David Silbert - Academia.edu (original) (raw)

Papers by David Silbert

Research paper thumbnail of Silent sinus syndrome presenting after a roller coaster ride: a case report

The American orthoptic journal, 2014

This is a case presentation of a 39-year-old male who presents with silent sinus syndrome. He was... more This is a case presentation of a 39-year-old male who presents with silent sinus syndrome. He was initially diagnosed by a neuroophthalmologist, and at first, the patient's otolaryngologist disagreed. The patient had a significant reduction in his symptoms with surgical and orthoptic intervention.

Research paper thumbnail of Association Between Accommodative Amplitudes and Amblyopia

Strabismus, 2013

To evaluate the relationship between amblyopia and accommodative ability. The open-field Grand Se... more To evaluate the relationship between amblyopia and accommodative ability. The open-field Grand Seiko binocular autorefractor has become the gold standard for automated measurement of static accommodation. We measured the accommodation amplitudes in 52 children ages 3 to 14 years employing the Grand Seiko auto refractor. Children wore their glasses for this test, which was prescribed based on a cycloplegic refraction performed by one pediatric ophthalmologist. No readings could be obtained for 9 eyes (5 patients). Normal accommodation with correction utilizing full accommodative effort at 1/3 meter is 3D assuming no accommodative lag, and would generate a reading of -3.00D from the Grand Seiko auto refractor. Lack of any accommodative should give a reading of 0.00D. Accommodative gradually declined as the acuity worsened. Our results suggest that amblyopic eyes do not accommodate as well as non-amblyopic eyes. Because accommodation amplitude is not subjective it may be a more sensitive indicator of regression of amblyopia than visual acuity. The Grand Seiko autorefractor could prove to be a useful tool to monitor the progress of patients with amblyopia.

Research paper thumbnail of Revised guidelines for reporting results from studies of preschool vision screening

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2012

Juvenile open-angle glaucoma (JOAG) and glaucoma post-childhood cataract removal (GPCC) prove cha... more Juvenile open-angle glaucoma (JOAG) and glaucoma post-childhood cataract removal (GPCC) prove challenging to manage, frequently requiring surgical intervention. Angle surgery, more often successful in primary infantile glaucoma, has some reported success in these cases. Purpose: to evaluate 360-degree trabeculotomy, facilitated by microcatheter, for medically-refractory JOAG and GPCC. Methods: Ongoing , multicenter study of all 360-degree trabeculotomy for JOAG and GPCC using iTrack catheter (2 surgeons/2 sites since 2008). Success5 intraocular pressure(IOP) 5 22 mmHg with. 20% reduction, without disease progression and without oral glaucoma medications or additional glaucoma surgery. One eye per subject analyzed. All cases had gonioscopically open angles preoperatively. Results: Included to date from one site are 28 eyes status/post iTrack-facilitated 360-degree trabeculotomy; 8 JOAG (mean age 16.7 years at diagnosis); 14 GPCC (mean age 20 months at diagnosis). Incomplete cannulation/opening of Schlemm canal occurred intraoperatively in 1 JOAG and 3 GPCC cases. At most recent follow-up, 6 of 7(86%) JOAG and 8 of 11(72%) GPCC cases were successful. Of successful cases, preoperative vs. final IOP decreased in both groups (31.1 AE 8.1 vs 12.1 AE 2.8 mm Hg for JOAG, P \ 0.0008, after mean 10 months; 33.1 AE 3.4 vs 17.3 AE 4.6 mm Hg for GPCC, P \ 0.0001, after mean 13 months). Preoperative versus final mean #glaucoma medications decreased for both groups(JOAG: 4.3 vs 2.8, P \ 0.098; and GPCC: 3.1 vs 1.8, P \ 0.02.) When the surgery failed, it did so within 2 months in all (n 5 4)cases. Complications included vitreous hemorrhage(2 GPCC eyes/one vitrectomy) and transient choroidal effusion(1 GPCC eye). Discussion: ITrack-facilitated 360-degree trabeculotomy shows early promise for initial surgical treatment of medically-refractory JOAG and GPCC, with low complication rates and without loss of remaining surgical options. Conclusions: Continuing study of this technique for JOAG and GPCC will include larger sample size with longer follow-op and may identify predictive factors for long-term success.

Research paper thumbnail of ROC Analysis to Improve Sensitivity and Specificity of the PlusoptiX Photoscreener

Journal of Ophthalmic & Vision Research, 2012

The current issue of JOVR includes an article entitled “Is Noncycloplegic Photorefraction Applica... more The current issue of JOVR includes an article entitled “Is Noncycloplegic Photorefraction Applicable for Screening Refractive Amblyopia risk Factors?”.1 This is a well-constructed study comparing noncycloplegic photorefraction utilizing the plusoptiX SO4 screener to cycloplegic autorefraction (or cycloplegic retinoscopy in those few children in whom cycloplegic autorefraction could not be performed) in detecting AAPOS defined amblyopia risk factors. The authors compared refractive readings of the right eye from 185 children. The authors found an agreement rate of 89.7% between noncycloplegic photoscreening and cycloplegic autorefraction/retinoscopy in determining AAPOS defined amblyopia risk factors. They then broke out myopia, hyperopia, and cylindrical power and analyzed them separately. While the authors found that sensitivity and specificity were quite good for both myopia and astigmatism, sensitivity was poor for hyperopia. This is not surprising given the accommodative state p...

Research paper thumbnail of Pediatric Frontalis Suspension With Braided Polyester: A Comparison of Two Techniques

Journal of pediatric ophthalmology and strabismus, Jan 27, 2018

To demonstrate the benefits of using braided polyester in the management of severe or recurrent p... more To demonstrate the benefits of using braided polyester in the management of severe or recurrent ptosis in children and young adults and to compare the efficacy of two surgical techniques. Retrospective, non-randomized record review of 30 patients (43 eyelid procedures) affected by congenital or acquired severe ptosis who underwent frontalis suspension with braided polyester from 2008 to 2016. Two surgical techniques were compared: the base-down triangle and the Fox pentagon, both of which were performed using a closed technique. Functional success was defined as clearing of the visual axis. Complications and results were examined. Functional success was obtained in 39 eyes of 43 procedures. Marginal reflex distance increased an average of 2.51 mm with the base-down triangle technique and 1.70 mm with the Fox pentagon technique (P = .05). The vertical palpebral fissure height increased an average of 4.60 mm with the base-down triangle technique and 2.45 mm with the Fox pentagon techn...

Research paper thumbnail of Use of green braided polyester in frontalis suspension for severe or recurrent ptosis

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Research paper thumbnail of Comparison of the INNOVA Visual Acuity System Stereotest with the Frisby-Davis 2 Stereotest for the Evaluation of Distance Stereoacuity

Distance stereo acuity has been shown to be useful in monitoring conditions such as control of in... more Distance stereo acuity has been shown to be useful in monitoring conditions such as control of intermittent strabismus. The Frisby Davis distance (FD2) stereotest has been shown to be reliable and is felt to be the gold standard in England. The device however is not widely available in the United States or Canada and is not automated. This study compares the Innova distance stereoacuity test with the Frisby Davis distance (FD2) stereotest. Twenty-seven patients with normal acuity and a normal ophthalmology exam were evaluated. Prior to dilation all patients had an Innova distance stereoacuity test and FD2 test. Both the Innova distance stereoacuity test and the FD2 test were performed at ten feet. The results of the tests were compared using Bland-Altman plot analysis. The INNOVA system tended to underestimate distance stereoacuity by approximately 30 arc seconds compared to the FD2 test. If the INNOVA results were corrected by this amount, then there was a good correlation between the INNOVA results and the FD2. The Innova distance stereoacuity test underestimates stereopsis by approximately 30 arc seconds but does so with sufficient consistency that it may serve as an acceptable method of measuring distance stereoacuity. This study is the first that has correlated the Innova stereoacuity test with the FD2.

Research paper thumbnail of Flip chart Visual Acuity Screening for Amblyopia Risk Factors Compared to the PlusoptiX A09 Photoscreener,Tests Performed by a Lay Screener

Research paper thumbnail of Effects of atropine on the accommodative system: parameters to consider in its use for penalization treatment of amblyopia

Binocular Vision Strabology Quarterly Simms Romano S, 2013

Purpose: We set out to determine the accommodative effects of Atropine on the visual system. Meth... more Purpose: We set out to determine the accommodative effects of Atropine on the visual system. Methods: A prospective study was done on a normal eye in a 31-year-old cooperative adult. One drop of 1% Atropine was instilled and the effect on accommodation, near visual acuity and pupil size was recorded. Accommodation was measured at 1/3 of a meter utilizing the Grand Seiko Auto Refractor. Near visual acuity was measured with the PEDIG ATS 4 near visual acuity test at a set distance of 16 inches. Results: Atropine caused its greatest effect to accommodation, and to pupil size, 3 hours after installation. Curiously, the greatest effect on near visual acuity was seen 27 hours after instillation at which time it dropped to 20/80. Near visual acuity had improved to 20/25 on day 4. Accommodation returned to normal 8 days after instillation and pupil size returned to normal 12 days after instillation. Conclusion: One drop of Atropine affected accommodation for 8 days. Despite this, near vision returned to 20/20 by day 5. These findings may impact how Atropine penalization is prescribed to treat amblyopia both to maximize effectiveness and minimize its impact on school performance.

Research paper thumbnail of Comparing Visual Acuity Measured by Lea Symbols and Patti Pics

The American orthoptic journal, 2015

There is little data validating most illiterate eye charts. Lea Symbols(®), however, have been we... more There is little data validating most illiterate eye charts. Lea Symbols(®), however, have been well validated in numerous studies. In this study, we compare the assessment of visual acuity employing both the Lea Symbol hanging wall Early Treatment Diabetic Retinopathy Study (ETDRS)-style chart and a similar Patti Pics(®) ETDRS-style chart in order to determine whether the two charts provide clinically similar data. We tested the vision of the right eyes of fifty-two consecutive patients. Patients were cooperative children or adults between the ages of 3 and 88 years (mean 58 years). We alternated the order of the chart used first. Patients were also categorized by age and by visual acuity. The visual acuities measured by the two charts were equal for 83% of the measurements (forty-three eyes). In 8% of eyes (four eyes), the visual acuity measured with the Lea Symbols was one line better than that measured by the Patti Pics; in 9% of eyes (five eyes), the acuity from the Patti Pics c...

Research paper thumbnail of Evaluation and Treatment of the Pediatric Tearing Patient

Techniques in Ophthalmology, 2008

ABSTRACT

Research paper thumbnail of Nine-Millimeter Endoscopic Balloon Dacryocystorhinostomy: A New, Less-Invasive Procedure for Tearing in Adults

The Lacrimal System, 2006

Research paper thumbnail of Just do it … better: tips for efficiency in clinical practice

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Research paper thumbnail of AOC/AACO workshop: sensory evaluation and surgical success. Is the Worth 4-Dot test really worth-less?

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Research paper thumbnail of 5- and 9-mm Balloon-Assisted Dacryocystorhinostomy

Principles and Practice of Lacrimal Surgery, 2014

Incisional Daryocystorhinostomy (DCR) was first introduced by Toti in Italy in 1904 [1]. Modifica... more Incisional Daryocystorhinostomy (DCR) was first introduced by Toti in Italy in 1904 [1]. Modifications were introduced over the years resulting in successful procedures by the 1920s. Advances over the past few decades have included the introduction of silicone tubes, antibiotics, and steroids both oral and topical to minimize scarring and infection. Various modifications have been introduced to decrease the size of the external incision or to relocate the incision into the eyelid to decrease the risk of scarring and webbing [2]. Despite this, external DCR remains an invasive procedure with significant morbidity.

Research paper thumbnail of Convergence insufficiency associated with migraine: a case series

The American orthoptic journal, 2014

The appearance of convergence insufficiency in migraineurs suggests a possible link between migra... more The appearance of convergence insufficiency in migraineurs suggests a possible link between migraine and convergence insufficiency. Relevant patients reporting to our neuro-ophthalmology clinic complained of symptoms consistent with convergence insufficiency and had a history of migraine. Patients underwent thorough neuro-ophthalmic evaluations including history, physical exam, and cranial imaging. Four illustrative cases are presented in this report. Convergence insufficiency may develop after migraine. In some cases, it may be a persistent cause of reduced visual functioning. In patients with persistent asthenopia, orthoptic therapy has proven successful. A history of migraine should be sought in patients complaining of reading difficulties secondary to new onset convergence insufficiency. Furthermore, migraineurs should be asked about whether they suffer asthenopia. Finally, a larger scale, prospective study should be considered to further explore a possible link between migraine...

Research paper thumbnail of Part-time vs. full-time occlusion for amblyopia: evidence for part-time patching

The American orthoptic journal, 2013

Amblyopia is characterized by a decreased uncorrectable visual acuity in a structurally normal ey... more Amblyopia is characterized by a decreased uncorrectable visual acuity in a structurally normal eye. Occlusion therapy has been used for years to improve acuity, and, traditionally, practitioners have utilized full-time patching. This article will explore more recent research looking at using part-time patching in the treatment of amblyopia.

Research paper thumbnail of Ocular hydrofluoric acid burns

American journal of ophthalmology, Jan 15, 1992

A 30-year-old man sustained exposure of his eyes, face, and neck involving 4% of body surface are... more A 30-year-old man sustained exposure of his eyes, face, and neck involving 4% of body surface area to hydrofluoric acid. He was treated with immediate lavage and topical calcium gluconate. Because free fluoride ions from ocular and facial exposures can form complexes with body stores of calcium and magnesium, the patient was transferred to a burn unit for cardiac and electrolyte monitoring. He was also treated with calcium gluconate skin injections, pulmonary nebulizer therapy, and topical antibiotics and corticosteroids. In another case, a 25-year-old man with less severe exposure to hydrofluoric acid was treated as an outpatient with topical antibiotics, corticosteroids, and cycloplegia. If an ophthalmologist is the first to treat a patient with chemical exposure, the history of hydrofluoric acid exposure must be obtained, and the burn team and other medical specialists must be quickly consulted to avoid potentially fatal complications.

Research paper thumbnail of Commentary on the outcomes of inferior oblique muscle weakening in inferior oblique muscle overaction

Journal of ophthalmic & vision research

Research paper thumbnail of Accuracy of the Retinomax K-plus3 in measuring refractive error in a pediatric population

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 2014

To compare the Retinomax K-plus3 handheld autorefractor to a retinscopically based refraction per... more To compare the Retinomax K-plus3 handheld autorefractor to a retinscopically based refraction performed by a pediatric ophthalmologist. The medical records of 311 children aged 5 months to 17 years who underwent cycloplegic refraction by both autorefractor and a pediatric ophthalmologist on the same day were retrospectively reviewed. Spherical equivalent, vector dioptric distance (VDD) values, and t tests were performed for each metric with an accompanying age-group comparison (<5 years, 5-7 years, 8-10 years, and ≥11 years). Bland-Altman plots were generated to evaluate the agreement between methods. Overall, the refraction provided by the Retinomax autorefractor was not significantly different in regard to cylinder power and axis. An age-group comparison showed statistically similar readings for all measures of refractive error in children 8-10 years of age. Statistically similar readings were obtained for cylinder power and axis except in children aged 5-7 years. The VDD was s...

Research paper thumbnail of Silent sinus syndrome presenting after a roller coaster ride: a case report

The American orthoptic journal, 2014

This is a case presentation of a 39-year-old male who presents with silent sinus syndrome. He was... more This is a case presentation of a 39-year-old male who presents with silent sinus syndrome. He was initially diagnosed by a neuroophthalmologist, and at first, the patient's otolaryngologist disagreed. The patient had a significant reduction in his symptoms with surgical and orthoptic intervention.

Research paper thumbnail of Association Between Accommodative Amplitudes and Amblyopia

Strabismus, 2013

To evaluate the relationship between amblyopia and accommodative ability. The open-field Grand Se... more To evaluate the relationship between amblyopia and accommodative ability. The open-field Grand Seiko binocular autorefractor has become the gold standard for automated measurement of static accommodation. We measured the accommodation amplitudes in 52 children ages 3 to 14 years employing the Grand Seiko auto refractor. Children wore their glasses for this test, which was prescribed based on a cycloplegic refraction performed by one pediatric ophthalmologist. No readings could be obtained for 9 eyes (5 patients). Normal accommodation with correction utilizing full accommodative effort at 1/3 meter is 3D assuming no accommodative lag, and would generate a reading of -3.00D from the Grand Seiko auto refractor. Lack of any accommodative should give a reading of 0.00D. Accommodative gradually declined as the acuity worsened. Our results suggest that amblyopic eyes do not accommodate as well as non-amblyopic eyes. Because accommodation amplitude is not subjective it may be a more sensitive indicator of regression of amblyopia than visual acuity. The Grand Seiko autorefractor could prove to be a useful tool to monitor the progress of patients with amblyopia.

Research paper thumbnail of Revised guidelines for reporting results from studies of preschool vision screening

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2012

Juvenile open-angle glaucoma (JOAG) and glaucoma post-childhood cataract removal (GPCC) prove cha... more Juvenile open-angle glaucoma (JOAG) and glaucoma post-childhood cataract removal (GPCC) prove challenging to manage, frequently requiring surgical intervention. Angle surgery, more often successful in primary infantile glaucoma, has some reported success in these cases. Purpose: to evaluate 360-degree trabeculotomy, facilitated by microcatheter, for medically-refractory JOAG and GPCC. Methods: Ongoing , multicenter study of all 360-degree trabeculotomy for JOAG and GPCC using iTrack catheter (2 surgeons/2 sites since 2008). Success5 intraocular pressure(IOP) 5 22 mmHg with. 20% reduction, without disease progression and without oral glaucoma medications or additional glaucoma surgery. One eye per subject analyzed. All cases had gonioscopically open angles preoperatively. Results: Included to date from one site are 28 eyes status/post iTrack-facilitated 360-degree trabeculotomy; 8 JOAG (mean age 16.7 years at diagnosis); 14 GPCC (mean age 20 months at diagnosis). Incomplete cannulation/opening of Schlemm canal occurred intraoperatively in 1 JOAG and 3 GPCC cases. At most recent follow-up, 6 of 7(86%) JOAG and 8 of 11(72%) GPCC cases were successful. Of successful cases, preoperative vs. final IOP decreased in both groups (31.1 AE 8.1 vs 12.1 AE 2.8 mm Hg for JOAG, P \ 0.0008, after mean 10 months; 33.1 AE 3.4 vs 17.3 AE 4.6 mm Hg for GPCC, P \ 0.0001, after mean 13 months). Preoperative versus final mean #glaucoma medications decreased for both groups(JOAG: 4.3 vs 2.8, P \ 0.098; and GPCC: 3.1 vs 1.8, P \ 0.02.) When the surgery failed, it did so within 2 months in all (n 5 4)cases. Complications included vitreous hemorrhage(2 GPCC eyes/one vitrectomy) and transient choroidal effusion(1 GPCC eye). Discussion: ITrack-facilitated 360-degree trabeculotomy shows early promise for initial surgical treatment of medically-refractory JOAG and GPCC, with low complication rates and without loss of remaining surgical options. Conclusions: Continuing study of this technique for JOAG and GPCC will include larger sample size with longer follow-op and may identify predictive factors for long-term success.

Research paper thumbnail of ROC Analysis to Improve Sensitivity and Specificity of the PlusoptiX Photoscreener

Journal of Ophthalmic & Vision Research, 2012

The current issue of JOVR includes an article entitled “Is Noncycloplegic Photorefraction Applica... more The current issue of JOVR includes an article entitled “Is Noncycloplegic Photorefraction Applicable for Screening Refractive Amblyopia risk Factors?”.1 This is a well-constructed study comparing noncycloplegic photorefraction utilizing the plusoptiX SO4 screener to cycloplegic autorefraction (or cycloplegic retinoscopy in those few children in whom cycloplegic autorefraction could not be performed) in detecting AAPOS defined amblyopia risk factors. The authors compared refractive readings of the right eye from 185 children. The authors found an agreement rate of 89.7% between noncycloplegic photoscreening and cycloplegic autorefraction/retinoscopy in determining AAPOS defined amblyopia risk factors. They then broke out myopia, hyperopia, and cylindrical power and analyzed them separately. While the authors found that sensitivity and specificity were quite good for both myopia and astigmatism, sensitivity was poor for hyperopia. This is not surprising given the accommodative state p...

Research paper thumbnail of Pediatric Frontalis Suspension With Braided Polyester: A Comparison of Two Techniques

Journal of pediatric ophthalmology and strabismus, Jan 27, 2018

To demonstrate the benefits of using braided polyester in the management of severe or recurrent p... more To demonstrate the benefits of using braided polyester in the management of severe or recurrent ptosis in children and young adults and to compare the efficacy of two surgical techniques. Retrospective, non-randomized record review of 30 patients (43 eyelid procedures) affected by congenital or acquired severe ptosis who underwent frontalis suspension with braided polyester from 2008 to 2016. Two surgical techniques were compared: the base-down triangle and the Fox pentagon, both of which were performed using a closed technique. Functional success was defined as clearing of the visual axis. Complications and results were examined. Functional success was obtained in 39 eyes of 43 procedures. Marginal reflex distance increased an average of 2.51 mm with the base-down triangle technique and 1.70 mm with the Fox pentagon technique (P = .05). The vertical palpebral fissure height increased an average of 4.60 mm with the base-down triangle technique and 2.45 mm with the Fox pentagon techn...

Research paper thumbnail of Use of green braided polyester in frontalis suspension for severe or recurrent ptosis

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Research paper thumbnail of Comparison of the INNOVA Visual Acuity System Stereotest with the Frisby-Davis 2 Stereotest for the Evaluation of Distance Stereoacuity

Distance stereo acuity has been shown to be useful in monitoring conditions such as control of in... more Distance stereo acuity has been shown to be useful in monitoring conditions such as control of intermittent strabismus. The Frisby Davis distance (FD2) stereotest has been shown to be reliable and is felt to be the gold standard in England. The device however is not widely available in the United States or Canada and is not automated. This study compares the Innova distance stereoacuity test with the Frisby Davis distance (FD2) stereotest. Twenty-seven patients with normal acuity and a normal ophthalmology exam were evaluated. Prior to dilation all patients had an Innova distance stereoacuity test and FD2 test. Both the Innova distance stereoacuity test and the FD2 test were performed at ten feet. The results of the tests were compared using Bland-Altman plot analysis. The INNOVA system tended to underestimate distance stereoacuity by approximately 30 arc seconds compared to the FD2 test. If the INNOVA results were corrected by this amount, then there was a good correlation between the INNOVA results and the FD2. The Innova distance stereoacuity test underestimates stereopsis by approximately 30 arc seconds but does so with sufficient consistency that it may serve as an acceptable method of measuring distance stereoacuity. This study is the first that has correlated the Innova stereoacuity test with the FD2.

Research paper thumbnail of Flip chart Visual Acuity Screening for Amblyopia Risk Factors Compared to the PlusoptiX A09 Photoscreener,Tests Performed by a Lay Screener

Research paper thumbnail of Effects of atropine on the accommodative system: parameters to consider in its use for penalization treatment of amblyopia

Binocular Vision Strabology Quarterly Simms Romano S, 2013

Purpose: We set out to determine the accommodative effects of Atropine on the visual system. Meth... more Purpose: We set out to determine the accommodative effects of Atropine on the visual system. Methods: A prospective study was done on a normal eye in a 31-year-old cooperative adult. One drop of 1% Atropine was instilled and the effect on accommodation, near visual acuity and pupil size was recorded. Accommodation was measured at 1/3 of a meter utilizing the Grand Seiko Auto Refractor. Near visual acuity was measured with the PEDIG ATS 4 near visual acuity test at a set distance of 16 inches. Results: Atropine caused its greatest effect to accommodation, and to pupil size, 3 hours after installation. Curiously, the greatest effect on near visual acuity was seen 27 hours after instillation at which time it dropped to 20/80. Near visual acuity had improved to 20/25 on day 4. Accommodation returned to normal 8 days after instillation and pupil size returned to normal 12 days after instillation. Conclusion: One drop of Atropine affected accommodation for 8 days. Despite this, near vision returned to 20/20 by day 5. These findings may impact how Atropine penalization is prescribed to treat amblyopia both to maximize effectiveness and minimize its impact on school performance.

Research paper thumbnail of Comparing Visual Acuity Measured by Lea Symbols and Patti Pics

The American orthoptic journal, 2015

There is little data validating most illiterate eye charts. Lea Symbols(®), however, have been we... more There is little data validating most illiterate eye charts. Lea Symbols(®), however, have been well validated in numerous studies. In this study, we compare the assessment of visual acuity employing both the Lea Symbol hanging wall Early Treatment Diabetic Retinopathy Study (ETDRS)-style chart and a similar Patti Pics(®) ETDRS-style chart in order to determine whether the two charts provide clinically similar data. We tested the vision of the right eyes of fifty-two consecutive patients. Patients were cooperative children or adults between the ages of 3 and 88 years (mean 58 years). We alternated the order of the chart used first. Patients were also categorized by age and by visual acuity. The visual acuities measured by the two charts were equal for 83% of the measurements (forty-three eyes). In 8% of eyes (four eyes), the visual acuity measured with the Lea Symbols was one line better than that measured by the Patti Pics; in 9% of eyes (five eyes), the acuity from the Patti Pics c...

Research paper thumbnail of Evaluation and Treatment of the Pediatric Tearing Patient

Techniques in Ophthalmology, 2008

ABSTRACT

Research paper thumbnail of Nine-Millimeter Endoscopic Balloon Dacryocystorhinostomy: A New, Less-Invasive Procedure for Tearing in Adults

The Lacrimal System, 2006

Research paper thumbnail of Just do it … better: tips for efficiency in clinical practice

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Research paper thumbnail of AOC/AACO workshop: sensory evaluation and surgical success. Is the Worth 4-Dot test really worth-less?

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Research paper thumbnail of 5- and 9-mm Balloon-Assisted Dacryocystorhinostomy

Principles and Practice of Lacrimal Surgery, 2014

Incisional Daryocystorhinostomy (DCR) was first introduced by Toti in Italy in 1904 [1]. Modifica... more Incisional Daryocystorhinostomy (DCR) was first introduced by Toti in Italy in 1904 [1]. Modifications were introduced over the years resulting in successful procedures by the 1920s. Advances over the past few decades have included the introduction of silicone tubes, antibiotics, and steroids both oral and topical to minimize scarring and infection. Various modifications have been introduced to decrease the size of the external incision or to relocate the incision into the eyelid to decrease the risk of scarring and webbing [2]. Despite this, external DCR remains an invasive procedure with significant morbidity.

Research paper thumbnail of Convergence insufficiency associated with migraine: a case series

The American orthoptic journal, 2014

The appearance of convergence insufficiency in migraineurs suggests a possible link between migra... more The appearance of convergence insufficiency in migraineurs suggests a possible link between migraine and convergence insufficiency. Relevant patients reporting to our neuro-ophthalmology clinic complained of symptoms consistent with convergence insufficiency and had a history of migraine. Patients underwent thorough neuro-ophthalmic evaluations including history, physical exam, and cranial imaging. Four illustrative cases are presented in this report. Convergence insufficiency may develop after migraine. In some cases, it may be a persistent cause of reduced visual functioning. In patients with persistent asthenopia, orthoptic therapy has proven successful. A history of migraine should be sought in patients complaining of reading difficulties secondary to new onset convergence insufficiency. Furthermore, migraineurs should be asked about whether they suffer asthenopia. Finally, a larger scale, prospective study should be considered to further explore a possible link between migraine...

Research paper thumbnail of Part-time vs. full-time occlusion for amblyopia: evidence for part-time patching

The American orthoptic journal, 2013

Amblyopia is characterized by a decreased uncorrectable visual acuity in a structurally normal ey... more Amblyopia is characterized by a decreased uncorrectable visual acuity in a structurally normal eye. Occlusion therapy has been used for years to improve acuity, and, traditionally, practitioners have utilized full-time patching. This article will explore more recent research looking at using part-time patching in the treatment of amblyopia.

Research paper thumbnail of Ocular hydrofluoric acid burns

American journal of ophthalmology, Jan 15, 1992

A 30-year-old man sustained exposure of his eyes, face, and neck involving 4% of body surface are... more A 30-year-old man sustained exposure of his eyes, face, and neck involving 4% of body surface area to hydrofluoric acid. He was treated with immediate lavage and topical calcium gluconate. Because free fluoride ions from ocular and facial exposures can form complexes with body stores of calcium and magnesium, the patient was transferred to a burn unit for cardiac and electrolyte monitoring. He was also treated with calcium gluconate skin injections, pulmonary nebulizer therapy, and topical antibiotics and corticosteroids. In another case, a 25-year-old man with less severe exposure to hydrofluoric acid was treated as an outpatient with topical antibiotics, corticosteroids, and cycloplegia. If an ophthalmologist is the first to treat a patient with chemical exposure, the history of hydrofluoric acid exposure must be obtained, and the burn team and other medical specialists must be quickly consulted to avoid potentially fatal complications.

Research paper thumbnail of Commentary on the outcomes of inferior oblique muscle weakening in inferior oblique muscle overaction

Journal of ophthalmic & vision research

Research paper thumbnail of Accuracy of the Retinomax K-plus3 in measuring refractive error in a pediatric population

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 2014

To compare the Retinomax K-plus3 handheld autorefractor to a retinscopically based refraction per... more To compare the Retinomax K-plus3 handheld autorefractor to a retinscopically based refraction performed by a pediatric ophthalmologist. The medical records of 311 children aged 5 months to 17 years who underwent cycloplegic refraction by both autorefractor and a pediatric ophthalmologist on the same day were retrospectively reviewed. Spherical equivalent, vector dioptric distance (VDD) values, and t tests were performed for each metric with an accompanying age-group comparison (<5 years, 5-7 years, 8-10 years, and ≥11 years). Bland-Altman plots were generated to evaluate the agreement between methods. Overall, the refraction provided by the Retinomax autorefractor was not significantly different in regard to cylinder power and axis. An age-group comparison showed statistically similar readings for all measures of refractive error in children 8-10 years of age. Statistically similar readings were obtained for cylinder power and axis except in children aged 5-7 years. The VDD was s...