Research Interests: Pharmacokinetics, Medicine, Endophthalmitis, Prospective studies, Humans, and 14 moreBioavailability, High Pressure Liquid Chromatography, Aged, Middle Aged, Anti-Bacterial Agents, Optometry and Ophthalmology, Tablets, Microbial Sensitivity Tests, Quinolines, Biological Availability, Vitrectomy, Fluoroquinolones, Moxifloxacin, and Tolerability
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BACKGROUND AND OBJECTIVE: To report the effect of intravitreal bevacizumab on visual acuity and central retinal thickness (CRT) in refractory diabetic macular edema. PATIENTS AND METHODS: Records of 60 eyes of 54 consecutive patients who... more
BACKGROUND AND OBJECTIVE: To report the effect of intravitreal bevacizumab on visual acuity and central retinal thickness (CRT) in refractory diabetic macular edema. PATIENTS AND METHODS: Records of 60 eyes of 54 consecutive patients who underwent intravitreal bevacizumab therapy for refractory diabetic macular edema were reviewed. All eyes received intravitreal bevacizumab 1.25 mg/0.05 mL, and 36 eyes underwent pretreatment and post-treatment optical coherence tomography. Mean follow-up was 7.4 months. RESULTS: Pretreatment mean visual acuity plus or minus standard deviation was 0.71 ± 0.28 logarithm of the minimum angle of resolution (LogMAR) Snellen letters. At final follow-up, mean visual acuity had improved to 0.66 ± 0.30 LogMAR ( P = .0543). Mean baseline CRT was 440 ± 106 µm, and follow-up mean CRT was 386 ± 129 µm ( P = .008). Vitrectomized eyes had worse visual acuity and CRT outcomes ( P = .002 and P = .028, respectively) compared with nonvitrectomized eyes. CONCLUSION: Intravitreal bevacizumab may provide a functional and anatomic benefit in eyes with persistent diabetic macular edema despite previous treatments. [Ophthalmic Surg Lasers Imaging 2010;41:323–329.]
Research Interests: Ophthalmology, Treatment Outcome, Optical coherence tomography, Medicine, Visual acuity, and 15 moreHumans, Diabetic Retinopathy, Female, Male, Monoclonal Antibodies, Aged, Middle Aged, Optometry and Ophthalmology, Adult, Retrospective Studies, Bevacizumab, Macular edema, Injections, Diabetic macular edema, and Angiogenesis inhibitors
ImportanceRetinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect... more
ImportanceRetinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.ObjectiveTo investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.Design, Setting, and ParticipantsThis economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 p...
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Fifteen eyes with complicated retinal detachments-11 with proliferative vitreoretinopathy (C 3 D 3 ), 2 with posterior segment trauma, and 2 with inflammatory retinopathy-were treated with vitrectomy, membrane peeling, and large posterior... more
Fifteen eyes with complicated retinal detachments-11 with proliferative vitreoretinopathy (C 3 D 3 ), 2 with posterior segment trauma, and 2 with inflammatory retinopathy-were treated with vitrectomy, membrane peeling, and large posterior retinotomy. All posterior relaxing retinotomies were circumferential, including temporal quadrants in all cases. With a minimum follow up of 6 months, 12 eyes (80%) were attached posterior to the retinotomy. Reproliferation resulted in redetachment in 3 eyes (20%). Visual acuity improved in 53%, remained unchanged in 20%, and decreased in 27%. Of the 11 eyes that achieved stable or improved visual acuity, 5 (45%) achieved 20/400 to 20/25 vision, 5 achieved counts fingers perception, and 1 patient remained stable at hand motion perception. Of all the eyes undergoing surgery, hypotony (intraocular pressure < 5 mm Hg) occurred in 6 eyes (40%); 3 of these were among the 12 eyes with attached retinas.
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The emerging literature on the novel coronavirus pandemic has reported several cases of varied retinal findings in patients with COVID-19. We report the case of a 59-year-old male who presented with complaint of bilateral blurry vision... more
The emerging literature on the novel coronavirus pandemic has reported several cases of varied retinal findings in patients with COVID-19. We report the case of a 59-year-old male who presented with complaint of bilateral blurry vision following hospital discharge after prolonged hospitalization for severe COVID-19 illness. On ocular exam, the patient demonstrated bilateral cotton wool spots localized to the posterior pole of each eye. Multimodal imaging demonstrated findings consistent with retinal nerve fiber layer infarcts in the areas of the cotton wool spots. Exam and imaging of our patient were most consistent with a Purtscher-like retinopathy. We suggest that as ophthalmologists care for increasing numbers of patients recuperating from COVID-19, they monitor for microangiopathic changes similar to those in our patient.
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PURPOSE To describe predominantly persistent intraretinal fluid (PP-IRF) and its association with visual acuity (VA) and retinal anatomic findings at long-term follow-up in eyes treated with pro re nata (PRN) ranibizumab or bevacizumab... more
PURPOSE To describe predominantly persistent intraretinal fluid (PP-IRF) and its association with visual acuity (VA) and retinal anatomic findings at long-term follow-up in eyes treated with pro re nata (PRN) ranibizumab or bevacizumab for neovascular age-related macular degeneration. DESIGN Cohort within a randomized clinical trial PARTICIPANTS: Participants in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) assigned to PRN treatment. METHODS IRF presence on optical coherence tomography (OCT) scans was assessed at baseline and monthly follow-up visits by the Duke OCT Reading Center. PP-IRF through week 12, year 1, and year 2 were defined as IRF presence at baseline and ≥80% of follow-up visits. Among eyes with baseline IRF, mean VA scores (letters) and change from baseline were compared between eyes with and without PP-IRF. Adjusted mean VA scores and change from baseline were also calculated using linear regression analysis to account for baseline patient features identified as predictors of VA in previous CATT studies. Outcomes were also adjusted by concomitant predominantly persistent subretinal fluid. PRIMARY OUTCOME MEASURES Predominantly persistent intraretinal fluid through week 12, year 1, and year 2, VA score and VA change, Scar development at year 2 RESULTS: Among 363 eyes with baseline IRF, 108 (29.8%) had PP-IRF through year 1 and 95 (26.1%) through year 2. Comparing eyes with and without PP-IRF through year 1, mean 1-year VA score was 62.4 vs. 68.5 (p=0.002) and was 65.0 vs. 67.4 after adjustment (p=0.13). PP-IRF through year 2 was associated with worse adjusted 1-year mean VA score (64.8 vs. 69.2; P=0.006) and change (4.3 vs. 8.1; P=0.01), and 2-year mean VA score (63.0 vs. 68.3; P=0.004) and change (2.4 vs. 7.1; P=0.009). PP-IRF through year 2 was associated with higher 2-year risk of scar development (adjusted hazard ratio=1.49; P=0.03). CONCLUSIONS Approximately one-quarter of eyes had PP-IRF through year 2. PP-IRF through year 1 was associated with worse long-term VA, but the relationship disappeared after adjustment for baseline predictors of VA. PP-IRF through year 2 was independently associated with worse long-term VA and scar development.
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BACKGROUND AND OBJECTIVE Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous... more
BACKGROUND AND OBJECTIVE Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous opacities (PVOs) that may correlate with Shaffer's sign, which may correlate with retinal breaks. PATIENTS AND METHODS Patients with symptomatic PVDs were retrospectively reviewed at a single institution by a single provider. Masked qualitative review of SD-OCTs by a single reviewer determined presence of PVOs. RESULTS Among 78 patients, PVOs were found in 32 of the patients (41%), and 19 (59%) had retinal breaks. In those without PVOs, six (13%) had a break. Sensitivity and specificity were 76.0% and 75.5%, respectively. Removing patients with vitreous hemorrhages, sensitivity, and specificity of PVOs was 82.4% and 86.4%, respectively. CONCLUSION In symptomatic PVDs, PVOs on OCT correlated with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:628-632.].
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Loeys‐Dietz syndrome is a heritable disorder of the connective tissue leading to multisystem involvement including craniofacial features, skeletal abnormalities, cutaneous findings and early‐onset and aggressive disease of the aorta and... more
Loeys‐Dietz syndrome is a heritable disorder of the connective tissue leading to multisystem involvement including craniofacial features, skeletal abnormalities, cutaneous findings and early‐onset and aggressive disease of the aorta and its branches. There are multiple types of Loeys‐Dietz syndrome related to pathogenic variants in TGFBR1, TGFBR2, SMAD3, TGFB2, and TGFB3. Individuals with Loeys‐Dietz syndrome may be misdiagnosed as having Marfan syndrome due to shared phenotypic features and aortic root dilation. However, ectopia lentis has been an important discriminating feature, being unique to Marfan syndrome and not reported to be associated with Loeys‐Dietz syndrome. We report the case of a 46‐year‐old woman with Loeys‐Dietz syndrome type 4 due to a pathogenic variant in TGFB2 who was diagnosed with ectopia lentis at age 44. The patient underwent whole exome sequencing and no other pathogenic variants were found to explain the ectopia lentis. Our findings indicate that ectopia lentis may be an uncommon finding in Loeys‐Dietz syndrome type 4 and emphasize the importance of genetic testing in familial thoracic aortic aneurysm disease.
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Purpose:This study examines treatment-based outcomes of endophthalmitis due to antivascular endothelial growth factor (anti-VEGF) intravitreal injection and its effect on subsequent management of neovascular disease.Methods:A... more
Purpose:This study examines treatment-based outcomes of endophthalmitis due to antivascular endothelial growth factor (anti-VEGF) intravitreal injection and its effect on subsequent management of neovascular disease.Methods:A retrospective multicenter study was conducted of 157 patients with a diagnosis of endophthalmitis following anti-VEGF intravitreal injection at 10 major ophthalmic centers.Results:The median number of injections before endophthalmitis was 10 (range, 1 to 84 injections). Initial treatment with tap and inject with or without subsequent vitrectomy trended toward smaller visual acuity changes from baseline (4 ETDRS [Early Treatment Diabetic Retinopathy Study] letter difference vs 19 ETDRS letter difference) compared with initial vitrectomy, but the difference was not statistically significant. There was no significant change in medication choice among injections after endophthalmitis. There was a statistically significant shift away from regular interval (1- to 2-m...
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We have seen the efficacy of anti-vascular endothelial growth factor (VEGF) therapy in the treatment of diabetic macular oedema (DMO) as demonstrated by the major clinical trials, but what do we do for those that respond poorly to the... more
We have seen the efficacy of anti-vascular endothelial growth factor (VEGF) therapy in the treatment of diabetic macular oedema (DMO) as demonstrated by the major clinical trials, but what do we do for those that respond poorly to the standard treatment regimen? Let’s discuss this issue and others as it pertains to the treatment of DMO.
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To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial. Randomized clinical trial with extended follow-up. Review of data collected on the first implant in the eye(s) of... more
To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial. Randomized clinical trial with extended follow-up. Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically-related. 250 eyes (146 patients) had at least one implant placed. Median time follow-up time after implant placement was 6 years (range 0.5 to 9.2). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval (CI): 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity >5 letters temporally related to the dissociation. 39 implant removal surgeries were performed, 33 with replacement. Twelve dissociations were no...
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To study the relationship between early response to intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration (nAMD) and long-term visual outcomes Seventeen patients with nAMD participated in this... more
To study the relationship between early response to intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration (nAMD) and long-term visual outcomes Seventeen patients with nAMD participated in this prospective clinical trial. All patients received three initial monthly IAIs, followed by IAIs at 8-week intervals. Study visits were scheduled at 1 week, followed by every 2 weeks for the first 3 months and then every 4 weeks until the conclusion of the study at 48 weeks. Eight eyes (47%) were dry on spectral-domain optical coherence tomography by week 2 (early responders), and the remaining nine eyes took an average of 7.5 weeks for fluid resolution (late responders). The mean change in best-corrected visual acuity (BCVA) at the final visit was +11.9 letters from baseline (P = .002). Average BCVA gain in early responders was +11.6 letters compared to +12.2 letters in late responders (P = .7). Although there was not a statistically significant correlation b...
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While copious data exist regarding the incidence, treatment, and prognosis of rhegmatogenous retinal detachment (RRD), fewer data exist regarding bilateral RRD. The authors performed a retrospective review of patients with sequential... more
While copious data exist regarding the incidence, treatment, and prognosis of rhegmatogenous retinal detachment (RRD), fewer data exist regarding bilateral RRD. The authors performed a retrospective review of patients with sequential bilateral rhegmatogenous retinal detachments over a 5-year period from January 1, 2009, through December 31, 2014, that were repaired at a single institution. Data were reviewed for 80 eyes of 40 patients, which is the largest series of sequential RRD reported. In patients with sequential RRD, the subsequently affected eyes were more likely to present with better initial visual acuity, shorter duration of symptoms, less macula-off status, and less concurrent proliferative vitreoretinopathy. The subsequent eye had better final visual acuity and was less likely to re-detach. Subsequent eyes tended to progress to RRD despite prophylactic retinopexy. The constellation of baseline characteristics in which subsequent eyes presented with better initial visual ...
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To compare efficacy of monthly treatment with bevacizumab or ranibizumab for macular edema due to retinal vein occlusion. Randomized, multicenter, comparative trial (ClinicalTrials.gov identifier: NCT01428388). Participants were... more
To compare efficacy of monthly treatment with bevacizumab or ranibizumab for macular edema due to retinal vein occlusion. Randomized, multicenter, comparative trial (ClinicalTrials.gov identifier: NCT01428388). Participants were randomized 1:1 to receive monthly treatment with bevacizumab or ranibizumab. The primary outcome was change in central foveal thickness at 6 months compared to baseline. The trial randomized 98 patients to treatment with bevacizumab or ranibizumab. At 6 months, there were no differences in change in central foveal thickness between groups (bevacizumab: mean reduction of 212.6 µm, 95% confidence interval [CI], -288.3 to -137.0; ranibizumab: mean reduction of 243.8 µm, 95% CI, -309.6 to -178.0; P = .72, analysis of variance [ANOVA]). Both groups showed similar functional outcomes (bevacizumab: 0.33 logMAR gain, 95% CI, -0.47 to -0.18; ranibizumab: 0.34 logMAR gain, 95% CI, -0.45 to -0.23; P = .38, ANOVA). In the treatment of retinal vein occlusion, bevacizumab...
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To identify factors associated with best-corrected visual acuity (BCVA) presentation and two-year outcome in 479 intermediate, posterior, and panuveitic eyes. Cohort study using randomized controlled trial data METHODS: Multicenter... more
To identify factors associated with best-corrected visual acuity (BCVA) presentation and two-year outcome in 479 intermediate, posterior, and panuveitic eyes. Cohort study using randomized controlled trial data METHODS: Multicenter Uveitis Steroid Treatment (MUST) Trial masked BCVA measurements at baseline and 2 years' follow-up used gold standard methods. Twenty-three clinical centers documented characteristics per protocol, which were evaluated as potential predictive factors for baseline BCVA and two-year change in BCVA. Baseline factors significantly associated with reduced BCVA included: age≥50 vs. <50 years; posterior vs. intermediate uveitis; uveitis duration>10 vs. <6 years; anterior chamber (AC) flare>grade 0; cataract; macular thickening; and exudative retinal detachment. Over two years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (p=0.52) and 10 letters (p<0.001) respectively. Both treatment groups and all sit...
Research Interests: Ophthalmology, Treatment Outcome, Optical coherence tomography, Medicine, Visual acuity, and 13 moreHumans, Female, Male, Follow-up studies, Clinical Sciences, Aged, Uveitis, Middle Aged, Optometry and Ophthalmology, Public health systems and services research, Time Factors, Randomized Controlled Trial, and Glucocorticoids
Refractive error (RE) is a complex, multifactorial disorder characterized by a mismatch between the optical power of the eye and its axial length that causes object images to be focused off the retina. The two major subtypes of RE are... more
Refractive error (RE) is a complex, multifactorial disorder characterized by a mismatch between the optical power of the eye and its axial length that causes object images to be focused off the retina. The two major subtypes of RE are myopia (nearsightedness) and hyperopia (farsightedness), which represent opposite ends of the distribution of the quantitative measure of spherical refraction. We performed a fixed effects meta-analysis of genome-wide association results of myopia and hyperopia from 9 studies of European-derived populations: AREDS, KORA, FES, OGP-Talana, MESA, RSI, RSII, RSIII and ERF. One genome-wide significant region was observed for myopia, corresponding to a previously identified myopia locus on 8q12 (p = 1.25×10(-8)), which has been reported by Kiefer et al. as significantly associated with myopia age at onset and Verhoeven et al. as significantly associated to mean spherical-equivalent (MSE) refractive error. We observed two genome-wide significant associations ...
Research Interests: Genetics, Biology, Myopia, Medicine, Multidisciplinary, and 15 moreHumans, Female, Male, Genetic Association Studies, Meta Analysis, Eye, Aged, Middle Aged, Adult, Linkage Disequilibrium, European Continental Ancestry Group, Genetic Markers, Age of Onset, alleles, and Genetic predisposition to disease
Research Interests: Ophthalmology, Natural History, Medicine, Retinal Pigment Epithelium, Visual acuity, and 15 moreMacular Degeneration, Prospective studies, Humans, Female, Retinal detachment, Male, Age related macular degeneration, Clinical Sciences, Aged, Middle Aged, Questionnaires, Optometry and Ophthalmology, Public health systems and services research, Disease Progression, and Drusen
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Research Interests: Ophthalmology, Photography, Optical coherence tomography, Medicine, Macular Degeneration, and 15 moreProspective studies, Humans, Female, Male, Age related macular degeneration, Clinical Sciences, Aged, Middle Aged, Optometry and Ophthalmology, Observer Variation, Public health systems and services research, Reproducibility, Reproducibility of Results, Disease Progression, and Geographic atrophy
Purpose To assess the efficacy and the safety of photodynamic therapy (PDT) for treatment of choroidal neovascularization linked to choroidal nevi. Methods It is a retrospective study including choroidal neovascularization secondary to... more
Purpose To assess the efficacy and the safety of photodynamic therapy (PDT) for treatment of choroidal neovascularization linked to choroidal nevi. Methods It is a retrospective study including choroidal neovascularization secondary to choroidal nevi treated by PDT for 1999 to 2005. PDT was performed according to the standard protocol used for treating choroidal neovascularization secondary to age-related macular degeneration (ARMD). Post-PDT follow-up was also done according to the guidelines used in ARMD. Moreover, tumors were controlled every 3 months. Results Six choroidal neovascularizations secondary to choroidal nevi were included in our study. All nevi were localized in the posterior choroids. The median of their largest diameter was of 3mm and their thickness was <2mm in all cases. Neovascular membranes were “classic” in all cases, subfoveal in 2 cases, juxtafoveal in 3 cases and extrafoveal in 1 case. The sizes of choroidal neovascularization were ≤ 1-disk-diameter in half the cases. On average 3.3 sessions of PDT were necessary to obtain the stabilization of choroidal neoascularization. The mean follow-up was 35 months without any patient lost of follow-up. Visual outcomes were extremely variable. Large or retrofoveal choroidal neovascularization but also antecedents of atrophic ARMD were related with worse functional results. No growth of the nevi was observed. Conclusion Choroidal neovascularization is considered to be a relative indicator of benignity of the naevus. However, it often marks a definitive turning point in the visual function. PDT appears as a safe and efficient procedure for treating choroidal neovascularization secondary to choroidal naevus with results similar to those observed in ARMD.
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Purpose: This work analyzes a series of eyes with brolucizumab-associated intraocular inflammation (IOI) without retinal vasculitis reported to the American Society of Retina Specialists. Methods: The American Society of Retina... more
Purpose: This work analyzes a series of eyes with brolucizumab-associated intraocular inflammation (IOI) without retinal vasculitis reported to the American Society of Retina Specialists. Methods: The American Society of Retina Specialists Research and Safety in Therapeutics Committee analyzed clinical characteristics from submitted reports of IOI after brolucizumab. Eyes with retinal vasculitis or that received intraocular antibiotics were excluded. Results: Forty-nine eyes of 45 patients were collected. Mean visual acuity (VA) at baseline was 20/49 (range, 20/20-5/200). Patients presented with IOI a mean of 24 days (range, 3-63 days) after their most recent brolucizumab injection; 61% presented for an unscheduled visit while 39% presented at routine follow-up. Mean VA at IOI presentation was 20/67 (range, 20/20-3/200). The most common symptoms were floaters (78%) and blurry vision (76%). Pain (20%) and redness (16%) were less common; 3 (6%) eyes were asymptomatic. IOI was anterior...
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Importance Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are used to treat a variety of posterior segment conditions, including some associated with glaucoma, such as macular edema due to central retinal vein... more
Importance Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are used to treat a variety of posterior segment conditions, including some associated with glaucoma, such as macular edema due to central retinal vein occlusion (CRVO). Therefore, information regarding intraocular pressure (IOP)-related events associated with anti-VEGF therapies is important to help balance the risks and benefits over the course of therapy. Objective To investigate IOP-related events among participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2). Design, Setting, and Participants Secondary analysis of a randomized clinical trial that included 312 participants with macular edema secondary to CRVO or hemiretinal vein occlusion (HRVO) who were not taking IOP-lowering medications at baseline. First randomization occurred on September 14, 2014, and contained data through data freeze on April 1, 2020. Analysis took place from April 2020 through December 2020. Interventions Study participants were initially randomized to 6 monthly intravitreal injections of aflibercept or bevacizumab. At month 6, protocol-defined good responders were rerandomized to continued monthly or treat-and-extend dosing of their originally assigned study drug, and protocol-defined poor or marginal responders were switched to alternative treatment. After month 12, participants were treated as per investigator discretion. Main Outcomes and Measures Three different outcomes: (1) IOP elevation more than 10 mm Hg from baseline, (2) IOP to a level higher than 35 mm Hg, and (3) IOP-lowering incisional or laser surgery. Results Of the 312 participants meeting inclusion criteria (138 [44.2%] were female; mean [SD] age, 67.8 [12.1] years), 25 (8.0%) had IOP elevation more than 10 mm Hg over baseline through month 60, and 5 (1.6%) had IOP higher than 35 mm Hg. The 60-month Kaplan-Meier cumulative incidence of IOP elevation more than 10 mm Hg over baseline was 0.13 (95% CI, 0.08-0.19), and the 60-month Kaplan-Meier cumulative incidence of IOP higher than 35 mm Hg was 0.02 (95% CI, 0.01-0.06), and did not differ among participants initially randomly assigned to receive aflibercept or bevacizumab. Three participants (1.0%) underwent IOP-lowering incisional surgery, and 3 participants (1.0%) underwent IOP-lowering glaucoma laser surgery. Conclusions and Relevance Intravitreal anti-VEGF injections are used to treat some conditions associated with glaucoma, such as macular edema due to CRVO, and the rates of IOP-related events in this trial support monitoring IOP in eyes treated with anti-VEGF therapy for macular edema associated with CRVO or HRVO for up to 60 months. Trial Registration ClinicalTrials.gov Identifier: NCT01969708.
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To compare baseline characteristics, treatment frequency, visual acuity (VA), and morphologic outcomes of eyes with >50% of the lesion composed of blood (B50 group) versus all other eyes (Other group) enrolled in the Comparison of... more
To compare baseline characteristics, treatment frequency, visual acuity (VA), and morphologic outcomes of eyes with >50% of the lesion composed of blood (B50 group) versus all other eyes (Other group) enrolled in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Prospective cohort study within a multicenter randomized clinical trial. CATT patients with neovascular age-related macular degeneration (AMD). Treatment for the study eye was assigned randomly to either ranibizumab or bevacizumab and to 3 different dosing regimens over a 2-year period. Reading center graders evaluated baseline and follow-up morphology in color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT). Masked examiners tested VA. Morphologic features and VA at 1 and 2 years. The B50 group consisted of 84 of 1185 (7.1%) patients enrolled in CATT. Baseline lesion characteristics differed between groups. In the B50 group, choroidal neovascularization ...
Research Interests: Ophthalmology, Treatment Outcome, Optical coherence tomography, Medicine, Visual acuity, and 13 moreProspective studies, Humans, Female, Male, Follow-up studies, Clinical Sciences, Aged, Optometry and Ophthalmology, Public health systems and services research, Cohort Studies, Intravitreal Injections, Angiogenesis inhibitors, and Choroidal Neovascularization
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Research Interests: Ophthalmology, Medicine, Macular Degeneration, Language Learning, Prospective studies, and 15 moreHumans, Female, Male, Age related macular degeneration, Clinical Sciences, Aged, Middle Aged, Optometry and Ophthalmology, Drug evaluation, Clinical Study, Exudates and Transudates, Choroidal Neovascularization Industry, Indocyanine green, Angiogenesis inhibitors, and Choroidal Neovascularization
Toxic Shock Syndrome: Centers for Disease Control (Atlanta) Case Definition3 Fever temperature: 38.9°C Rash: Diffuse macular erythroderma with desquamation 1-2 wk after onset of illness, particularly of palms and soles Hypotension... more
Toxic Shock Syndrome: Centers for Disease Control (Atlanta) Case Definition3 Fever temperature: 38.9°C Rash: Diffuse macular erythroderma with desquamation 1-2 wk after onset of illness, particularly of palms and soles Hypotension systolic blood pressure: <90 mm ...
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Research Interests: Genetics, Retinal Pigment Epithelium, Case Report, Humans, Child, and 15 moreRetinitis pigmentosa, Female, Male, Genetic determinism, Pedigree, Phenotype, Deafness, Clinical Sciences, Association, Optometry and Ophthalmology, Public health systems and services research, Degeneration, Night Blindness, Dark Adaptation, and Electroretinogram
Research Interests: Fluorescence, Porphyrins, Medicine, Macular Degeneration, Humans, and 15 moreFemale, Retinal detachment, Male, American, Risk factors, Clinical Sciences, Aged, Optometry and Ophthalmology, Photochemotherapy, Public health systems and services research, Retrospective Studies, Risk Factors, Ophthalmoscopy, Acute Disease, and Randomized Controlled Trials as Topic
Purpose. To describe the clinical response of refractory macular edema associated with Coats’ disease following treatment with aflibercept and laser photocoagulation. Methods. Case report. Results. A 17-year-old female presented with... more
Purpose. To describe the clinical response of refractory macular edema associated with Coats’ disease following treatment with aflibercept and laser photocoagulation. Methods. Case report. Results. A 17-year-old female presented with decreased vision of the left eye. Ophthalmic exam demonstrated intraretinal hemorrhages and exudation with associated edema centrally. Angiographic evaluation revealed central leaking microaneurysms and peripheral capillary dropout. These findings and a systemic work-up that yielded an incidental Factor V Leiden mutation lead to a diagnosis of Coats’ disease. Initial treatment consisted of laser photocoagulation and intravitreal bevacizumab but with poor response. Switching to intravitreal aflibercept resulted in resolution of the refractory macular edema and improvement of visual acuity to 20/25 in the left eye. Conclusion. We describe a case of refractory macular edema which responded more favorably to intravitreal aflibercept compared with bevacizuma...
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Research Interests: Ophthalmology, Optical coherence tomography, Medicine, Retinal Pigment Epithelium, Visual acuity, and 10 moreMacular Degeneration, Prospective studies, Humans, Retina, Clinical Sciences, Middle Aged, Optometry and Ophthalmology, Public health systems and services research, Intravitreal Injections, and Angiogenesis inhibitors
Purpose: To analyze the surgical and visual outcomes in patients who underwent early versus delayed vitrectomy for dense nondiabetic, nonvascular vitreous hemorrhage from undetermined cause. Methods: A retrospective, consecutive series... more
Purpose: To analyze the surgical and visual outcomes in patients who underwent early versus delayed vitrectomy for dense nondiabetic, nonvascular vitreous hemorrhage from undetermined cause. Methods: A retrospective, consecutive series evaluating all patients with a preoperative diagnosis of nondiabetic vitreous hemorrhage treated surgically at The Retina Institute over the past 5 years. Vitreous hemorrhage had to be described as dense, with first-order vessels not visualized on funduscopic examination. Exclusion criteria included a diagnosis of diabetes mellitus, retinal vascular disease, any prior intraocular surgery other than cataract extraction, or any previously diagnosed ocular conditions. A total of 275 patients and 286 eyes were evaluated, with 52 patients and 52 eyes meeting inclusion criteria. Surgical treatment was with standard pars plana vitrectomy. Results: Of the 52 eyes that met inclusion criteria, 32 (61.5%) were found to have at least 1 retinal break. Sixteen eyes...
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Assess associations of 2-year visual acuity (VA) outcomes with VA and optical coherence tomography central subfield thickness (CST) after 12 weeks of anti-vascular endothelial growth factor treatment for diabetic macular edema in DRCR.net... more
Assess associations of 2-year visual acuity (VA) outcomes with VA and optical coherence tomography central subfield thickness (CST) after 12 weeks of anti-vascular endothelial growth factor treatment for diabetic macular edema in DRCR.net Protocol T. Randomized clinical trial. SETTING: Multicenter (89 U.S. sites). Eyes with VA and CST data from baseline and 12-week visits (616 of 660 eyes randomized [93.3%]). Six monthly injections of 2.0-mg aflibercept, 1.25-mg bevacizumab, or 0.3-mg ranibizumab; subsequent injections and focal/grid laser as needed for stability. Change in VA from baseline and VA letter score at 2 years. Twelve-week VA response was associated with 2-year change in VA and 2-year VA letter score for each drug (P <.001) but with substantial individual variability (multivariable R = 0.38, 0.29, and 0.26 for 2-year change with aflibercept, bevacizumab, and ranibizumab, respectively). Among eyes with less than 5-letter gain at 12 weeks, the percentages of eyes gaining...
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To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) antagonists in the treatment of macular edema secondary to retinal vein occlusion (RVO) in clinical practice. A multicenter... more
To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) antagonists in the treatment of macular edema secondary to retinal vein occlusion (RVO) in clinical practice. A multicenter retrospective study of the medical records of 165 patients (95 branch RVO, 70 central RVO) treated with at least three anti-VEGF injections in the study eye was conducted. Available data collected for at least 6 months after the first injection included Snellen best-corrected visual acuity (BCVA), central retinal thickness (CRT) by time-domain optical coherence tomography (TD-OCT) or spectral-domain optical coherence tomography (SD-OCT), anti-VEGF injections, other treatments/procedures for RVO, and adverse events. At baseline prior to anti-VEGF treatment, mean BCVA was 20/80 Snellen equivalent and mean CRT was 499 μm. Mean number of anti-VEGF injections received was 7.1 during the first year, 5.4 during the second year, and 5.9 during the third year; 51.3% (8...
Research Interests:
Prevalence of persistent central-involved diabetic macular edema (DME) through 24 weeks of anti-vascular endothelial growth factor therapy and its longer-term outcomes may be relevant to treatment. To assess outcomes of DME persisting at... more
Prevalence of persistent central-involved diabetic macular edema (DME) through 24 weeks of anti-vascular endothelial growth factor therapy and its longer-term outcomes may be relevant to treatment. To assess outcomes of DME persisting at least 24 weeks after randomization to treatment with 2.0-mg aflibercept, 1.25-mg bevacizumab, or 0.3-mg ranibizumab. Post hoc analyses of a clinical trial, the DRCR.net Protocol T among 546 of 660 participants (82.7%) meeting inclusion criteria for this investigation. Six monthly intravitreous anti-vascular endothelial growth factor injections (unless success after 3 to 5 injections); subsequent injections or focal/grid laser as needed per protocol to achieve stability. Persistent DME through 24 weeks, probability of chronic persistent DME through 2 years, and at least 10-letter (≥ 2-line) gain or loss of visual acuity. The mean age of participants was 60 years, 363 (66.5%) were white, and 251 (46.0%) were women. Persistent DME through 24 weeks was ...
To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) inhibitors as used in clinical practice for the treatment of diabetic macular edema. Multicenter (10 sites), retrospective chart review... more
To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) inhibitors as used in clinical practice for the treatment of diabetic macular edema. Multicenter (10 sites), retrospective chart review in patients (n=156) who received ≥3 anti-VEGF injections. Data collected for ≥6 months after the first injection included Snellen best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by time-domain or spectral-domain optical coherence tomography (TD-OCT or SD-OCT). Mean number of anti-VEGF injections (627 bevacizumab, 594 ranibizumab, 1 aflibercept) was 5.8 (year 1), 5.0 (year 2), and 3.4 (year 3). Percentage of patients with BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) ranged from 16.4% to 38.9% after the first 10 injections; 51.9%-62.3% achieved ≥20/40 BCVA and 26.2%-48.0% met CRT criteria. Therapy was well tolerated with 19 treatment-related adverse events (all ocu...
Research Interests:
Research Interests: Immunology, Cornea, Endophthalmitis, Humans, Gram Positive, and 15 moreFemale, Male, Bacteria, Antibiotic Prophylaxis, High Performance Liquid Chromatography, Clinical Sciences, Eye, High Pressure Liquid Chromatography, Aged, Middle Aged, Adult, Microbial Sensitivity Tests, Biological Availability, Fluoroquinolones, and HPLC Chromatography
ABSTRACT Purpose: It is reported in utility elicitation that people with a disability value their health state more highly than community members who have not experienced the disability. We compared the willingness to pay (WTP) to avoid... more
ABSTRACT Purpose: It is reported in utility elicitation that people with a disability value their health state more highly than community members who have not experienced the disability. We compared the willingness to pay (WTP) to avoid loss of visual function in a community based sample of people to people with visual impairment (VI) using a discrete choice experiment (DCE). Methods: A DCE was constructed in which visual function was described using 9 attributes. These were used to construct a DCE describing insurance policies which offered a 100% guarantee that the participant would never experience functional loss worse than described in the scenario. Attributes were presented in three levels of difficulty ranging from never a problem to always a problem. Premiums ranged from $60 to $12,000/year. Each respondent chose between two scenarios consisting of five attributes selected from the 9 (the insurance premium was always included). The community sample was recruited from a volunteer registry. All community participants had self-reported vision of excellent or good. The VI sample was recruited from retina practices or the volunteer registry. All had best-corrected vision of 20/40 or worse, or self-reported vision of fair or poor. Preference scores from the DCE were estimated using multinomial logit regression and a demand curve for the prevention of loss of visual function was fitted. Results: The DCE was completed by 194 community participants and 56 participants with VI. In the Figure below we plot the demand curves for preserving vision function. The curve for people with VI is inelastic compared to that of the community based sample. This indicates a higher value placed on preserving visual function for the VI sample than the community based sample. Conclusions: We demonstrated using a WTP approach to health state valuation that people with VI place a higher value on maintaining visual function than did those in the community. Whether this is true of all people with disabilities, or an artifact of our sample merits further investigation. :