chemotherapy, and was discharged one month later. Follow up appointment in the ophthalmology clinic demonstrated functional and anatomic improvement in the serous retinal detachment and choroidal thickening suggestive of infiltration in her right eye.Conclusions: SRDs are an uncommon ocular manifestation of leukemia, and even less common as a presenting sign of the disease. A comprehensive literature review demonstrated 11 other cases reported worldwide. We present the first such case with additional findings of leukemic retinopathy, optic nerve and choroidal infiltration, and vasculitis, as well as a complete library of ophthalmic imaging from the patient's initial presentation.Importance: A new diagnosis of serous retinal detachment(s) without any obvious cause should raise suspicion for leukemia and prompt further workup. Early recognition of this hematologic malignancy is crucial for prompt initiation of life-saving therapy.

    View details for DOI 10.1016/j.ajoc.2021.101142

    View details for PubMedID 34222714

  • Fall risk in patients with pseudophakic monovision. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Rosenblatt, T. R., Vail, D., Ludwig, C. A., Al-Moujahed, A., Pasricha, M. V., Ji, M. H., Callaway, N. F., Moshfeghi, D. M. 2021

    Abstract

    OBJECTIVE: Vision changes can precipitate falls in the elderly resulting in significant morbidity and mortality. We hypothesized that pseudophakic monovision and ensuing anisometropia and aniseikonia impact elderly fall risk. This study assessed fall risk in patients with pseudophakic monovision, pseudophakic single vision distance (classic cataract surgery), and cataracts with no surgery.DESIGN: Retrospective single-institution cohort study PARTICIPANTS: Patients with bilateral cataracts diagnosed at 60 years of age or older who underwent bilateral cataract surgery (monovision or single vision distance) or did not undergo any cataract surgery (n = 13 385). Patients with unilateral surgery or a fall prior to cataract diagnosis were excluded.METHODS: Data were obtained from the Stanford Research Repository. Time-to-fall analysis was performed across all 3 groups. Primary outcome was hazard ratio (HR) for fall after second eye cataract surgery or after bilateral cataract diagnosis.RESULTS: Of 13 385 patients (241 pseudophakic monovision, 2809 pseudophakic single vision, 10 335 no surgery), 850 fell after cataract diagnosis. Pseudophakic monovision was not associated with fall risk after controlling for age, sex, and myopia. Pseudophakic single-vision patients had a decreased time to fall compared with no-surgery patients (log rank, p < 0.001). Older age at cataract diagnosis (HR =1.05, 95% confidence interval [CI] 1.04-1.06, p < 0.001) or at time of surgery (HR = 1.05, 95% CI 1.03-1.07, p < 0.001) increased fall risk, as did female sex (HR = 1.29, 95% CI 1.10-1.51, p = 0.002) and preexisting myopia (HR = 1.31, 95% CI 1.01-1.71, p = 0.046) among nonsurgical patients.CONCLUSIONS: Pseudophakic monovision did not impact fall risk, but pseudophakic single vision may increase falls compared with patients without cataract surgery.

    View details for DOI 10.1016/j.jcjo.2021.07.010

    View details for PubMedID 34419423

  • Comparison between wide-field digital imaging system and the red reflex test for universal newborn eye screening in Brazil. Acta ophthalmologica da Cunha, L. P., Cavalcante Costa, M. A., de Miranda, H. A., Reis Guimaraes, J., Aihara, T., Ludwig, C. A., Rosenblatt, T., Callaway, N. F., Pasricha, M., Al-Moujahed, A., Vail, D., Ji, M. H., Kumm, J., Moshfeghi, D. M. 2021

    Abstract

    PURPOSE: To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system.METHODS: Prospective cohort study. Newborns (n=380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericordia de Sao Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [kappa] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).RESULTS: While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (kappa=-0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns.CONCLUSION: While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.

    View details for DOI 10.1111/aos.14759

    View details for PubMedID 34032022

  • Visual acuity and progression of macular atrophy in patients receiving intravitreal anti-VEGF for age-related macular degeneration. European journal of ophthalmology Ji, M. H., Callaway, N. F., Ludwig, C. A., Vail, D., Al-Moujahed, A., Rosenblatt, T. R., Leng, T., Sanislo, S. R., Moshfeghi, D. M. 2021: 11206721211001708

    Abstract

    PURPOSE: Whether intravitreal anti-vascular endothelial growth factors (VEGFs) cause retinal atrophy is still a subject of debate. We reported 13 eyes that received several injections of anti-VEGF for wet age-related macular degeneration (AMD) with good visual acuity despite geographic atrophy on imaging.METHODS: This is a case series study conducted at Byers Eye Institute at Stanford University. Patients of three retina specialists with wet AMD who received six or more intravitreal injection of anti-VEGFs with visual acuity of 20/60 or better and incomplete RPE and outer retina atrophy (iRORA) or complete RPE and outer retinal atrophy (cRORA) were enrolled in this case series. Different imaging modalities were reviewed by three retina specialists comparing the baseline with the most recent exam.RESULTS: About 13 eyes of 10 patients met the selection criteria. Eleven eyes were classified as iRORA and 2 as cRORA. Despite the development of macular atrophy on imaging after an average of 38.1 injections, eyes maintained stable visual acuity.CONCLUSION: The discrepancy between structural and functional findings in this cohort suggests that patients treated by anti-VEGF drugs exhibit divergent clinical outcomes for currently unknown reasons. The authors propose anti-VEGF may affect melanosomes within RPE without disrupting RPE and photoreceptors function completely. This requires further investigation.

    View details for DOI 10.1177/11206721211001708

    View details for PubMedID 33781106

  • Key factors in a rigorous longitudinal image-based assessment of retinopathy of prematurity. Scientific reports Rosenblatt, T. R., Ji, M. H., Vail, D., Ludwig, C. A., Al-Moujahed, A., Pasricha, M. V., Callaway, N. F., Kumm, J., Moshfeghi, D. M. 2021; 11 (1): 5369

    Abstract

    To describe a database of longitudinally graded telemedicine retinal images to be used as a comparator for future studies assessing grader recall bias and ability to detect typical progression (e.g. International Classification of Retinopathy of Prematurity (ICROP) stages) as well as incremental changes in retinopathy of prematurity (ROP). Cohort comprised of retinal images from 84 eyes of 42 patients who were sequentially screened for ROP over 6 consecutive weeks in a telemedicine program and then followed to vascular maturation or treatment, and then disease stabilization. De-identified retinal images across the 6 weekly exams (2520 total images) were graded by an ROP expert based on whether ROP had improved, worsened, or stayed the same compared to the prior week's images, corresponding to an overall clinical "gestalt" score. Subsequently, we examined which parameters might have influenced the examiner's ability to detect longitudinal change; images were graded by the same ROP expert by image view (central, inferior, nasal, superior, temporal) and by retinal components (vascular tortuosity, vascular dilation, stage, hemorrhage, vessel growth), again determining if each particular retinal component or ROP in each image view had improved, worsened, or stayed the same compared to the prior week's images. Agreement between gestalt scores and view, component, and component by view scores was assessed using percent agreement, absolute agreement, and Cohen's weighted kappa statistic to determine if any of the hypothesized image features correlated with the ability to predict ROP disease trajectory in patients. The central view showed substantial agreement with gestalt scores (kappa=0.63), with moderate agreement in the remaining views. Of retinal components, vascular tortuosity showed the most overall agreement with gestalt (kappa=0.42-0.61), with only slight to fair agreement for all other components. This is a well-defined ROP database graded by one expert in a real-world setting in a masked fashion that correlated with the actual (remote in time) exams and known outcomes. This provides a foundation for subsequent study of telemedicine's ability to longitudinally assess ROP disease trajectory, as well as for potential artificial intelligence approaches to retinal image grading, in order to expand patient access to timely, accurate ROP screening.

    View details for DOI 10.1038/s41598-021-84723-7

    View details for PubMedID 33686091

  • Higher prevalence of fundus haemorrhages in early-screened (NEST Study) as compared to late-screened (SUNDROP Study) newborn populations. The British journal of ophthalmology Ludwig, C. A., Jabbehdari, S., Ji, M., Vail, D., Al-Moujahed, A., Rosenblatt, T., Azad, A. D., Veerappan, M., Callaway, N. F., Moshfeghi, D. M. 2021

    Abstract

    BACKGROUND/AIMS: To determine whether timing of ophthalmic screening influences prevalence of neonatal fundus haemorrhages. We compared the prevalence of fundus haemorrhages in two populations: term newborns screened early (less than 72 hours) and preterm newborns screened late (4-11 weeks). Additionally, we reviewed the literature on timing and prevalence of newborn haemorrhages.METHODS: Retrospective observational cohort study. Infants who underwent wide-angle ophthalmic digital imaging over one overlapping year in the Newborn Eye Screen Testing (NEST) or Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) programme were included. The PubMed database was filtered to include English-language articles dating back to 1950. Nine articles were selected for review based on inclusion of the prevalence of newborn fundus haemorrhages at multiple time points.RESULTS: A total of 202 patients received early imaging in the NEST cohort and 73 patients received late imaging in the SUNDROP cohort. In the NEST cohort, 20.2% of newborns had haemorrhages. In contrast, we found haemorrhages in only one case or 1.4% of the SUNDROP cohort. Using prevalence data from nine additional studies, we developed a predicted probabilities model of newborn haemorrhages. Per this model, the probability of seeing a haemorrhage if you screen an infant at 1 hour is 18.8%, at 2 weeks is 2.9% and at 1 month is 0.28%.CONCLUSION: We found a significant difference in the prevalence of fundus haemorrhages between the early-screened NEST cohort and the late-screened, preterm SUNDROP cohort. Likely, this difference is due to the transient nature of most newborn haemorrhages.

    View details for DOI 10.1136/bjophthalmol-2020-317908

    View details for PubMedID 33514529

  • Statins and the progression of age-related macular degeneration in the United States. PloS one Ludwig, C. A., Vail, D., Rajeshuni, N. A., Al-Moujahed, A., Rosenblatt, T., Callaway, N. F., Veerappan Pasricha, M., Ji, M. H., Moshfeghi, D. M. 2021; 16 (8): e0252878

    Abstract

    To study the effect of statin exposure on the progression from non-exudative to exudative age-related macular degeneration (AMD).Retrospective cohort study of commercially insured patients diagnosed with non-exudative AMD (n = 231,888) from 2007 to 2015. Time-to-event analysis of the association between exposure to lipid-lowering medications and time from non-exudative AMD to exudative AMD diagnosis was conducted. Outcome measures included progression to exudative AMD, indicated by diagnosis codes for exudative AMD or procedural codes for intravitreal injections.In the year before and after first AMD diagnosis, 11,330 patients were continuously prescribed lipid-lowering medications and 31,627 patients did not take any lipid-lowering medication. Of those taking statins, 21 (1.6%) patients were on very-high-dose lipophilic statins, 644 (47.6%) on high-dose lipophilic statins, and 689 (50.9%) on low-dose lipophilic statins. We found no statistically significant relationship between exposure to low (HR 0.89, 95% CI 0.83 to 1.38) or high-dose lipophilic statins (HR 1.12, 95% CI 0.86 to 1.45) and progression to exudative AMD. No patients taking very-high-dose lipophilic statins converted from non-exudative to exudative AMD, though this difference was not statistically significant due to the subgroup size (p = .23, log-rank test).No statistically significant relationship was found between statin exposure and risk of AMD progression. Interestingly, no patients taking very-high-dose lipophilic statins progressed to exudative AMD, a finding that warrants further exploration.

    View details for DOI 10.1371/journal.pone.0252878

    View details for PubMedID 34347799

  • Intravitreal Fluocinolone Acetonide (Retisert) Implantation Using a Keratome Blade JOURNAL OF VITREORETINAL DISEASES Pasricha, M., Callaway, N. F., Mahajan, V. B. 2021; 5 (1): 66-67
  • Risk of Retinal Artery Occlusion in Patients with Migraine. American journal of ophthalmology Al-Moujahed, A., Tran, E. M., Azad, A., Vail, D., Ludwig, C. A., Pasricha, M. V., Rosenblatt, T. R., Callaway, N. F., Moshfeghi, D. M. 2020

    Abstract

    PURPOSE: To determine if migraine is associated with increased risk of retinal artery occlusion (RAO).DESIGN: Retrospective cohort study METHODS: Setting: A large insurance claims database.PARTICIPANTS: Patients with migraine and matched controls without migraine between 2007 to 2016.PROCEDURES: Cox proportional hazard regression models were used to investigate the association between migraine and risk of all RAO, central RAO (CRAO), branch RAO (BRAO), and "other" RAO, which includes transient and partial RAO.MAIN OUTCOME MEASURES: Incidence of all RAO, including CRAO, BRAO, and other RAO, following first migraine diagnosis.RESULT: There were 418,965 patients with migraine who met study criteria and were included in the analysis with the appropriate matched controls. Among the 418,965 patients with migraine, 1,060 (0.25%) were subsequently diagnosed with RAO, whereas only 335 (0.08%) of the patients without migraine were diagnosed with RAO. The hazard ratio (HR) for incident all RAO in patients with migraine compared with those without migraine was 3.48 (95% Confidence Interval (CI): 3.07 - 3.94; P <0.0001]. This association was consistent across all types of RAO, including CRAO (HR = 1.62; 95% CI: 1.15 - 2.28; P=0.004) BRAO (HR 2.09; 95% CI 1.60 - 2.72; P <0.001), and other types of RAO (HR 4.61; 95% CI 3.94 - 5.38; P <0.001). Patients with migraine with aura had a higher risk for incident RAO compared with those with migraine without aura (HR = 1.58; 95% CI: 1.40 - 1.79; P <0.001). This association was consistent for BRAO (HR = 1.43; 95% CI 1.04 - 1.97; P <0.03) and other types of RAO (HR = 1.67; 95% CI 1.45 - 1.91; P <0.001), but was not statistically significant for CRAO (HR = 1.18; 95% CI 0.75 - 1.87; P = 0.475). Significant risk factors for this association included increased age, male sex, acute coronary syndrome, valvular disease, carotid disease, hyperlipidemia, hypertension, retinal vasculitis and/or inflammation, and systemic lupus erythematosus.CONCLUSIONS: Migraine is associated with increased risk of all types of RAO and migraine with aura is associated with increased risk of RAO compared with migraine without aura.

    View details for DOI 10.1016/j.ajo.2020.11.004

    View details for PubMedID 33359716

  • The Influence of Surgical Timing on Clinical Outcomes in Primary Extramacular Retinal Detachment in a Tertiary Referral Center. Journal of vitreoretinal diseases Yannuzzi, N. A., Brown, K., Callaway, N. F., Patel, N. A., Albini, T. A., Berrocal, A. M., Davis, J. L., Gregori, N. N., Fortun, J., Haddock, L. J., Lee, W. H., Schwartz, S. G., Sridhar, J., Smiddy, W. E., Flynn, H. W., Townsend, J. 2020; 4 (2): 91-95

    Abstract

    This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center.A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA).There were 202 eyes of 198 patients with an average of 22 months' follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.18 (Snellen equivalent, 20/30; SD, 0.36). In those treated the day of presentation, average postoperative logMAR BCVA was 0.18 (Snellen, 20/31) in comparison to 0.18 (Snellen, 20/30) in those treated the day after presentation and 0.14 (Snellen, 20/28) in those treated after 2 days or more (P = .92).Regarding timing of surgery, SOAS and BCVA outcomes in primary extramacular RRDs were favorable with an urgent and semiurgent approach to repair. There was no difference in visual and anatomic outcomes between patients who were operated on the day of presentation and those treated a short time later when clinical decisions were made by the treating surgeon on a case-by-case basis.

    View details for DOI 10.1177/2474126419893816

    View details for PubMedID 37008372

    View details for PubMedCentralID PMC9976257

  • Idiopathic bilateral inner retinal defects in a child CANADIAN JOURNAL OF OPHTHALMOLOGY-JOURNAL CANADIEN D OPHTALMOLOGIE Ji, M. H., Callaway, N. F., Vail, D., Moshfeghi, D. M. 2020; 55 (6): E197–E199
  • Morning glory optic nerve in Aicardi syndrome: Report of a case with fluorescein angiography. European journal of ophthalmology Al-Moujahed, A., Callaway, N. F., Ludwig, C. A., Rayess, N., Wood, E., Moshfeghi, D. M. 2020: 1120672120942702

    Abstract

    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

  • Bilateral focal choroidal excavations in a patient with Stargardt disease and ocular toxoplasmosis. European journal of ophthalmology Ji, M. H., Jabbehdari, S., Callaway, N. F., Moshfeghi, D. M. 2020: 1120672120932092

    Abstract

    INTRODUCTION: Focal choroidal excavation (FCE) is a concavity of the choroid detected on optical coherence tomography (OCT). It is usually idiopathic and the affected eyes are otherwise healthy with near-normal overlying retinal architecture and good visual acuity.PURPOSE: To report a case of bilateral conforming FCE in the setting of Stargardt disease and inactive ocular toxoplasmosis.CASE REPORT: A 20-year-old man with known history of Stargardt disease, healed toxoplasmosis, and high myopia presented to our ophthalmology department for follow-up examination and was found with bilateral FCEs not present in any of his previous examinations.CONCLUSION: FCEs have been reported in the literature in otherwise healthy eyes as well as a broad spectrum of ocular diseases. The case herein reported Stargardt disease, toxoplasmosis, and high myopia all could potentially contribute to the pathogenesis of these findings. Further studies are needed to define etiologies as well as clinical significance and course of FCEs.

    View details for DOI 10.1177/1120672120932092

    View details for PubMedID 32486902

  • Progression of Dry to Wet Age-related Macular Degeneration in Patients Receiving Intensive Statin Treatment Al Moujahed, A., Ludwig, C. A., Davila, J., Vail, D., Callaway, N. F., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Absolute Risk of Rhegmatogenous Retinal Detachment in High Myopes in the United States Ludwig, C. A., Vail, D., Callaway, N. F., Al-Moujahed, A., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Absolute Risk of Rhegmatogenous Retinal Detachment in High Myopes in the United States Ludwig, C. A., Vail, D., Callaway, N. F., Al-Moujahed, A., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Absolute Risk of Rhegmatogenous Retinal Detachment in High Myopes in the United States Ludwig, C. A., Vail, D., Callaway, N. F., Al-Moujahed, A., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Absolute Risk of Rhegmatogenous Retinal Detachment in High Myopes in the United States Ludwig, C. A., Vail, D., Callaway, N. F., Al-Moujahed, A., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Absolute Risk of Rhegmatogenous Retinal Detachment in High Myopes in the United States Ludwig, C. A., Vail, D., Callaway, N. F., Al-Moujahed, A., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Effective Field of View of Wide-Field Fundus Camera for Retinopathy of Prematurity Screening Ji, M. H., Bodnar, Z., Callaway, N. F., Ludwig, C. A., Kumm, J., Rosenblatt, T., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Retinopathy of prematurity and neurodevelopmental outcomes in premature infants. Eye (London, England) Al-Moujahed, A., Azad, A., Vail, D., Ludwig, C. A., Callaway, N. F., Moshfeghi, D. M. 2020

    View details for DOI 10.1038/s41433-020-0941-x

    View details for PubMedID 32398837

  • Telemedicine Follow-Up for Intravitreal Bevacizumab Injection in the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Cohort. Clinical ophthalmology (Auckland, N.Z.) Ji, M. H., Callaway, N. F., Greven, M. A., Vail, D., Moshfeghi, D. M. 2020; 14: 1161-1163

    Abstract

    Telemedicine has emerged as a potential solution to face the disproportion between infants that need to be screened for retinopathy of prematurity (ROP) and the lack of ophthalmologists. We evaluated its utility in the follow-up after off-label intravitreal injection of bevacizumab. None of the treated infants ended up with bad anatomic outcome. Telemedicine is an alternative safe method to monitor patients after treatment.

    View details for DOI 10.2147/OPTH.S250361

    View details for PubMedID 32431486

    View details for PubMedCentralID PMC7200391

  • The Influence of Surgical Timing on Clinical Outcomes in Primary Extramacular Retinal Detachment in a Tertiary Referral Center JOURNAL OF VITREORETINAL DISEASES Yannuzzi, N. A., Brown, K., Callaway, N. F., Patel, N. A., Albini, T. A., Berrocal, A. M., Davis, J. L., Gregori, N. N., Fortun, J., Haddock, L. J., Lee, W., Schwartz, S. G., Sridhar, J., Smiddy, W. E., Flynn, H. W., Townsend, J. 2020; 4 (2): 91-95
  • Resolution of optic disc pit-associated macular retinoschisis after topical carbonic anhydrase inhibitor treatment: Report of a case. European journal of ophthalmology Al-Moujahed, A., Callaway, N. F., Vail, D., Ludwig, C. A., Ji, M. H., Moshfeghi, D. M. 2020: 1120672120904664

    Abstract

    BACKGROUND: Optic disc pits frequently lead to visual deterioration due to macular retinoschisis or serous retinal detachment. Here, we report a case of optic disc pit-associated macular retinoschisis due to intraretinal fluid accumulation that resolved with improvement in visual acuity after treatment with topical dorzolamide.CASE DESCRIPTION: A 56-year-old otherwise healthy female with no ocular history presented with 2weeks of slowly worsening blurry vision in her right eye. Visual acuity was 20/30 in the right eye. Posterior segment examination revealed posterior vitreous detachment, an optic disc pit at 9 o'clock, macular edema and foveoschisis with fluid extending from the optic nerve, and a normal peripheral retina. Optical coherence tomography imaging of the macula showed central subfield thickness of 526m. The patient preferred no surgical intervention, so topical dorzolamide 2% three times daily was initiated. Over the next 2 years, the central subfield thickness steadily declined from 526 to 262m, and her vision improved to 20/20 with improvement in the macular retinoschisis.CONCLUSION: Our report presents a case of resolution of optic disc pit-associated macular retinoschisis due to intraretinal fluid accumulation with possible role for dorzolamide as a potential treatment option.

    View details for DOI 10.1177/1120672120904664

    View details for PubMedID 32019335

  • Von Hippel-Lindau Syndrome Phenotype With Prominent Vitreoretinal Neovascularization Treated With Early PPV: A Case Series and Literature Review OPHTHALMIC SURGERY LASERS & IMAGING RETINA Zubair, T., Callaway, N. F., Ludwig, C., Tang, P. H., Shields, R. A., Ji, M. H., Vail, D., Powers, M. A., Moshfeghi, D. M. 2020; 51 (2): 109–15

    Abstract

    To describe a case series of three patients in one family with Von Hippel-Lindau (VHL) disease who presented with vitreoretinal neovascularization and resulting tractional retinal detachments (TRDs). This vitreoretinal phenotype of VHL may benefit from early surgical intervention.Descriptive case series of three patients in one family with VHL disease. A review of the literature regarding surgical intervention for VHL was performed.All three patients developed prominent intravitreal neovascularization with fibrovascular growth within the vitreous secondary to a retinal capillary hemangioma. Two subjects with intravitreal neovascularization were treated with laser and cryotherapy but eventually developed a TRD. The final vision in these two patients was light perception and 20/300. The eye that was preemptively treated with vitrectomy to remove the vitreous sustaining the neovascularization had visual acuity of 20/50 after surgery.Intravitreal neovascularization with fibrovascular proliferation may be an indication for vitrectomy prior to the development of retinal detachment. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:109-115.].

    View details for DOI 10.3928/23258160-20200129-07

    View details for Web of Science ID 000516809400007

    View details for PubMedID 32084284

  • Idiopathic bilateral inner retinal defects in a child. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Ji, M. H., Callaway, N. F., Vail, D. n., Moshfeghi, D. M. 2020

    View details for DOI 10.1016/j.jcjo.2020.04.018

    View details for PubMedID 32646600

  • Telemedicine Follow-Up for Intravitreal Bevacizumab Injection in the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Cohort CLINICAL OPHTHALMOLOGY Ji, M. H., Callaway, N. F., Greven, M. A., Vail, D., Moshfeghi, D. M. 2020; 14: 1161–63
  • Timing and Reoperation Rate of Rhegmatogenous Retinal Detachments Occurring During Major Ophthalmology Meetings. Ophthalmic surgery, lasers & imaging retina Vail, D. n., Al-Moujahed, A. n., Callaway, N. F., Ji, M. H., Ludwig, C. A., Moshfeghi, D. M. 2020; 51 (6): 328–37

    Abstract

    To investigate whether surgical management of newly diagnosed rhegmatogenous retinal detachment (RRD) varies if patients are diagnosed during a major national ophthalmology conference.This retrospective cohort study included 34,759 patients with incident RRD, of whom, 1,246 (3.6%) were diagnosed during dates of three national ophthalmology conferences, and 1,170 (3.4%) underwent surgery during conference dates. The authors identified patients with primary repair with cryotherapy, laser, scleral buckle, pneumatic retinopexy, or pars plana vitrectomy. Multinomial logistic regression models were used to determine patients' likelihood of receiving each type of repair within 30 days of their diagnosis depending on whether they were diagnosed during a national ophthalmology conference. Linear regression models were used to determine the relationship between the date patients were diagnosed and how long they waited to receive a repair. Main outcome measures included days between diagnosis with RRD and RRD repair, receiving repair on the same day of diagnosis, and reoperation rate within 30 days of the primary repair.Mean time from diagnosis to repair was 1.5 days (standard deviation: ± 2.4 days), and 71% of patients underwent repair within a day of diagnosis. Repairs were followed by a second surgery within 30 days in 11.1% of patients. Patients diagnosed during conferences waited 0.23 days longer between diagnosis and repair compared with patients diagnosed outside of conference dates (P = .001). Patients diagnosed with RRD during conferences were less likely to receive surgical repair within a day of diagnosis compared to patients diagnosed during non-conference dates (P = .037). Patients who were diagnosed with RRD during a conference date and also received surgery during a conference date were more likely to undergo a second surgery within 30 days of the primary procedure (P = .006) CONCLUSIONS: Patients diagnosed with RRD during national ophthalmology conference dates waited slightly longer for surgery, were slightly less likely to receive surgery within a day, and were more likely to undergo a second surgery within 30 days of the primary procedure. The "national meeting effect" phenomenon is present in ophthalmology, albeit to a lesser degree that is likely not visually significant. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:328-337.].

    View details for DOI 10.3928/23258160-20200603-03

    View details for PubMedID 32579691

  • Intravitreal methotrexate and fluocinolone acetonide implantation for Vogt-Koyanagi-Harada uveitis. American journal of ophthalmology case reports Park, J. G., Callaway, N. F., Ludwig, C. A., Mahajan, V. B. 2020; 19: 100859

    Abstract

    To report a case of intravitreal methotrexate treatment and fluocinolone acetonide (Retisert®) implantation in a patient with Vogt-Koyanagi-Harada syndrome (VKH).A 34-year-old male was referred for worsening vision and bilateral panuveitis consistent with VKH. He was treated with prednisone, mycophenolate mofetil, prednisolone acetate eye drops, and injections of triamcinolone and adalimumab. He failed to improve with these therapies and developed multiple adverse effects, including hepatotoxicity, severe eye pain, cataracts, and cystoid macular edema. We treated him with intravitreal methotrexate injections in both eyes, which rapidly improved his eye pain, inflammation, and vision. He subsequently underwent fluocinolone acetonide (Retisert®) implantation, cataract extraction with intraocular lens insertion, and Ahmed tube placement for long-term intraocular pressure control. His vision improved from hand motions to 20/30, intraocular pressure remained stable at 17, there was complete resolution of his panuveitis and uveitic macular edema, and his systemic medications were able to be discontinued./Importance: This case demonstrates intravitreal methotrexate may successfully treat intraocular inflammation, pain, and macular edema in VKH. Excellent long-term vision and reduction of adverse effects of systemic medications were also achieved with subsequent fluocinolone acetonide implantation. Combining these two targeted therapies may be an effective strategy in treating VKH in patients who have severe pain and cannot tolerate systemic therapy.

    View details for DOI 10.1016/j.ajoc.2020.100859

    View details for PubMedID 32793845

    View details for PubMedCentralID PMC7415829

  • Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect. European journal of ophthalmology Ji, M. H., Moshfeghi, D. M., Shields, R. A., Bodnar, Z. n., Ludwig, C. A., Callaway, N. F., Orazi, L. n., Amorelli, G. M., Lepore, D. n. 2020: 1120672120945101

    Abstract

    To determine if fluorescein angiographic (FA) findings after intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) conform to a class effect previously described with bevacizumab.Single-center retrospective case series of all infants treated with 0.2 mg (0.02 mL) IVR for Type 1 ROP from July 2016 to November 2018. FA were obtained at 40, 52, 62, and 72 weeks of postmenstrual age (PMA) using wide-angle photography. FA images were analyzed and the peripheral avascular areas measured with ImageJ using a reference disc diameter (DD). Based on the extent of the avascular area and tortuosity of the retinal vessels all eyes were classified into four categories: complete vascular maturity (vascularization within 2 DD of the ora serrata), VAA (avascular area >2 DD of the ora serrata), VAT (avascular area >2 DD of the ora serrata and posterior tortuosity), and reactivation (recurrence of stage disease).About 13 infants were enrolled and 24 eyes were available in this study. None of the eyes reached complete vascular maturity at an average PMA of 60 weeks, 7 (29%) eyes presented with VAA, 8 (33%) with VAT, and 9 (37.5%) reactivated. The reactivated eyes presented with the largest area of peripheral ischemia, followed by the VAT and then the VAA groups (p = 0.02).IVR conforms to the previously described regression patterns following intravitreal bevacizumab for ROP indicative of a class effect. Follow-up using FA might help to optimize the management of these infants after injection of the drug.

    View details for DOI 10.1177/1120672120945101

    View details for PubMedID 32722932

  • Sex Differences in the Repair of Retinal Detachments in the United States. American journal of ophthalmology Callaway, N. F., Vail, D. n., Al-Moujahed, A. n., Ludwig, C. n., Ji, M. H., Mahajan, V. B., Pershing, S. n., Moshfeghi, D. M. 2020

    Abstract

    To determine differences between women and men in the repair of rhegmatogenous retinal detachments (RRD) in the United States.Retrospective cohort study.SETTING: A large insurance claims database.Subjects with an incident RRD between 2007-2015.Demographic data, comorbid ocular conditions associated with RRD,systemic comorbidities,and surgical intervention (pneumatic retinopexy (PR), pars plana vitrectomy (PPV), laser barricade, or scleral buckle (SB)) were collected.Odds of receipt of surgical intervention for incident RRD, time to repair, type of intervention, and the rate of reoperation by sex.The study period included 133 million eligible records with 61,071 cases of incident RRD meeting inclusion criteria among which 43% (n = 26,289) were women. Women had 34% reduced odds of receipt of surgical repairof an RRD (OR 0.66, 95% CI 0.59 - 0.73, p<0.001) after adjusting for confounders. This effect persisted in all sensitivity models. Among patients that received repair, women were more often delayed (0.17 days, p = 0.04). Women were more likely to undergo primary laser barricade (RRR 1.68, p < 0.001), primary SB (RRR 1.15, p < 0.001), and PR (RRR 1.07, p < 0.04) than men. The odds of reoperation were lower in women (OR 0.91, 95% CI 0.85 - 0.96, p=0.002) after adjustment.Insured women are less likely than insured men to receive surgical intervention for an RRD. If the odds of repair were equal between women and men in the U.S. then 781 more women would receive surgery each year, or 7,029 more during the study period. Women are more likely to have the repair performed with scleral buckle and laser barricade. The reason for thesesex differences in RRD repair remains unknown and requires further investigation.

    View details for DOI 10.1016/j.ajo.2020.06.039

    View details for PubMedID 32640255

  • Surgical Outcomes Of Rhegmatogenous Retinal Detachment In Young Adults Ages 18-30 Years. Clinical ophthalmology (Auckland, N.Z.) Brown, K., Yannuzzi, N. A., Callaway, N. F., Patel, N. A., Relhan, N., Albini, T. A., Berrocal, A. M., Davis, J. L., Fortun, J. A., Smiddy, W. E., Sridhar, J., Flynn, H. W., Townsend, J. H. 2019; 13: 2135-2141

    Abstract

    The purpose of this study is to investigate associations with and surgical outcomes of rhegmatogenous retinal detachment (RRD) in young adults.This is a retrospective consecutive case series of patients aged 18-30 years who underwent surgical repair for RRD between January 1, 2014 and December 1, 2016 at a university referral center.The current study includes 38 eyes with RRD. Documented high or moderate myopia was present in 28 (74%) eyes. Connective tissue disease was present in 3 (8%) eyes. Median pre-operative visual acuity (VA) was 20/70. Surgery was performed via scleral buckle (SB) alone in 27/38 (71%) and via combined SB and pars plana vitrectomy (SB/PPV) in 11/38 (29%) eyes. Single surgery anatomical success (SSAS) rate was 20/27 (74%) for SB and 7/11 (64%) for SB/PPV. The retina was reattached at last follow-up in 25/27 (93%) for SB and 11/11 (100%) for SB/PPV. The median postoperative VA was 20/40.In the current study of young adults with RRD, the most common association was high or moderate myopia. Visual and anatomic outcomes at last follow-up were generally favorable.

    View details for DOI 10.2147/OPTH.S213042

    View details for PubMedID 31802843

    View details for PubMedCentralID PMC6827499

  • Persistent Plus Disease Subsequent to Panretinal Photocoagulation in an Infant With Retinopathy of Prematurity OPHTHALMIC SURGERY LASERS & IMAGING RETINA Shah, S. M., Callaway, N. F., Moshfeghi, D. M. 2019; 50 (8): 520–21

    Abstract

    Plus disease, or the presence of vascular dilation and tortuosity, is the most reliable predictor of the progression of retinopathy of prematurity (ROP), making resolution of plus disease one of the earliest signs of ROP regression. Patients with certain comorbid conditions such as anemia and cardiovascular disease may have persistent plus-like disease following successful resolution of ROP. The authors present a case of a 24-week premature infant who was treated with panretinal photocoagulation for stage 3, zone II. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:520-521.].

    View details for DOI 10.3928/23258160-20190806-08

    View details for Web of Science ID 000481659700013

    View details for PubMedID 31415700

  • Retinopathy of Prematurity Reactivated 28 Months after Injection of Ranibizumab. Ophthalmology. Retina Ji, M. H., Moshfeghi, D. M., Callaway, N. F., Bodnar, Z., Schachar, I. H., Amorelli, G. M., Orazi, L., Molle, F., Lepore, D. 2019

    View details for DOI 10.1016/j.oret.2019.06.017

    View details for PubMedID 31474514

  • Birth-related subconjunctival and retinal haemorrhages in the Newborn Eye Screening Test (NEST) Cohort. Eye (London, England) Ji, M. H., Ludwig, C. A., Callaway, N. F., Moshfeghi, D. M. 2019

    View details for DOI 10.1038/s41433-019-0523-y

    View details for PubMedID 31285570

  • High-Dose Statins and Progression of Age-Related Macular Degeneration in Commercially Insured Patients, 2007 to 2016 Ludwig, C. A., Rajeshuni, N., Vail, D., Callaway, N. F., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Regression patterns of Retinopathy of Prematurity after intravitreal injection of Ranibizumab Ji, M. H., Moshfeghi, D., Shields, R. A., Bodnar, Z., Ludwig, C. A., Callaway, N. F., Leng, T., Sanislo, S., Orazi, L., Amorelli, G., Lepore, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • A Spectrum of Regression Following Intravitreal Bevacizumab in Retinopathy of Prematurity AMERICAN JOURNAL OF OPHTHALMOLOGY Chen, T. A., Shields, R. A., Bodnar, Z. H., Callaway, N. F., Schachar, I. H., Moshfeghi, D. M. 2019; 198: 63–69
  • Widefield imaging of retinal and choroidal tumors. International journal of retina and vitreous Callaway, N. F., Mruthyunjaya, P. n. 2019; 5 (Suppl 1): 49

    Abstract

    Wide-field imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review is to describe the commonly used wide-field imaging devices and review conditions seen in ocular oncology clinic that underwent wide-field imaging as part of the multimodal evaluation.Wide-field or wide-angle imaging is defined as greater than 50° field of view. Modern devices can reach far beyond this reporting fields of view up to 267°, when utilizing montage features, with increasingly impressive resolution. Wide-field imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and recently wide-field OCT Angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The wide-field systems include laser, optical, and lens based systems that are contact or non-contact lens systems each with its own benefits and drawbacks. The purpose of this review is to discuss commonly used wide-field imaging modalities for retinal and choroidal tumors and demonstrate the use of various widefield imaging modalities in select ocular oncology cases.Clinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Wide-field imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment, and monitoring for recurrence.

    View details for DOI 10.1186/s40942-019-0196-5

    View details for PubMedID 31890289

    View details for PubMedCentralID PMC6907111

  • Surgical Outcomes Of Rhegmatogenous Retinal Detachment In Young Adults Ages 18-30 Years CLINICAL OPHTHALMOLOGY Brown, K., Yannuzzi, N. A., Callaway, N. F., Patel, N. A., Relhan, N., Albini, T. A., Berrocal, A. M., Davis, J. L., Fortun, J. A., Smiddy, W. E., Sridhar, J., Flynn, H. W., Townsend, J. H. 2019; 13: 2135–41
  • Colour change in the newborn iris: 2-year follow-up of the Newborn Eye Screening Test study. Acta ophthalmologica Jabbehdari, S. n., Sinow, C. n., Ludwig, C. A., Callaway, N. F., Moshfeghi, D. M. 2019

    View details for DOI 10.1111/aos.14321

    View details for PubMedID 31811709

  • Lipid-Lowering Medications are Associated with Lower Risk of Retinopathy and Ophthalmic Interventions among U.S. Patients with Diabetes. American journal of ophthalmology Vail, D. n., Callaway, N. F., Ludwig, C. A., Saroj, N. n., Moshfeghi, D. M. 2019

    Abstract

    To evaluate the impact of lipid-lowering medications on diabetic retinopathy and diabetic complications requiring intervention in the U.S.Retrospective cohort analysis.Administrative insurance claims drawn from the Truven MarketScan Commercial Claims and Encounters database.Beneficiaries with Type 2 diabetes mellitus (T2DM).Any signs of diabetic retinopathy, as measured by diagnosis codes for non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), and procedure codes for retinopathy treatments (anti-VEGF injections, laser therapy, and vitrectomy).We analyzed a population of 269,782 patients diagnosed with T2DM between 2008 and 2015. 99,233 (37%) of patients were undergoing treatment with lipid-lowering medications. Approximately 6% of patients on lipid-lowering medications had a diagnosis code for NPDR, PDR, or DME, or a procedural code for intravitreal injections, PPV, or laser in their record following diagnosis with diabetes, compared to 6.5% of patients who did not take lipid-lowering medications (p<0.01). In adjusted time-to-event analyses, patients who took lipid-lowering medications prior to diagnosis with T2DM were less likely to progress to any retinopathy diagnosis (HR 0.60, 95% CI 0.55-0.65) and less likely to receive any treatment for retinopathy (HR 0.81, 95% CI 0.78-0.84). These findings were significant at the aggregate level, as well as at the level of individual diagnosis (NPDR HR 0.63, 95% CI 0.57-0.69; PDR HR 0.45, 95% CI 0.37-0.54; DME HR 0.39, 95% CI 0.33-0.45), and at the level of each treatment category (anti-VEGF injection HR 0.81, 95% CI 0.78-0.84; laser HR 0.62, 95% CI 0.47-0.81; vitrectomy HR 0.71, 95% CI 0.59-0.85).We find consistent evidence that patients on lipid-lowering medications are less likely to develop NPDR, PDR, or DME, and modest evidence that these patients are less likely to receive intravitreal injections of anti-VEGF medication, laser treatments, or vitrectomy. Our study validates the findings of studies that have used claims databases in East Asia in relatively homogeneous populations to estimate an association between statin use and retinopathy, replicating them in a U.S. context in a large commercial claims database.

    View details for DOI 10.1016/j.ajo.2019.05.029

    View details for PubMedID 31194953

  • Bilateral Endophthalmitis after Immediately Sequential Bilateral Cataract Surgery. Ophthalmology. Retina Callaway, N. F., Ji, M. H., Mahajan, V. B., Moshfeghi, D. M. 2019

    View details for DOI 10.1016/j.oret.2019.04.007

    View details for PubMedID 31153851

  • Pentosan Polysulfate Sodium Exposure and Drug-Induced Maculopathy in Commercially Insured Patients in the United States. Ophthalmology Ludwig, C. A., Vail, D. n., Callaway, N. F., Pasricha, M. V., Moshfeghi, D. M. 2019

    Abstract

    To determine the association and cumulative dose-response pattern between pentosan polysulfate sodium (PPS) use for interstitial cystitis (IC) and maculopathy.Large, multicenter, retrospective cohort study of commercially insured patients in the MarketScan database (Truven Health Analytics, San Jose, CA).Two hundred twenty-seven thousand three hundred twenty-five patients with IC who were enrolled continuously in the MarketScan database.Cox proportional hazards models (controlling for patient gender, age at index diagnosis of IC, and diagnosis with diabetes mellitus) followed up patients from index diagnosis of IC for 5 years, or until patients discontinued insurance coverage, or until patients' first diagnosis with a maculopathy. As a sensitivity analysis, we re-estimate all models after excluding all patients with diabetes. To assess for dose response, we calculated the total days of PPS prescriptions filled and created a categorical variable indicating total exposure.The primary outcome measure was association between binary PPS exposure and any maculopathy. Secondary outcome measures included exposure between binary and categorical, time-dependent, exposure to PPS and to drusen, nonexudative age-related macular degeneration (AMD), exudative AMD, hereditary maculopathy, and toxic maculopathy.The most common diagnoses of maculopathy in patients with IC were exudative AMD (1.5%), drusen (0.8%), nonexudative AMD (0.3%), toxic maculopathy (0.1%), and hereditary dystrophy (0.04%). In unadjusted analyses, the percentage of patients who filled a PPS prescription and were diagnosed later with a maculopathy (2.37%) was very similar to the percentage of patients who did not fill a prescription (2.77%). Survival models using a binary variable indicating PPS exposure showed no significant associations between PPS exposure and diagnosis of drusen, nonexudative AMD, exudative AMD, toxic maculopathy, hereditary dystrophy, or an aggregate variable of any maculopathy. Similarly, there was no dose-dependent relationship between PPS exposure and diagnosis of any maculopathy. These findings remained stable in sensitivity analysis models that excluded patients with diabetes mellitus.In this large, commercial claims database analysis, no association was found between PPS exposure and subsequent diagnosis of maculopathy.

    View details for DOI 10.1016/j.ophtha.2019.10.036

    View details for PubMedID 31899034

  • A Prospective Randomized Comparative Clinical Trial to Analyze Pain and Surgical Outcomes Between Frontal Nerve Blocks and Subconjunctival Anesthesia for Conjunctival Mullerectomy Resection OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Zatezalo, C. C., Tavakoli, M., Ayala-Haedo, J., Callaway, N. F., Ko, M. J., Anagnostopoulos, A. G., Vanner, E. A., Lee, W. W. 2018; 34 (6): 575–78

    Abstract

    Conjunctival Müller's muscle resection (CMMR) is a posterior approach surgical technique to correct blepharoptosis. The purpose of this study is to compare patient-reported pain scores and surgical outcomes for patients who received 2 different anesthetic techniques during CMMR, frontal nerve block and subconjunctival injection.A prospective randomized comparative clinical trial enrolled 33 CMMR subjects from one tertiary eye center. Patients undergoing unilateral CMMR were randomized to receive either frontal nerve block or subconjunctival injection. For patients undergoing bilateral CMMR, each side was randomized to one of the injection techniques. Upper eyelid margin reflex distance was measured and recorded for each eye before and after surgery. Patients' pain scores were quantified using the Wong Baker Pain Scale. Subjects quantified their pain during, immediately after, 12 and 24 hours after surgery.Twenty-four bilateral and 9 unilateral cases were enrolled in the study. Twenty-two (92%) subjects were female, and the mean patient age was 69 ± 12 years. The mean margin reflex distance was 1.1 mm preoperatively, which increased to 3.5 and 3.6 mm 2 months postoperatively in frontal nerve block and subconjunctival injection groups, respectively (p value <0.0001). Both paired and nonpaired analyses demonstrated no significant difference in the pain score reported by the patients or the surgical outcomes between the 2 anesthesia techniques at any time during or after the surgery. There were no anesthetic-related complications.There was no statistically significant difference in pain scores or surgical outcomes in patients receiving frontal nerve block compared with those receiving subconjunctival injection during CMMR surgery.

    View details for PubMedID 29634604

  • A spectrum of regression following intravitreal bevacizumab in retinopathy of prematurity. American journal of ophthalmology Chen, T. A., Shields, R. A., Bodnar, Z. H., Callaway, N., Schachar, I. H., Moshfeghi, D. M. 2018

    Abstract

    PURPOSE: To describe an improved understanding of the regression patterns following off-label intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP).DESIGN: Retrospective cohort study. MethodsAll infants treated with IVB for Type 1 ROP at a single institution from June 2013 to March 2018 were retrospectively reviewed and the amount of retinal non-perfusion on fluorescein angiogram was calculated. ResultsOnly 3 eyes (3.3%) reached full vascular maturity in the 92 eyes of 46 patients analyzed. Of the 89 eyes not reaching maturity, 39 eyes (43.8%) had vascular arrest alone (VAA), 34 eyes (38.2%) had vascular arrest with persistent tortuosity (VAT), and 16 (18.0%) had ROP reactivation. Those eyes that reactivated were more likely to be initially classified as aggressive posterior ROP (p = 0.004) and of Asian ethnicity (p = 0.008). There were greater areas of ischemia in eyes with reactivation as compared to VAT and VAA (112.1 mm2 vs 72.5 mm2 vs. 56.6 mm2, respectively, p = 0.007). Younger gestational age at birth was found to be an independent predictor of persistent tortuosity (VAT vs. VAA) in a logistic regression model. ConclusionsIncomplete vascularization following IVB is very common and is associated with a younger gestational age at birth, Asian ethnicities, and aggressive posterior ROP. The presence of tortuosity following IVB may be indicative of persistently elevated VEGF levels and an early indicator of potential reactivation.

    View details for PubMedID 30312578

  • INTERNAL LIMITING MEMBRANE PEELING DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT Cost Analysis, Review of the Literature, and Meta-analysis RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Yannuzzi, N. A., Callaway, N. F., Sridhar, J., Smiddy, W. E. 2018; 38 (10): 2081–87
  • Retinal Anatomy and Electrode Array Position in Retinitis Pigmentosa Patients After Argus II Implantation: An International Study AMERICAN JOURNAL OF OPHTHALMOLOGY Gregori, N. Z., Callaway, N. F., Hoeppner, C., Yuan, A., Rachitskaya, A., Feuer, W., Ameri, H., Arevalo, J., Augustin, A. J., Birch, D. G., Dagnelie, G., Grisanti, S., Davis, J. L., Hahn, P., Handa, J. T., Ho, A. C., Huang, S. S., Humayun, M. S., Iezzi, R., Jayasundera, K., Kokame, G. T., Lam, B. L., Lim, J. I., Mandava, N., Montezuma, S. R., de Koo, L., Szurman, P., Vajzovic, L., Wiedemann, P., Weiland, J., Yan, J., Zacks, D. N. 2018; 193: 87–99
  • INTERNAL LIMITING MEMBRANE PEELING DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: Cost Analysis, Review of the Literature, and Meta-analysis. Retina (Philadelphia, Pa.) Yannuzzi, N. A., Callaway, N. F., Sridhar, J., Smiddy, W. E. 2018

    Abstract

    PURPOSE: To evaluate the visual and potential economic impact of primary internal limiting membrane (ILM) peeling in primary treatment of rhegmatogenous retinal detachment.METHODS: A PubMed search was performed to extract data regarding the rate of epiretinal membrane formation and the rate of secondary pars plana vitrectomy with membrane peel after repair of rhegmatogenous retinal detachment with or without ILM peeling. Data were aggregated and analyzed in a meta-analysis. This information was used to perform a cost analysis to determine the economic ramifications of primary ILM peeling.RESULTS: Six included studies compared the outcomes of eyes receiving pars plana vitrectomy for rhegmatogenous retinal detachment repair with and without primary ILM peel. The cumulative rate of epiretinal membrane formation was 29% (86/295) in the eyes without ILM peel and 3% (8/289) in the eyes with ILM peel. The cumulative rate of secondary pars plana vitrectomy/membrane peel was 16% (22/141) in the eyes without ILM peel and 0% (0/158) in the eyes with ILM peel. The weighted summary point estimate odds ratio was 0.083 (95% confidence interval 0.042-0.164), indicating a statistically significant protective effect across the 6 studies of ILM peeling and the development of epiretinal membrane. Based on published data, the average dollars saved by conducting a primary ILM peel was $615 in a facility setting and $364 in an ambulatory surgical center.CONCLUSION: Published, mainly retrospective, data suggest that primary ILM peel in rhegmatogenous retinal detachment repair may have a significant reduction in the rate of postoperative epiretinal membrane and may lessen the need for secondary pars plana vitrectomy/membrane peel. Furthermore, from an economic perspective, the reduction in the need for secondary surgery may justify the higher cost with primary ILM peel.

    View details for PubMedID 29994905

  • Retinal Anatomy and Electrode Array Position in Retinitis Pigmentosa Patients After Argus II Implantation: An International Study. American journal of ophthalmology Gregori, N. Z., Callaway, N. F., Hoeppner, C., Yuan, A., Rachitskaya, A., Feuer, W., Ameri, H., Arevalo, J. F., Augustin, A. J., Birch, D. G., Dagnelie, G., Grisanti, S., Davis, J. L., Hahn, P., Handa, J. T., Ho, A. C., Huang, S. S., Humayun, M. S., Iezzi, R. J., Jayasundera, K. T., Kokame, G. T., Lam, B. L., Lim, J. I., Mandava, N., Montezuma, S. R., Olmos de Koo, L., Szurman, P., Vajzovic, L., Wiedemann, P., Weiland, J., Yan, J., Zacks, D. N. 2018; 193: 87–99

    Abstract

    PURPOSE: To assess the retinal anatomy and array position in Argus II retinal prosthesis recipients.DESIGN: Prospective, noncomparative cohort study.METHODS: Setting: International multicenter study.PATIENTS: Argus II recipients enrolled in the Post-Market Surveillance Studies.PROCEDURES: Spectral-domain optical coherence tomography images collected for the Surveillance Studies (NCT01860092 and NCT01490827) were reviewed. Baseline and postoperative macular thickness, electrode-retina distance (gap), optic disc-array overlap, and preretinal membrane presence were recorded at 1, 3, 6, and 12months.MAIN OUTCOME MEASURES: Axial retinal thickness and axial gap along the array's long axis (a line between the tack and handle); maximal retinal thickness and maximal gap along a B-scan near the tack, midline, and handle.RESULTS: Thirty-three patients from 16 surgical sites in the United States and Germany were included. Mean axial retinal thickness increased from month 1 through month 12 at each location, but reached statistical significance only at the array midline (P= .007). The rate of maximal thickness increase was highest near the array midline (slope= 6.02, P= .004), compared to the tack (slope= 3.60, P < .001) or the handle (slope= 1.93, P= .368). The mean axial and maximal gaps decreased over the study period, and the mean maximal gap size decrease was significant at midline (P= .032). Optic disc-array overlap was seen in the minority of patients. Preretinal membranes were common before and after implantation.CONCLUSIONS: Progressive macular thickening under the array was common and corresponded to decreased electrode-retina gap over time. By month 12, the array was completely apposed to the macula in approximately half of the eyes.

    View details for PubMedID 29940167

  • Wnt-Spectrum Vitreoretinopathy Masquerading as Congenital Toxoplasmosis OPHTHALMIC SURGERY LASERS & IMAGING RETINA Callaway, N. F., Berrocal, A. M. 2018; 49 (6): 446–50

    Abstract

    Wnt-spectrum vitreoretinopathies are a group of rare inherited disorders of retinal angiogenesis that include familial exudative vitreoretinopathy/Norrie disease and are most commonly autosomal dominant; however, they can rarely present with other inheritance patterns that are more difficult to diagnose. The authors describe a case of an uncle misdiagnosed as congenital toxoplasmosis for decades and his 2-month-old nephew presenting with bilateral retinal detachments. Genetic analysis revealed an NDP gene mutation in the child and the uncle, as well as heterozygosity of the mother confirming a Wnt-spectrum vitreoretinopathy. This report describes the evaluation, diagnosis, and importance of early laser stabilization of this disorder. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:446-450.].

    View details for DOI 10.3928/23258160-20180601-10

    View details for Web of Science ID 000436108300010

    View details for PubMedID 29927473

  • Validity of the Red Reflex Exam in the Newborn Eye Screening Test Cohort. Ophthalmic surgery, lasers & imaging retina Ludwig, C. A., Callaway, N. F., Blumenkranz, M. S., Fredrick, D. R., Moshfeghi, D. M. 2018; 49 (2): 103–10

    Abstract

    The validity of the red reflex exam has yet to be tested against new methods of wide-angle imaging that may improve early detection of neonatal ocular pathology. The authors aimed to determine the validity of the pediatrician's red reflex exam using 130° wide-angle external and fundus digital imaging as a gold standard.This was a prospective cohort study of 194 healthy, term newborns enrolled in the Newborn Eye Screening Test study at Lucile Packard Children's Hospital from July 25, 2013, to July 25, 2014. Red reflex screening was performed by a pediatrician in the newborn nursery and wide-angle fundus digital imaging was performed by a neonatal intensive care unit-certified nurse. The main outcome measure was the validity of the pediatrician's red reflex exam (unweighted kappa [κ] statistic, sensitivity, specificity).Compared to no subjects with abnormal red reflex exams reported in the pediatrician's notes, 49 subjects demonstrated one or multiple ocular abnormalities on 130° wide-angle fundus imaging (κ = 0.00). The pediatrician's red reflex exam had a sensitivity of 0.0% (95% CI, 0.0%-7.3%) and specificity of 100.0% (95% CI, 97.5%-100.0%) for the detection of ocular abnormalities.This study demonstrates the ability of wide-angle fundus imaging to detect fundus abnormalities not otherwise identified by standard newborn red reflex screening prior to hospital discharge. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:103-110.].

    View details for DOI 10.3928/23258160-20180129-04

    View details for PubMedID 29443359

  • OUTCOMES OF PARS PLANA VITRECTOMY FOR MACULAR HOLE IN PATIENTS WITH UVEITIS. Retina (Philadelphia, Pa.) Callaway, N. F., Gonzalez, M. A., Yonekawa, Y., Faia, L. J., Mandelcorn, E. D., Khurana, R. N., Saleh, M. G., Lin, P., Sobrin, L., Albini, T. A. 2017

    Abstract

    PURPOSE: Inflammatory macular hole is a rare complication of uveitis, and data on surgical outcomes of closure are scarce. The purpose of this study is to evaluate the anatomical and visual outcomes of conventional pars plana vitrectomy for patients with uveitis.METHODS: Noncomparative, interventional, and consecutive case series from 6 vitreoretinal surgical centers from 2007 to 2015. Twenty eyes of 19 patients were included with 4 patients separated as viral retinitis. The primary outcome was change in best-corrected visual acuity at Month 3. Secondary outcomes were closure of the macular hole and postoperative optical coherence tomography characteristics.RESULTS: All eyes underwent conventional three-port pars plana vitrectomy with indocyanine green-assisted internal limiting membrane peeling. Mean Snellen best-corrected visual acuity improved from 20/200 to 20/63 (P = 0.01 for a difference in logarithm of the minimum angle of resolution) at Month 3. Twelve (75%) of patients achieved 2 or more lines of visual acuity improvement by postoperative Month 3. Surgery resulted in decreased epiretinal membrane (P = 0.002), intraretinal fluid (P < 0.001), subretinal fluid (P = 0.029), central subfield thickness (P < 0.001), and central cube volume (P = 0.041). Surgical intervention achieved anatomical success, as measured by macular hole closure, in 13 (81%) of patients at postoperative Month 3.CONCLUSION: Patients with inflammatory macular hole respond well to conventional surgery, with good anatomical and visual acuity outcomes.

    View details for PubMedID 29117067

  • OCT Characteristics Among Subjects Implanted with the Argus II Retinal Prosthesis System; the Argus II OCT Study Group Hoeppner, C., Callaway, N. F., Gregori, N., Lam, B. L., Ameri, H., Augustin, A. J., Ho, A., Iezzi, R., Jayasundera, T., Kokame, G., Lim, J. I., Szurman, P., Vajzovic, L., Wiedemann, P. H., Yan, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Trends in Hospitalization and Incidence Rate for Syphilitic Uveitis in the United States from 1998-2009. American journal of ophthalmology Albini, T., Callaway, N. F., Pershing, S., Wang, S. K., Moshfeghi, A. A., Moshfeghi, D. M. 2017

    Abstract

    This study evaluates the annual incidence of syphilitic uveitis in the US and trends in hospital admissions over time.Retrospective, longitudinal incidence rate analysis of the National Inpatient Sample (NIS) data from 1998 to 2009.The NIS is a de-identified, random sample dataset of inpatient hospitalizations from 46 states. The number of cases of syphilitic uveitis was defined by (1) International Classification of Diseases, 9th Revision (ICD-9) code for syphilis and uveitis or (2) ICD-9 code for syphilitic uveitis. Annual case count, incidence rate, and trend over time were calculated. Multivariate logistic regression was used to evaluate associated factors for a syphilitic uveitis diagnosis.The study included 455 310 286 hospitalizations during a 12-year study period with a mean of 37 942 524 patients annually. Syphilis and uveitis was recorded for 1861 patients (155 annually) and syphilitic uveitis was diagnosed in 204 subjects (average of 17 cases annually). There was no change in the incidence of syphilitic uveitis, using either definition, over the study period (P for trend = .46). The mean annual incidence of syphilis and uveitis was 0.0004%, or 4 per million. Syphilitic uveitis had an annual incidence of 0.000045%, or 0.45 per million. The odds of syphilitic uveitis were lower among women (odds ratio [OR] 0.40, CI 0.28-0.57) and increased with comorbid acquired immunodeficiency syndrome (OR 4.52, CI 3.01-6.79).We report the first incidence of syphilitic uveitis in the United States. Fortunately, this remains a rare condition. The results demonstrate no change in the number of inpatient admissions for syphilitic uveitis during the study period.

    View details for DOI 10.1016/j.ajo.2017.05.013

    View details for PubMedID 28549847

  • Reply re: "Diplopia and Symblepharon Following Muller's Muscle Conjunctival Resection in Patients on Long-Term Multiple Antiglaucoma Medications" OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Callaway, N. F., Sayed, M. S., Lee, W. W. 2017; 33 (2): 152

    View details for DOI 10.1097/IOP.0000000000000881

    View details for Web of Science ID 000396014700033

    View details for PubMedID 28272172

  • What colour are newborns' eyes? Prevalence of iris colour in the Newborn Eye Screening Test (NEST) study. Acta ophthalmologica Ludwig, C. A., Callaway, N. F., Fredrick, D. R., Blumenkranz, M. S., Moshfeghi, D. M. 2016; 94 (5): 485-488

    Abstract

    This study aims to assess the birth prevalence of iris colour among newborns in a prospective, healthy, full-term newborn cohort.The Newborn Eye Screening Test (NEST) study is a prospective cohort study conducted at Lucile Packard Children's Hospital at Stanford University School of Medicine. A paediatric vitreoretinal specialist (DMM) reviewed images sent to the Byers Eye Institute telemedicine reading centre and recorded eye colour for every infant screened. Variables were graphed to assess for normality, and frequencies per subject were reported for eye colour, sex, ethnicity and race.Among 192 subjects screened in the first year of the NEST study with external images of appropriate quality for visualization of the irides, the birth prevalence of iris colour was 63.0% brown, 20.8% blue, 5.7% green/hazel, 9.9% indeterminate and 0.5% partial heterochromia. The study population was derived from a quaternary care children's hospital. We report the birth prevalence of iris colour among full-term newborns in a diverse prospective cohort.The study demonstrates a broad range of iris colour prevalence at birth with a predominance of brown iris coloration. Future studies with the NEST cohort will assess the change in iris colour over time and whether the frequencies of eye colour change as the child ages.

    View details for DOI 10.1111/aos.13006

    View details for PubMedID 27061128

  • Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study. Ophthalmology Callaway, N. F., Ludwig, C. A., Blumenkranz, M. S., Jones, J. M., Fredrick, D. R., Moshfeghi, D. M. 2016; 123 (5): 1043-1052

    Abstract

    To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.Prospective cohort study at Stanford University School of Medicine.All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant.Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

    View details for DOI 10.1016/j.ophtha.2016.01.004

    View details for PubMedID 26875004

  • Retinal and Optic Nerve Hemorrhages in the Newborn Infant OPHTHALMOLOGY Callaway, N. F., Ludwig, C. A., Blumenkranz, M. S., Jones, J. M., Fredrick, D. R., Moshfeghi, D. M. 2016; 123 (5): 1043-1052

    Abstract

    To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.Prospective cohort study at Stanford University School of Medicine.All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant.Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

    View details for DOI 10.1016/j.ophtha.2016.01.004

    View details for Web of Science ID 000375942300026

  • THINKING LEAN: Improving Vitreoretinal Clinic Efficiency by Decentralizing Optical Coherence Tomography. Retina (Philadelphia, Pa.) Callaway, N. F., Park, J. H., Maya-Silva, J., Leng, T. 2016; 36 (2): 335-341

    Abstract

    Patients in vitreoretinal clinic have long wait times that could be reduced by improving the efficiency of patient flow. The objective of this study was to determine whether decentralizing optical coherence tomography (OCT) into the technicians' room would reduce patient wait times and improve clinic efficiency.Randomized, single-center, clinical trial for 1 month without follow-up at Byers Eye Institute at Stanford. Subjects were return patients of three vitreoretinal specialists in March 2013. The intervention consisted of decentralizing OCT devices from the central photography suite into the technician screening rooms. Total clinic times and total wait times throughout subject appointments were recorded and compared with the control group (centralized photography suite). Secondary outcomes included frequency of injections, procedures, and primary diagnosis codes.Decentralized OCT reduced patient wait times by 74% and reduced total clinic appointment time by 36%. Subjects in the intervention arm experienced significantly reduced total wait time (mean difference = 15.9 minutes, P < 0.0001) and total time in clinic (mean difference = 22.9 minutes, P < 0.0001).Decentralized OCT represents the application of lean process concepts to improve vitreoretinal clinic efficiency. Decentralized OCT reduced both the total wait time and total time in clinic for return patients in a vitreoretinal clinic.

    View details for DOI 10.1097/IAE.0000000000000712

    View details for PubMedID 26815931

  • Newborn Retinal Hemorrhages: One-year Results of the Newborn Eye Screening Test (NEST) Study Callaway, N., Ludwig, C., Moshfeghi, D. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015
  • Validity of the Newborn Eye Exam in the Newborn Eye Screening Test (NEST) Cohort Ludwig, C. A., Callaway, N., Moshfeghi, D. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015
  • Fundus Hemorrhages in a Term Newborn and Preterm Population: Does Examination Timing Influence Findings? Moshfeghi, D. M., Ludwig, C. A., Callaway, N. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015
  • SUNDROP: six years of screening for retinopathy of prematurity with telemedicine. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Wang, S. K., Callaway, N. F., Wallenstein, M. B., Henderson, M. T., Leng, T., Moshfeghi, D. M. 2015; 50 (2): 101-106

    Abstract

    To report the 6-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) initiative in the context of telemedicine screening initiatives for retinopathy of prematurity (ROP).A retrospective analysis.Premature newborns requiring ROP screening at 6 neonatal intensive care units from December 1, 2005, to November 30, 2011.Infants were evaluated via remote retinal photography by an ROP specialist. A total of 608 preterm infants meeting ROP examination criteria were screened with the RetCam II/III (Clarity Medical Systems, Pleasanton, Calif.). Primary outcomes were treatment-warranted ROP (TW-ROP) and adverse anatomical events.During the 6 years, 1216 total eyes were screened during 2169 examinations, generating 26 970 retinal images, an average of 3.56 examinations and 44.28 images per patient. Twenty-two (3.6%) of the infants screened met criteria for TW-ROP. Compared with bedside binocular ophthalmoscopy, remote interpretation of RetCam II/III images had a sensitivity of 100%, specificity of 99.8%, positive predicative value of 95.5%, and negative predicative value of 100% for the detection of TW-ROP. No adverse anatomical outcomes were observed for any enrolled patient.The 6-year results for the SUNDROP telemedicine initiative were highly favourable with respect to diagnostic accuracy. Telemedicine appears to be a safe, reliable, and cost-effective complement to the efforts of ROP specialists, capable of increasing patient access to screening and focusing the resources of the current ophthalmic community on infants with potentially vision-threatening disease.

    View details for DOI 10.1016/j.jcjo.2014.11.005

    View details for PubMedID 25863848

  • Ambulatory surgery center utilization by vitreoretinal surgeons: 1999-2011. Ophthalmic surgery, lasers & imaging retina Vaziri, K., Moshfeghi, D. M., Hernandez-Boussard, T., Callaway, N. F., Moshfeghi, A. A. 2015; 46 (3): 355-361

    Abstract

    To evaluate the utilization rates of ambulatory surgery centers (ASCs) in the state of Florida for vitreoretinal, cataract, and glaucoma surgical procedures over a 13-year period from 1999 through 2011.Retrospective analysis utilizing the State Ambulatory Surgery Databases (SASD) for Florida from 1999 through 2011. ICD-9 codes for vitreoretinal, cataract, and glaucoma procedures were queried. Joinpoint regression was used to calculate average annual percent change (APC) in ASC utilization by these procedures over the 13-year study period and also separately for the years 2007 to 2011.From 1999 through 2011, APC in ambulatory surgery center utilization was +26.4% (P = .0039) for vitreoretinal, +21.3% (P = .012) for cataract, and +20.9% (P = .0063) for glaucoma surgery. The APC from 2007 through 2011 was -1.2% for vitreoretinal (P = .47), -9.2% for cataract (P = .0039), and -17.3% for glaucoma surgery (P = .008).A significant overall increase in ASC utilization by vitreoretinal, cataract, and glaucoma surgeons over the study period was seen; however, the most recent 5-year data show that these trends may have begun to reverse. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:355-361.].

    View details for DOI 10.3928/23258160-20150323-10

    View details for PubMedID 25856823

  • Parallel rarebits: A novel, large-scale visual field screening method. Clinical & experimental optometry : journal of the Australian Optometrical Association Lin, S. R., Fijalkowski, N., Lin, B. R., Li, F., Singh, K., Chang, R. T. 2014; 97 (6): 528-33

    Abstract

    Rarebit perimetry (RBP) is a computer-based perimetric testing program with sensitivity and specificity for detection of visual field defects comparable to traditional automated perimetry. To make large-scale screening more efficient, we developed a parallel rarebit perimetric method to screen groups of subjects simultaneously. We then used this method to report the mean hit rate (MHR) among subjects aged 13 to 19 years.Rarebit perimetry was installed on computers in an existing school computer laboratory. All subjects provided medical and demographic information and underwent a basic visual examination. Testing instructions were provided to groups of up to 35 subjects and rarebit perimetry was subsequently administered. Two or three test supervisors answered questions and ensured that subjects were well aligned with their test screens. Mean hit rate, reaction times, error rates and testing time were calculated, and time estimates for rarebit, frequency doubling perimetry and Humphrey 24-2 Swedish Interactive Thresholding Algorithm (SITA) fast test were compared.A total of 364 rarebit perimetric tests were conducted on 182 subjects. Of these, 154 subjects met our inclusion criteria for the reference range (three testing errors or less and visual acuity 6/9 or better). The average mean hit rate was 94.3 ± 4.63 per cent. Screening of 500 subjects using this parallel rarebit perimetric method would require approximately nine hours, which is far less than an estimated 77 hours required for frequency doubling perimetry C-20 screening tests or an estimated 127 hours required for Humphrey 24-2 SITA fast tests.Using our methods, rarebit perimetry can be administered in parallel to groups of subjects. The mean hit rate was comparable to that reported in previously published studies. This parallel technique may improve the efficiency of large-scale visual field screenings.

    View details for DOI 10.1111/cxo.12221

    View details for PubMedID 25331077

  • Mediastinal Kaposiform Hemangioendothelioma and Kasabach-Merritt Phenomenon in a Patient with no Skin Changes and a Normal Chest CT. Pediatric hematology and oncology Wallenstein, M. B., Hole, M. K., McCarthy, C., Fijalkowski, N., Jeng, M., Wong, W. B. 2014; 31 (6): 563-567

    Abstract

    A 16-month-old previously healthy boy was admitted to the hospital with respiratory distress and thrombocytopenia. Initial workup demonstrated large pleural and pericardial effusions. The patient had no cutaneous abnormality on physical examination, and his initial chest CT (computed tomography) was nondiagnostic. He required multiple platelet transfusions, chest tube placement, and pericardiocentesis. Sixteen days after admission, a chest MRI (magnetic resonance imaging) revealed a large infiltrative mass of the superior mediastinum, consistent with kaposiform hemangioendothelioma (KHE). The patient's thrombocytopenia was due to associated Kasabach-Merritt phenomenon (KMP). The patient now has complete resolution of KMP after medical treatment with prednisolone, aminocaproic acid, vincristine, and aspirin.

    View details for DOI 10.3109/08880018.2013.825356

    View details for PubMedID 24047193

  • Gender differences in compensation in academic medicine: the results from four neurological specialties within the University of California Healthcare System SCIENTOMETRICS Henderson, M. T., Fijalkowski, N., Wang, S. K., Maltenfort, M., Zheng, L. L., Ratliff, J., Moshfeghi, A. A., Moshfeghi, D. M. 2014; 100 (1): 297-306
  • Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): five years of screening with telemedicine. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wang, S. K., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2014; 45 (2): 106-113

    Abstract

    To report the 5-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.Infants requiring retinopathy of prematurity (ROP) screening at six neonatal intensive care units from December 1, 2005, to November 30, 2010, were evaluated with remote retinal photography by an ROP specialist. Every infant received outpatient binocular indirect ophthalmoscope examinations until termination criteria were achieved or until treatment. Outcomes were treatment-warranted ROP (TW-ROP, ETROP type 1) and adverse anatomical events.Five hundred eleven infants (1,022 eyes) were screened. Fifteen infants had TW-ROP and underwent laser photocoagulation. The TW-ROP cohort had significantly lower birth weight and gestational age (both P < .001). No patient progressed to adverse anatomical outcomes and no case of TW-ROP was missed. Tele-medicine had 100% sensitivity, 99.8% specificity, 93.8% positive predictive value, and 100% negative predictive value for detection of TW-ROP.Telemedicine demonstrates high diagnostic accuracy for detection of TW-ROP and can complement ROP screening. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:106-113.].

    View details for DOI 10.3928/23258160-20140122-01

    View details for PubMedID 24444469

  • Active aspiration of suprachoroidal hemorrhage using a guarded needle. Ophthalmic surgery, lasers & imaging retina Mandelcorn, E. D., Kitchens, J. W., Fijalkowski, N., Moshfeghi, D. M. 2014; 45 (2): 150-152

    Abstract

    To describe a novel technique using a guarded needle to drain suprachoroidal hemorrhage.A guarded needle is used to drain suprachoroidal hemorrhage under direct microscope visualization. A scleral buckling sleeve is used to create a guarded 26-gauge needle to avoid over-penetration of the needle beyond the suprachoroidal space. Active extrusion can be used to drain suprachoroidal blood.The authors report two cases in which active aspiration using a guarded needle was successful in draining suprachoroidal hemorrhage without complications. In both cases, the vitreous cavity could be restored, allowing for subsequent pars plana vitrectomy.The technique of active aspiration using a guarded needle optimizes surgeon control of suprachoroidal hemorrhage drainage and also has the added benefit of easy transition to secondary vitrectomy after drainage has been completed. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:150-152.].

    View details for DOI 10.3928/23258160-20140306-09

    View details for PubMedID 24635157

  • Oxidized Low-Density-Lipoprotein-Induced Injury in Retinal Pigment Epithelium Alters Expression of the Membrane Complement Regulatory Factors CD46 and CD59 through Exosomal and Apoptotic Bleb Release Ebrahimi, K. B., Fijalkowski, N., Cano, M., Handa, J. T., Ash, J. D., Grimm, C., Hollyfield, J. G., Anderson, R. E., LaVail, M. M., Rickman, C. B. SPRINGER-VERLAG BERLIN. 2014: 259-265

    Abstract

    Genetic and immunohistochemical studies have identified the alternative complement pathway as an important component of age-related macular degeneration (AMD). The objective of this chapter is to review the impact of complement regulators on complement activation in the macula as it relates to AMD. Our laboratory and other investigators have identified CD46 and CD59 as important retinal pigment epithelium (RPE) cell membrane complement regulators, which are decreased in AMD. Using oxidized low-density lipoproteins (oxLDLs), which are found in Bruch's membrane in AMD, we found that CD46 and CD59 were decreased in RPE cells in part, by their release in exosomes and apoptotic particles. The release of complement regulators could potentially impair complement regulation on RPE cells and contribute to lesion formation in the outer retina and Bruch's membrane during the development of AMD.

    View details for DOI 10.1007/978-1-4614-3209-8_33

    View details for Web of Science ID 000350418200034

    View details for PubMedID 24664706

  • Academic productivity and its relationship to physician salaries in the University of California Healthcare System. Southern medical journal Fijalkowski, N., Zheng, L. L., Henderson, M. T., Moshfeghi, A. A., Maltenfort, M., Moshfeghi, D. M. 2013; 106 (7): 415-421

    Abstract

    To evaluate whether physicians with higher academic productivity, as measured by the number of publications in Scopus and the Scopus Hirsch index (h-index), earn higher salaries.This was a cross-sectional study. Participants were ophthalmologists, otolaryngologists, neurosurgeons, and neurologists classified as "top earners" (>$100,000 annually) within the University of California (UC) healthcare system in 2008. Bibliometric searches on Scopus were conducted to retrieve the total number of publications and Hirsch indices (h-index), a measure of academic productivity. The association between the number of publications and h-index on physicians' total compensation was determined with multivariate regression models after controlling for the four specialties (ophthalmology, otolaryngology, neurosurgery, and neurology), the five institutions (UC San Francisco, UC Los Angeles, UC San Diego, UC Irvine, and UC Davis), and academic rank (assistant professor, associate professor, and professor).The UC healthcare system departments reported 433 faculty physicians among the four specialties, with 71.6% (n = 310) earning more than $100,000 in 2008 and classifying as top earners. After controlling for the specialty, institution, and ranking, there was a significant association between the number of publications on salary (P < 0.000001). Scopus number of publications and h-index were correlated (P < 0.001). Scopus h-index was of borderline significance in predicting physician salary (P = 0.12). Physicians with higher Scopus publications had higher total salaries across all four specialties. Every 10 publications were associated with a 2.40% increase in total salary after controlling for specialty, institution, rank, and chair.Ophthalmologists, otolaryngologists, neurosurgeons, and neurologists in the UC healthcare system who are more academically productive receive greater remuneration.

    View details for DOI 10.1097/SMJ.0b013e31829b9dae

    View details for PubMedID 23820322

  • Validation of a grading system for lateral nasal wall insufficiency. Allergy & rhinology (Providence, R.I.) Tsao, G. J., Fijalkowski, N., Most, S. P. 2013; 4 (2): e66-8

    Abstract

    This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.

    View details for DOI 10.2500/ar.2013.4.0054

    View details for PubMedID 24124639

  • Ambulatory Surgery Center (ASC) Utilization by three Ophthalmic Sub-specialists: 1999-2011 Vaziri, K., Moshfeghi, A., Hernandez-Boussard, T., Fijalkowski, N., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013
  • Decreased membrane complement regulators in the retinal pigmented epithelium contributes to age-related macular degeneration JOURNAL OF PATHOLOGY Ebrahimi, K. B., Fijalkowski, N., Cano, M., Handa, J. T. 2013; 229 (5): 729-742

    Abstract

    Dysregulated complement is thought to play a central role in age-related macular degeneration (AMD) pathogenesis, but the specific mechanisms have yet to be determined. In maculae of AMD specimens, we found that the complement regulatory protein, CD59, was increased in regions of uninvolved retinal pigmented epithelium (RPE) of early AMD, but decreased in the RPE overlying drusen and in geographic atrophy, an advanced form of AMD. While CD46 immunostaining was basolaterally distributed in the RPE of unaffected controls, it was decreased in diseased areas of early AMD samples. Since oxidized low-density lipoproteins (oxLDL) collect in drusen of AMD and are a known complement trigger, we treated ARPE-19 cells with oxLDL and found that cellular CD46 and CD59 proteins were decreased by 2.9- and nine-fold (p < 0.01), respectively. OxLDLs increased complement factor B mRNA and Bb protein, but not factor D, I or H. OxLDLs increased C3b, but not C3a, C5 or C5b-9. C5b-9 was increased by 27% (p < 0.01) when the medium was supplemented with human serum, which was sufficient to induce poly(ADP-ribose) polymerase cleavage, a marker of apoptosis. The decreased levels of CD46 and CD59 were in part explained by their release in exosomal and apoptotic membranous particles. In addition, CD59 was partially degraded through activation of IRE1α. Collectively, these results suggest that a combination of impaired complement regulators results in inadequately controlled complement by the RPE in AMD that induces RPE damage.

    View details for DOI 10.1002/path.4128

    View details for Web of Science ID 000316326100009

    View details for PubMedID 23097248

  • Fever Literacy and Fever Phobia CLINICAL PEDIATRICS Wallenstein, M. B., Schroeder, A. R., Hole, M. K., Ryan, C., Fijalkowski, N., Alvarez, E., Carmichael, S. L. 2013; 52 (3): 254-259

    Abstract

    To identify the percentage of parents who define the threshold for fever between 38.0°C and 38.3°C, which has not been reported previously, and to describe parental attitudes toward fever and antipyretic use.Thirteen-question survey study of caregivers.Overall, 81% of participants defined the threshold for fever as <38.0°C, 0% correctly defined fever between 38.0°C and 38.3°C, and 19% defined fever as >38.3°C. Twenty percent of children brought to clinic for a chief complaint of fever were never truly febrile. Ninety-three percent of participants believed that high fever can cause brain damage. For a comfortable-appearing child with fever, 89% of caregivers reported that they would give antipyretics and 86% would schedule a clinic visit.Our finding that 0% of parents correctly defined fever is both surprising and unsettling, and it should inform future discussions of fever between parents and clinicians.

    View details for DOI 10.1177/0009922812472252

    View details for Web of Science ID 000317849900007

    View details for PubMedID 23349363

  • The importance of keeping a broad differential in retina clinic: the spectrum of ophthalmic disease seen by retina specialists in a tertiary outpatient clinic setting. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Pershing, S., Moshfeghi, D. M. 2013; 44 (2): 133-139

    Abstract

    To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States.Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011.Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%).Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.

    View details for DOI 10.3928/23258160-20130313-06

    View details for PubMedID 23510039

  • Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Four-years of Screening with Telemedicine CURRENT EYE RESEARCH Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2013; 38 (2): 283-291

    Abstract

    To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP).A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes.The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome.The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.

    View details for DOI 10.3109/02713683.2012.754902

    View details for Web of Science ID 000314900400008

    View details for PubMedID 23330739

  • More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's Isotopic response in an Asian female More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's Isotopic response in an Asian female Fijalkowski N, Wysong A, Kuu P, Chang A 2012; 3 (2): 24-28
  • Advanced Glycation Endproduct Changes to Bruch's Membrane Promotes Lipoprotein Retention by Lipoprotein Lipase AMERICAN JOURNAL OF PATHOLOGY Cano, M., Fijalkowski, N., Kondo, N., Dike, S., Handa, J. 2011; 179 (2): 850-859

    Abstract

    Lipoprotein particles accumulate in Bruch's membrane before the development of basal deposits and drusen, two histopathologic lesions that define age-related macular degeneration (AMD). We therefore, sought to determine which molecules could participate in lipoprotein retention. Wild-type or lipoprotein lipase-deficient mice were injected with low-dose D-galactose or PBS subcutaneously for 8 weeks to induce advanced glycation endproduct (AGE) formation. Some mice were also injected with the AGE breaker phenacylphiazolium bromide and D-galactose. Rhodamine-labeled low-density lipoproteins were injected into mice, and the fluorescence was measured up to 72 hours later. AGEs, proteoglycans, and other lipid-retaining molecules were evaluated by IHC. Lipoprotein lipase distribution was assessed in AMD samples by IHC. D-galactose-treated mice retained lipoproteins in the retinal pigment epithelial and Bruch's membrane to a greater extent than either PBS- or phenacylphiazolium bromide/D-galactose-treated mice at 24 and 72 hours after injection (P ≤ 0.04). Immunolabeling for carboxymethyllysine, biglycan, and lipoprotein lipase was found in D-galactose-treated mice only. Mice deficient for lipoprotein lipase treated with D-galactose did not retain lipoproteins to any measureable extent. Human AMD samples had lipoprotein lipase labeling within drusen, basal deposits, and the choroid. Mice treated with D-galactose to induce AGE formation in Bruch's membrane retain intravenously injected lipoproteins. Our results suggest that lipoprotein retention in Bruch's membrane is mediated by lipoprotein lipase.

    View details for DOI 10.1016/j.ajpath.2011.04.010

    View details for Web of Science ID 000298307200031

    View details for PubMedID 21801873

    View details for PubMedCentralID PMC3157214