Clinical Assistant Professor, Ophthalmology
Internship: Stanford Health Care at Lucile Packard Children's Hospital (2014) CA
Board Certification: American Board of Ophthalmology, Ophthalmology (2018)
Fellowship: UCLA Ophthalmology Fellowships (2018) CA
Residency: Stanford University Ophthalmology Residency (2017) CA
Medical Education: Harvard Medical School (2013) MA
Efficacy of Netarsudil as an Additional Therapy for Glaucoma in Patients Already on Maximally Tolerated Medical Therapy
ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
View details for Web of Science ID 000690761400725
Effectiveness of Netarsudil as an Additional Therapy for Glaucoma in Patients Already on Maximally Tolerated Medical Therapy.
Clinical ophthalmology (Auckland, N.Z.)
2021; 15: 4367-4372
Purpose: This study seeks to evaluate the effectiveness of netarsudil (Rhopressa) in patients with inadequately controlled IOP on otherwise maximally tolerated medical therapy.Methods: This is a retrospective study of patients started on netarsudil at Stanford University. Exclusion criteria included glaucoma surgery or laser within 6 months of starting netarsudil and other modifications to the baseline medication regimen within 4 weeks of starting netarsudil. The primary outcome was treatment success, defined as IOP reduction meeting a predetermined target, and no further medication, laser, or surgery recommended subsequent to starting netarsudil.Results: Sixty-two eyes were included, and 36 (58%) achieved treatment success at first follow-up. Mean baseline IOP was 19.5 ± 5.6 mmHg on a mean of 3.5 ± 0.7 ocular hypotensive medications. The mean change in IOP from baseline to first follow-up was -3.53 mmHg (-17%). In patients who achieved treatment success, mean IOP change was -5.22 mmHg (-28.0%). Of the eyes with baseline IOP ≤ 20 mmHg, 69% achieved treatment success, compared to only 17% of eyes with baseline IOP ≥ 21 mmHg (P < 0.05).Conclusion: Netarsudil is effective in lowering IOP for patients on otherwise maximally tolerated medical therapy, for which glaucoma laser or surgery would have been the only remaining therapeutic options. Treatment success was more likely in eyes with baseline IOP under 20 mmHg.
View details for DOI 10.2147/OPTH.S337105
View details for PubMedID 34754176
An Open-Label Phase Ib Study to Evaluate Retinal Imaging After Short-term Use of the Balance Goggles System (BGS) in Patients with Glaucoma
ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
View details for Web of Science ID 000554528303047
Cataract Surgery and Rate of Visual Field Progression in Primary Open-Angle Glaucoma
AMERICAN JOURNAL OF OPHTHALMOLOGY
2019; 201: 19–30
To test the hypothesis that cataract surgery slows the apparent rate of visual field (VF) decay in primary open-angle glaucoma patients compared with rates measured during cataract progression.Retrospective cohort study.Consecutive open-angle glaucoma patients who underwent cataract surgery and who had ≥4 VFs and ≥3 years of follow-up before and after surgery were retrospectively reviewed. Mean deviation (MD) rate, visual field index (VFI) rate, pointwise linear regression (PLR), pointwise rate of change (PRC), and the Glaucoma Rate Index (GRI) were compared before and after cataract surgery.A total of 134 eyes of 99 patients were included. Median (interquartile range) follow-up was 6.5 (4.7-8.1) and 5.3 (4.0-7.3) years before and after cataract surgery, respectively. All intraocular pressure (IOP) parameters (mean IOP, standard deviation of IOP, and peak IOP) significantly improved (P < .001) after cataract surgery. All VF indices indicated an accelerated VF decay rate after cataract surgery: MD rate (-0.18 ± 0.40 dB/year vs -0.40 ± 0.62 dB/year, P < .001), VFI rate (-0.44% ± 1.09%/year vs -1.19% ± 1.85%/year, P < .001), GRI (-5.5 ± 10.8 vs -13.5 ± 21.5; P < .001), and PRC (-0.62% ± 2.47%/year before and -1.35% ± 3.71%/year after surgery; P < .001) and PLR (-0.20 ± 0.82 dB/year before and -0.42 ± 1.16 dB/year after surgery; P < .001) for all VF locations. Worse baseline MD and postoperative peak IOP were significantly associated with the postoperative VF decay rate and the change in the decay rate after cataract surgery.Although all IOP parameters improved after cataract surgery, VFs continued to progress. Cataract surgery does not slow the apparent rate of glaucomatous VF decay as compared to rates measured during the progression of the cataract.
View details for DOI 10.1016/j.ajo.2019.01.019
View details for Web of Science ID 000468253700003
View details for PubMedID 30703355
Comparison of simulated keratometric changes following wavefront-guided and wavefront-optimized myopic laser-assisted in situ keratomileusis
2018; 12: 613–19
The aim of the study was to determine and compare the relationship between change in simulated keratometry (K) and degree of refractive correction in wavefront-guided (WFG) and wavefront-optimized (WFO) myopic laser-assisted in situ keratomileusis (LASIK).A total of 51 patients were prospectively randomized to WFG LASIK in one eye and WFO LASIK in the contralateral eye at the Byers Eye Institute, Stanford University. Changes in simulated K and refractive error were determined at 1 year post-operatively. Linear regression was employed to calculate the slope of change in simulated K (ΔK) for change in refractive error (ΔSE). The mean ratio (ΔK/ΔSE) was also calculated.The ratio of ΔK to ΔSE was larger for WFG LASIK compared to WFO LASIK when comparing the slope (ΔK/ΔSE) as determined by linear regression (0.85 vs 0.83, p = 0.04). Upon comparing the mean ratio (ΔK/ΔSE), subgroup analysis revealed that ΔK/ΔSE was larger for WFG LASIK for refractive corrections of >3.00 D and >4.00 D (0.89 vs 0.83; p = 0.0323 and 0.88 vs 0.83; p = 0.0466, respectively). Both linear regression and direct comparison of the mean ratio (ΔK/ΔSE) for refractive corrections <4.00 D and >4.00 D revealed no difference in ΔK/ΔSE between smaller and larger refractive corrections.WFO LASIK requires a smaller amount of corneal flattening compared to WFG LASIK for a given degree of refractive correction. For both, there was no significant difference in change in corneal curvature for a given degree of refractive error between smaller and larger corrections.
View details for PubMedID 29636597
Phototherapeutic keratectomy for epithelial basement membrane dystrophy.
Clinical ophthalmology (Auckland, N.Z.)
2017; 11: 15-22
The purpose of this study was to evaluate the long-term efficacy of phototherapeutic keratectomy (PTK) in treating epithelial basement membrane dystrophy (EBMD).Preoperative and postoperative records were reviewed for 58 eyes of 51 patients with >3 months follow-up (range 3-170 months) treated for EBMD with PTK after failure of conservative medical treatment at Byers Eye Institute of Stanford University. Symptoms, clinical findings, and corrected distance visual acuity (CDVA) were assessed. The primary outcome measure was symptomatic recurrence as measured by erosions or visual complaints >3 months after successful PTK.For eyes with visual disturbances (n=30), preoperative CDVA waŝ20/32 (0.24 Log-MAR, SD 0.21) and postoperative CDVA was ~20/25 (0.07 LogMAR, SD 0.12; P<0.0001). Twenty-six eyes (86.7%) responded to treatment, with symptomatic recurrence in 6 eyes (23.1%) at an average of 37.7 months (SD 42.8). For eyes with painful erosions (n=29), preoperative CDVA was ~20/25 (0.12, SD 0.19) and postoperative CDVA was ~20/20 (0.05. SD 0.16; P=0.0785). Twenty-three eyes (79.3%) responded to treatment, with symptomatic recurrence in 3 eyes (13.0%) at an average of 9.7 months (SD 1.5). The probability of being recurrence free after a successful treatment for visual disturbances and erosions at 5 years postoperatively was estimated at 83.0% (95% confidence interval 68.7%-97.0%) and 88.0% (95% confidence interval 65.3%-96.6%), respectively.The majority of visual disturbances and painful erosions associated with EBMD respond to PTK. For those with a treatment response, symptomatic relief is maintained over long-term follow-up.
View details for DOI 10.2147/OPTH.S122870
View details for PubMedID 28031698
Comparison of Simulated Keratometric Changes Following Wavefront-Guided and Wavefront-Optimized Myopic Photorefractive Keratectomy
JOURNAL OF REFRACTIVE SURGERY
2016; 32 (8): 542-548
To determine the relationship between change in simulated keratometry and corrected refractive error in both wavefront-guided and wavefront-optimized myopic photorefractive keratectomy (PRK), and to determine whether there is a difference in this relationship between these two ablation profiles.Sixty-eight patients received wavefront-guided PRK in one eye and wavefront-optimized PRK in the contralateral eye. The changes in simulated keratometry and corresponding refractive changes for both were determined at 1 year postoperatively. Linear regression was employed to calculate the slope of change in simulated keratometry (ΔK) for change in refractive error (ΔSE) for both wavefront-guided and wavefront-optimized PRK and compared. The mean ratio ΔK/ΔSE was also calculated for both wavefront-guided and wavefront-optimized PRK and compared.There was no significant difference in the ratio of ΔK to ΔSE between wavefront-optimized and wavefront-guided PRK by both linear regression modeling and comparison of the mean ratio ΔK/ΔSE. Linear regression modeling revealed that the ratio of ΔK/ΔSE was greater for small amounts of change in refractive error and smaller for large amounts of change in refractive error. This trend was only statistically significant for the wavefront-optimized group when comparing the means of the ratio ΔK/ΔSE (P = .0287).The change in corneal curvature induced for a given degree of refractive correction was similar for both wavefront-optimized and wavefront-guided PRK. For both, a proportionally smaller amount of corneal flattening was required for larger degrees of refractive correction compared to smaller degrees. [J Refract Surg. 2016;32(8):542-548.].
View details for DOI 10.3928/1081597X-20160525-01
View details for Web of Science ID 000384899900005
View details for PubMedID 27505315