Susan Ruyu Qi, MD, is an Ophthalmology Resident (PGY4) from Canada currently at Stanford for a Master of Science program in Clinical Informatics Management. She is passionate about innovation in medicine, particularly the role of Artificial Intelligence in the field of ophthalmology. She was Editor in Chief of one of the first Medium publications dedicated to AI in Healthcare back in 2017.
In her spare time, she has completed the Machine Learning Certificate from Stanford on Coursera and is pursuing an online MBA program at Quantic School of Business. In residency, her research interest focused on Immediately Sequential Bilateral Cataract Surgery (ISBCS), Topography-guided LASIK outcomes, and the clinical trial of a novel retinal oximetry device, Zilia Ocular.
Having grown up in Montreal, Canada and China, she is fully fluent in English, French and Mandarin Chinese, and works occasionally as a medical translator. She holds a Doctor of Medicine (M.D.) degree from Université de Montréal.
Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle.
Retina (Philadelphia, Pa.)
PURPOSE: To compare outcomes following primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB).METHODS: This is a retrospective cohort study with propensity score analysis in a single tertiary care center between 2014 and 2018 comparing patients with primary uncomplicated RRD repaired using PPV only or PPV-SB (full cohort: n=1516, propensity-matched cohort: n=908). The primary outcome was single surgery anatomic success (SSAS), while secondary outcomes were 3-month and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR) and final retina status.RESULTS: In the full cohort, SSAS was achieved in 745 (91%) of PPV patients vs. 623 (89%) of PPV-SB patients (p=0.13). This was 390 (92%) vs. 314 (88%) in phakic patients (p=0.06) compared to 353 (91%) vs. 301 (90%) in pseudophakic patients (p=0.79), respectively. After matching, SSAS was achieved in 424 (93%) of PPV patients vs. 412 (91%) of PPV-SB patients (p=0.14). Median PHVA after PPV was better at 3 months (PPV: 20/40 vs. PPV-SB: 20/50; both cohorts: p<0.001) and final follow-up (PPV: 20/29 vs. PPV-SB: 20/38; full cohort: p<0.001 and PPV: 20/29 vs. PPV-SB: 20/36; matched cohort: p<0.001).CONCLUSION: Addition of SB does not significantly change the rate of SSAS compared to PPV only in primary uncomplicated RRD. It is also associated with worse PHVA at follow-up.
View details for DOI 10.1097/IAE.0000000000003425
View details for PubMedID 35174803
Reply: Immediately sequential bilateral cataract surgery (ISBCS): an Academic Teaching Center's experience
JOURNAL OF CATARACT AND REFRACTIVE SURGERY
2021; 47 (12): 1605
View details for Web of Science ID 000756558800033
- Reply: Immediately sequential bilateral cataract surgery (ISBCS): an Academic Teaching Center's experience. Journal of cataract and refractive surgery 2021; 47 (15): 1604-1605
Cystoid macular edema secondary to latanoprostene bunod
CANADIAN JOURNAL OF OPHTHALMOLOGY-JOURNAL CANADIEN D OPHTALMOLOGIE
2021; 56 (6): E185-E187
View details for Web of Science ID 000721094800010
Retinal Displacement: Providing New Insights for Retinal Detachment Surgery
JOURNAL OF OPHTHALMOLOGY
2021; 2021: 9999797
To review the current literature on retinal displacement and provide a discussion of potential risk factors, postoperative outcomes, and future directions.Two databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles on retinal displacement.We identified 1522 articles. A total of n = 14 articles were retained. We provide an overview on the potential influence of surgical type (n = 4), tamponade agents (n = 5), postoperative posture (n = 6), and preoperative retinal status (n = 5) on incidence of retinal displacement and visual outcomes (n = 8). Discussion. Pars plana vitrectomy (PPV) with gas tamponade is associated with displacement rates of up to 72%, typically in a downward direction. Meanwhile, pneumatic retinopexy and PPV with silicone oil may offer similar surgical success with a significantly lower risk of displacement. The impact of heavy liquids such as perfluorocarbon liquid, postoperative positioning and preoperative extent of detachment on displacement remains inconclusive. Patients with displacement had a significantly lower visual acuity and higher rates of distortion than those without displacement. However, not all patients with displacement experienced visual symptoms.Retinal displacement is a new concept in our understanding of retinal detachment. Additional studies are needed to better define its impact on postsurgical outcomes.
View details for DOI 10.1155/2021/9999797
View details for Web of Science ID 000692897800003
View details for PubMedID 34484815
View details for PubMedCentralID PMC8413052
Immediately Sequential Bilateral Cataract Surgery (ISBCS): An Academic Teaching Center's Experience.
Journal of cataract and refractive surgery
(max. 250).PURPOSE: To evaluate the safety and outcomes of immediately sequential bilateral cataract surgery (ISBCS) at a Canadian academic teaching center.SETTING: Tertiary university teaching hospital of Laval University, Quebec City, Canada.DESIGN: Retrospective cohort study of 2003 consecutive patients (4006 eyes) who underwent ISBCS under topical anesthesia from January 2019 to December 2019.METHODS: All charts were retrospectively reviewed. Outcome measures included intraoperative and postoperative complications, postoperative uncorrected (UCVA) and pinhole (PHVA) visual acuities, and autorefraction measurements.RESULTS: 1218 (60.8%) female and 785 (39.2%) male patients with a mean age of 74 ± 8 years old had a mean preoperative visual acuity of 0.503 LogMAR (Snellen 20/63). The mean axial length was 23.53 ± 1.37 mm. The majority of eyes had monofocal intraocular lenses (IOL) implanted (n=3738, 93.3%) followed by toric (n=226, 5.6%), multifocal (n=25, 0.6%), and multifocal toric (n=17, 0.4%) IOLs. Intraoperative complications included 14 (0.3%) posterior capsule ruptures with 5 (0.1%) requiring sulcus IOL placement, and 7 (0.2%) partial zonulysis, with 3 requiring capsular tension rings (0.07%). There were no cases of endophthalmitis or toxic anterior segment syndrome. Mean 5-week postoperative UCVA was 0.223 (Snellen 20/33), PHVA was 0.153 (Snellen 20/28) with a mean spherical equivalent of -0.21 diopters.CONCLUSIONS: ISBCS performed following iSBCS recommended guidelines is a safe procedure. This cohort of 4006 eyes had very few complications, with none attributable to the surgery being done bilaterally. The UCVA, PHVA and refractive outcomes were good.
View details for DOI 10.1097/j.jcrs.0000000000000750
View details for PubMedID 34415861
Conjunctival Infiltration in a Child as a Rare Manifestation of IgG4-Related Disease.
PURPOSE: Ocular manifestations of immunoglobulin G4 (IgG4)-related disease are common in children although remain ill-defined because of the disease's rarity. We describe a pediatric case of IgG4-related orbital disease (IgG4-ROD) who presented with persistent conjunctival infiltration before developing lacrimal gland enlargement 3 years later.METHODS: This was a case report.RESULTS: An 8-year-old girl developed forniceal salmon-patch-like conjunctival lesions in her left eye that were refractory to topical corticosteroids. Investigations, including an orbital MRI and 2 conjunctival biopsies, were negative for lymphoma. She was treated with topical corticosteroids and then nonsteroidal antiinflammatory drops. The lesions decreased mildly, and no new lesion emerged. After 3 years, the patient developed a ptosis, new salmon-patch conjunctival lesions, and papillae. Vision deteriorated to 20/80 because of severe punctate epithelial erosions in the left eye, and the Schirmer test was significantly reduced. A repeat MRI revealed an enlarged left lacrimal gland. A biopsy was performed and was compatible with IgG4-ROD. An elevated IgG4 level of 4.61 g/L was also found. The patient was successfully treated with oral prednisone but flared on tapering the dosage. Rituximab was therefore initiated with excellent clinical response, and prednisone was discontinued. Vision returned to 20/20 after aggressive lubrification, punctal plugs, and autologous serum eye drops. Tear function came back to normal, and local treatments were stopped.CONCLUSIONS: This case describes a pediatric case of IgG4-ROD presenting initially with conjunctival follicular reaction, later developing lacrimal gland involvement. Therefore, it is important to consider IgG4-ROD in chronic atypical follicular conjunctival lesions in children, even in the absence of orbital disease.
View details for DOI 10.1097/ICO.0000000000002773
View details for PubMedID 34050069
Large Axis Difference Between Topographic Anterior Corneal Astigmatism and Manifest Refractive Astigmatism: Can Topography-Guided LASIK Target the Manifest Axis?
Journal of refractive surgery (Thorofare, N.J. : 1995)
2021; 37 (10): 662-673
To investigate whether the degree of astigmatism axis discrepancy between preoperative manifest refractive astigmatism and anterior corneal astigmatism impacts refractive and visual outcomes of primary topography-guided laser in situ keratomileusis (LASIK) targeting the refractive astigmatism, and to provide guidance on treating eyes with very large axis discrepancy.Comparative retrospective analysis of 25,396 consecutive eyes treated with topography-guided LASIK on the manifest refractive astigmatism. Standard outcomes of the 14,534 eyes with small axis discrepancy (SAD) (Δ in axis ⩽ 10°) were compared to the 2,222 eyes with very large axis discrepancy (VLAD) (Δ in axis ⩾ 45°). Pearson correlation coefficient was used to assess relationships between selected variables.The mean axis discrepancy was 4.47 ± 2.92° in SAD eyes, and 65.0 ± 13.4° in VLAD eyes. An equivalent number of eyes achieved a cumulative postoperative unilateral uncorrected distance visual acuity of 20/20 in both the SAD and VLAD groups (93.02% vs 93.42%; P = .4892). The efficacy index (0.98 ± 0.13 vs 0.98 ± 0.07; P = .3931) and the safety index (1.00 ± 0.11 vs 1.00 ± 0.03; P = .4757) were identical between groups. There was no clinically meaningful correlation between the preoperative axis discrepancy and preoperative total root mean square anterior corneal coma, postoperative refractive astigmatism, defocus equivalent, spherical equivalent, and angle of error, all with weak correlation coefficients (R = -0.02, -0.03, -0.02, 0.01, and 0.05).Large preoperative axis discrepancy (45° to 90°) between refractive astigmatism and topography-measured anterior corneal astigmatism does not negatively impact topography-guided LASIK, having identical refractive and visual outcomes compared to eyes with small (0° to 10°) discrepancy. There is no basis to exclude eyes with large axis discrepancy from topography-guided LASIK, and these eyes should be treated on the manifest refractive astigmatism. [J Refract Surg. 2021;37(10):662-673.].
View details for DOI 10.3928/1081597X-20210712-05
View details for PubMedID 34661476
- Cystoid macular edema secondary to latanoprostene bunod. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2021
Optic Pit Maculopathy: Adjunctive Treatment Using Oral Spironolactone and Topical Dorzolamide
INTERNATIONAL MEDICAL CASE REPORTS JOURNAL
2021; 14: 357-360
There is no consensus for the treatment of optic disc pit maculopathy (ODPM). We describe a case of ODPM refractory to vitrectomy that was successfully treated with systemic spironolactone and topical dorzolamide 2%.Case report.A 27-year-old male was referred for decreased vision in the right eye secondary to macular edema. Fundus examination and optical coherence tomography imaging revealed an optic pit maculopathy with significant macular schisis and intraretinal fluid. After an initial observation period, we performed pars plana vitrectomy with internal limiting membrane peeling, fibrin glue, and gas endotamponade. At the 2 months postoperative follow-up, anatomic and functional outcomes remained unimproved. Oral spironolactone and topical dorzolamide 2% were, therefore, added. Significant reduction in the intraretinal fluid and macular schisis was demonstrated at the last follow-up 2 years postoperative.The mechanisms underlying optic disc pit maculopathy remain controversial, and treatment guidelines are unclear. To our knowledge, this is the first description of an OPDM treated with a combination systemic mineralocorticoid receptor antagonist and topical carbonic anhydrase inhibitor as adjuvant therapy to vitrectomy with favorable outcomes. We also review the literature and propose mechanisms through which these treatment entities may act.
View details for DOI 10.2147/IMCRJ.S307057
View details for Web of Science ID 000665793400001
View details for PubMedID 34079390
View details for PubMedCentralID PMC8165556
- Systematic review of recommendations on the use of disease-modifying antirheumatic drugs in rheumatoid arthritis and cancer: comment on the article by Lopez-Olivo et al Reply ARTHRITIS CARE & RESEARCH 2020; 72 (12): 1828-1829
Effect of the Vectorial Difference Between Manifest Refractive Astigmatism and Anterior Corneal Astigmatism on Topography Guided LASIK Outcomes
JOURNAL OF REFRACTIVE SURGERY
2020; 36 (7): 449-+
To characterize the preoperative vectorial difference between manifest refractive astigmatism and anterior corneal astigmatism, termed ocular residual astigmatism (ORA), and to investigate its influence on topography-guided laser in situ keratomileusis (LASIK) outcomes.Comparative retrospective analysis of 21,581 consecutive eyes treated on the manifest refractive astigmatism. Standard outcomes of the 7,180 eyes with the lowest ORA (first tercile: 0.35 ± 0.13 diopters [D]) were compared to the 7,208 eyes with the highest ORA (last tercile: 1.13 ± 0.25 D).The ORA followed a right-skewed normal distribution (R2 = 0.99) with a mean ± standard deviation of 0.73 ± 0.36 D. The efficacy index of eyes with low versus high ORA was identical (0.98 ± 0.07 vs 0.98 ± 0.08; P = .99), with a similar percentage having a spherical equivalent within ±0.50 D of the intended target (94.7% vs 94.1%; P = .11). The safety index (1.00 ± 0.04 vs 1.00 ± 0.04; P = .99) and Alpins correction index (1.01 ± 0.37 vs 1.00 ± 0.43; P = .10) were identical. A greater number of eyes with high versus low ORA had postoperative residual astigmatism of 0.75 D or greater (6.1% vs 3.9%). Eyes with very high ORA (ORA ⩾ 1.50 D; 2.5% of the population) marginally reduced the efficacy index from 0.98 to 0.97 (P < .001).The contribution of ORA to topography-guided clinical outcomes in most virgin eyes is negligible, with excellent efficacy, accuracy, and safety in both low ORA and high ORA groups. Myopic eyes with high ORA treated on the manifest refraction should not be excluded from topography-guided LASIK. [J Refract Surg. 2020;36(7):449-458.].
View details for DOI 10.3928/1081597X-20200609-01
View details for Web of Science ID 000565344000004
View details for PubMedID 32644167
Systematic Review of Recommendations on the Use of Disease-Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis and Cancer
ARTHRITIS CARE & RESEARCH
2020; 72 (3): 309-318
To evaluate consensus recommendations regarding management of rheumatoid arthritis (RA) in patients with cancer.We searched electronic databases, guideline registries, and relevant websites for cancer-specific recommendations on RA management. Reviewers independently selected and appraised the recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. We identified similarities and discrepancies among recommendations.Of 4,077 unique citations, 39 recommendations were identified of which half described their consensus process. Average scores for the AGREE II domains ranged from 33% to 87%. Cancer risk in RA was addressed in 79% of recommendations, with acknowledgement of increased overall cancer risk. Recommendations did not agree on the safety of using disease-modifying antirheumatic drugs in RA patients with cancer, except for the contraindication of tumor necrosis factor inhibitors in patients at risk for lymphoma. Most recommendations agreed that RA treatment should be stopped and re-evaluated with a new diagnosis of cancer. Recommendations for patients with a history of cancer differed depending on the drug, cancer type, and time since cancer diagnosis. Few recommendations addressed all issues.Recommendations for the treatment of RA in patients with cancer often fail to meet expected methodologic criteria. There was agreement on the need for caution when prescribing DMARDs to these patients. However, several areas remain lacking consensus and given the paucity of evidence, there is an urgent need for research and expert opinion to guide and standardize the management of RA in patients with cancer. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/acr.23865
View details for Web of Science ID 000516667800003
View details for PubMedID 30821928
Primary Topography-Guided LASIK: Treating Manifest Refractive Astigmatism Versus Topography-Measured Anterior Corneal Astigmatism
JOURNAL OF REFRACTIVE SURGERY
2019; 35 (1): 15-+
To investigate whether topography-guided laser in situ keratomileusis (LASIK) with anterior corneal astigmatism measured on the WaveLight Contoura (Alcon Laboratories, Inc., Fort Worth, TX) leads to better refractive outcomes compared to treating on the clinically measured manifest refractive astigmatism axis in eyes with primary myopic astigmatism.Retrospective analysis of 1,274 consecutive LASIK eyes treated on the topography-measured anterior corneal astigmatism axis compared to eyes treated on the conventional clinical manifest refractive astigmatism axis.In eyes with a small axis discrepancy between anterior corneal astigmatism and refractive astigmatism of 5° to 20°, there was no significant difference in efficacy index, refractive astigmatism accuracy, and most Alpins vector analysis parameters. Both treatment modalities achieved 20/20 uncorrected distance visual acuity (UDVA) in 90% of eyes, with 95% having postoperative cylinder of 0.50 diopters (D) or less. In eyes with a large axis discrepancy between 21° and 45° treated on the anterior corneal astigmatism axis, outcomes were both statistically and clinically inferior. Fewer eyes achieved UDVA of 20/20 (88.9% vs 73.6%; P = .01) and fewer had a defocus equivalent of 0.25 (65.6% vs 52.7%), 0.50 (86.9% vs 80.0%), and 0.75 (97.5% vs 90.9%) D or less (P < .05 for all). Significantly more eyes achieved an angle of error greater than 15° (25.4% vs 8.1%; P = .004), had postoperative residual astigmatism of 0.75 D or less (18.2% vs 7.4%; P = .03), and needed an excimer laser re-treatment (11% vs 1.6%; P = .007).Topography-guided myopic astigmatism LASIK treated on the topography-measured anterior corneal astigmatism axis resulted in inferior refractive and visual outcomes compared to treating on the clinical manifest refractive astigmatism axis. [J Refract Surg. 2019;35(1):15-23.].
View details for DOI 10.3928/1081597X-20181113-01
View details for Web of Science ID 000455674900002
View details for PubMedID 30633783
Utility of Serum IgG4 Levels in a Multiethnic Population
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
2018; 355 (1): 61-66
IgG4-related disease (IgG4-RD) is a recently recognized condition defined by characteristic histopathologic findings in affected organs. Serum IgG4 concentration is often but not always elevated. The sensitivity and specificity of serum IgG4 vary greatly across studies and has been anecdotally associated to ethnicity. Our study was conducted to investigate the difference in serum IgG4 levels between Asian and non-Asian patients with IgG4-RD.This is a single-center retrospective study of 26 Asian and 10 non-Asian patients with histologically confirmed IgG4-RD. Serum IgG4 levels, clinical features and other laboratory findings were compared between the 2 groups, 31 Asian and 11 non-Asian patients with non-IgG4-RD rheumatic diseases were randomly identified to evaluate test characteristics of serum IgG4 measurement.Median serum IgG4 at time of diagnosis was significantly higher in Asian (median = 11.2g/L, interquartile range: 4.6-19.7) than non-Asian patients (median = 2.9g/L, interquartile range: 0.7-5.4, P = 0.0094), as well as the median serum IgG and total protein. Asian patients had more eosinophilia and polyclonal hypergammaglobulinemia than non-Asian patients (P = 0.016 and 0.001, respectively). Test sensitivity was higher in Asian (96%) than non-Asian patients (67%), whereas test specificity was higher in non-Asian patients (91% versus 71%).Asian patients with IgG4-RD have more exuberant serum IgG4, IgG and polyclonal hypergammaglobulinemia than non-Asian patients; the mechanism of this difference requires further study. These findings have significant clinical importance and must be accounted for in the diagnostic workup of patients in multiethnic settings.
View details for Web of Science ID 000418892100012
View details for PubMedID 29289265
Recommendations on the Management of Rheumatoid Arthritis in Patients with Cancer: A Systematic Review of Clinical Practice Guidelines and Consensus Statements
View details for Web of Science ID 000411824105237
- Brodie abscess CANADIAN MEDICAL ASSOCIATION JOURNAL 2017; 189 (3): E117