Laura Enyedi - Academia.edu (original) (raw)

Papers by Laura Enyedi

Research paper thumbnail of Parents’ expectations regarding their children’s eye care: interview results

To determine a relevant set of concerns that parents express as expectations regarding their chil... more To determine a relevant set of concerns that parents express as expectations regarding their children's eye care. Qualitative, cross-sectional, pilot study. A total of 48 interviews were conducted with parents of pediatric ophthalmology patients at Duke University Eye Center and the McGovern Davidson Children's Health Center at Duke University to elicit parents' expectations regarding their children's eye care. Interviews were audiotaped, transcribed, and coded for parent expectations. Content analysis of transcripts from the 48 interviews yielded 35 different expectation areas for eye care, which were further classified into six groups: (1) Communication, (2) Interpersonal Manner, (3) Doctor's Skill, (4) Examination and Testing, (5) Logistics, and (6) Other. The six expectation areas most frequently identified by parents as the single "most important" expectation were the following: (1) Clinical Competence, (2) Interaction with Child, (3) Education/Training, (4) Explanation in Clear Language, (5) Information about Diagnosis, and (6) Personal Connection. Parents of pediatric ophthalmology patients expressed expectation areas in the Communication group more frequently than any other group. However, when asked to identify their single most important expectation area, more than half of parents identified Clinical Competence.

Research paper thumbnail of A comparison of the Marcus Gunn and alternating light tests for afferent pupillary defects

Research paper thumbnail of Safety and Efficacy of Silicone Rod Frontalis Suspension Surgery for Childhood Ptosis Repair

Journal of Pediatric Ophthalmology & Strabismus, 2008

To evaluate the safety and efficacy of silicone rod frontalis suspension surgery for childhood pt... more To evaluate the safety and efficacy of silicone rod frontalis suspension surgery for childhood ptosis. The authors retrospectively studied 89 consecutive children (110 eyelids) who had silicone rod frontalis suspension surgery for ptosis at Duke University Eye Center from 1983 to 2004. Marginal reflex distance1 (MRD1) elevation of 2 mm or more (vs preoperative MRD1) was considered satisfactory. MRD1 was measured as the vertical distance from the corneal light reflex in primary gaze to the upper eyelid margin. The postoperative eyelid symmetry (< or = 1 mm = satisfactory) was the difference between the MRD1 of the surgical and fellow eyelid. Median age at surgery was 45 months (range: 3 to 223 months) and median follow-up was 17 months (range: 1 to 88 months). Ptosis types (number of eyelids) were unilateral congenital (53), bilateral congenital (30), third nerve palsy (16), Marcus Gunn jaw wink (7), trauma (2), and myasthenia gravis (2). Median MRD1 elevation was 2 mm or greater for all ptosis types, whereas satisfactory postoperative symmetry occurred in 60% of unilateral and 100% of bilateral congenital ptosis cases (last follow-up). Complications occurred in 10 eyelids (9%) and reoperation occurred in 10 eyelids (9%). The use of silicone rod frontalis suspension surgery for ptosis repair in pediatric patients is modestly effective, with few complications and easy removal and adjustment.

Research paper thumbnail of Central Corneal Thickness in Children: Racial Differences (Black vs. White) and Correlation With Measured Intraocular Pressure

Journal of Glaucoma, 2006

To test the hypotheses that the mean central corneal thickness (CCT) of healthy black children is... more To test the hypotheses that the mean central corneal thickness (CCT) of healthy black children is thinner than that of healthy white children and to confirm the relationship between increased CCT and measured intraocular pressure (IOP) in children. This prospective observational case series included 178 eyes of 92 children aged 9 months to 17 years without anterior segment abnormalities or a clinical diagnosis of glaucoma. CCT was measured by ultrasonic pachymetry and IOP was measured by Goldmann or Tono-pen technique. The mean CCT for the 102 eyes of 52 white children was 562+/-35 microm versus 543+/-37 microm for the 66 eyes of 35 black children (P = 0.02). There was a positive relationship between CCT and IOP (P = 0.0002). For every 100 mum increase in CCT, the IOP increased by 2.2+/-0.6 mm Hg. The mean CCT of black children is thinner than that of white children. There is a positive relationship between increasing measured IOP and CCT among children with normal corneas and anterior segments. The interpretation of elevated IOP in eyes with abnormal anterior segment anatomy and thickened corneas awaits further study.

Research paper thumbnail of The effectiveness of latanoprost for the treatment of pediatric glaucoma

Journal of American Association for Pediatric Ophthalmology and Strabismus, 1999

atanoprost (Xalatan, Pharmacia & Upjohn, Kalamazoo, Mich) is a newly FDA-approved prostaglandin F... more atanoprost (Xalatan, Pharmacia & Upjohn, Kalamazoo, Mich) is a newly FDA-approved prostaglandin F 2α analogue that has been shown to reduce mean intraocular pressure (IOP) in adult glaucoma patients by 13% to 35%. 1-10 Latanoprost reduces IOP via enhancement of uveoscleral outflow ; this drug's IOPlowering effect has been shown to be additive in combined therapy with other ocular hypotensive agents. In adults, latanoprost is well tolerated and has an excellent systemic and ocular safety profile. There have been no documented systemic side effects, and the most common ocular side effects, conjunctival hyperemia and irritation and increased iris pigmentation, are relatively mild.

Research paper thumbnail of Combined superior oblique muscle recession and inferior oblique muscle advancement and transposition for cyclotorsion associated with macular translocation surgery

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2000

The purpose of this study was to evaluate the effects of oblique muscle surgery on the large-angl... more The purpose of this study was to evaluate the effects of oblique muscle surgery on the large-angle incyclotorsion resulting from macular translocation surgery for severe age-related macular degeneration. Patients undergoing macular translocation (superiorly) at our institution from May 1996 until November 1998 were included. In the Staged Group, strabismus surgery for symptomatic incyclotorsion was performed after the macular translocation, and in the Combined Group, it was performed simultaneous with the macular translocation. Cyclotorsion was quantified using Maddox rod testing. Surgery for incyclotorsion included superior oblique muscle recession combined with inferior oblique muscle advancement and transposition in the affected eyes. The minimum follow-up time was 6 weeks. Fifteen patients (15 eyes) were included (ages 66-89 years). Nine eyes (Baseline Group) had macular translocation surgery before any strabismus surgery; the mean postoperative incylotorsional angle was 33.4 +/- 18.3 degrees (range, 20-80 degrees) after a mean follow-up of 6.6 months. Four of these eyes (Staged Group) underwent oblique muscle surgery for symptomatic incyclotorsion, which reduced the mean incyclotorsion from 26.9 +/- 6.9 degrees (range, 20-35 degrees) to 9. 9 +/- 7.9 degrees (range, 2.5-20 degrees)-a mean reduction of 16.9 +/- 1.3 degrees (P =.00012), after a mean follow-up of 4.6 months. Six additional eyes (Combined Group) had simultaneous macular translocation and oblique muscle surgery, with a mean postoperative cyclotorsional angle of 14.0 +/- 6.7 degrees (range, 4-22.5 degrees), after a mean follow-up of 3.75 months. Oblique muscle surgery is effective at reducing the large degree of incyclotorsion resulting from macular translocation surgery and may be used either following or simultaneous with retinal surgery.

Research paper thumbnail of 126: Success rates of adjustable and nonadjustable strabismus surgery in adults

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Research paper thumbnail of The accuracy of photoscreening at detecting treatable ocular conditions in children with Down syndrome

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

Background-Children with Down syndrome (DS) have an increased prevalence of ocular disorders, inc... more Background-Children with Down syndrome (DS) have an increased prevalence of ocular disorders, including amblyopia, strabismus, and refractive error. Health maintenance guidelines from the DS Medical Interest Group recommend ophthalmologic examinations every 1 to 2 years for these children. Photoscreening may be a cost-effective option for subsequent examinations after an initial complete examination, but no study has evaluated the accuracy of photoscreening in children with DS. The purpose of this study is to determine the sensitivity, specificity, and positive and negative predictive values of photoscreening in detecting treatable ocular conditions in children with DS.

Research paper thumbnail of 041: Latanoprost in pediatric glaucoma—pediatric exposure over a decade

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Research paper thumbnail of Travoprost in children: Adverse effects and intraocular pressure response

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Because of the limited ability to perform controlled, randomized studies in children, the safety ... more Because of the limited ability to perform controlled, randomized studies in children, the safety and effectiveness of topical medications in pediatric glaucoma is sometimes difficult to determine. Although travoprost has been commercially available since 2001, there are no published reports on its use in children. This retrospective study found travoprost to have minimal adverse events in children and to reduce IOP in select cases of pediatric glaucoma.

Research paper thumbnail of Travoprost in pediatric glaucoma—safety and effectiveness

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2007

all conjugate eye movement systems, but spares vergence eye movements. In the five patients with ... more all conjugate eye movement systems, but spares vergence eye movements. In the five patients with presurgical recordings, such eye movement abnormalities were not seen.

Research paper thumbnail of Latanoprost in pediatric glaucoma—pediatric exposure over a decade

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Although numerous studies of latanoprost in adult glaucoma have shown it to be an effective hypot... more Although numerous studies of latanoprost in adult glaucoma have shown it to be an effective hypotensive agent with a low incidence of side effects, these issues have not been well studied in pediatric glaucomas. The purpose of the current study is to evaluate the safety and intraocular pressure (IOP) lowering effect of latanoprost in various pediatric glaucomas over a long period. This retrospective study included all children treated with latanoprost at our institution from 1996 to 2007. Demographic, glaucoma-related, and side-effect information was recorded for each subject. Duration of latanoprost exposure was calculated in child-months (1 child exposed for 1 month). If interpretable IOP data were available, the presence or absence of a treatment response (IOP reduction > or =15% from baseline) was determined for each subject. A total of 115 subjects with latanoprost exposure were identified, with a collective exposure of 2,325 child-months. Exposure for > or =1 year occurred in 52 subjects. Side effects were mild and infrequently reported. Of the 115 subjects, 63 had interpretable IOP data, and 22 (35%) were treatment responders. Predictors of a response included a diagnosis of juvenile open-angle glaucoma, monotherapy, and older age. This large study of latanoprost-treated children confirms the excellent safety profile of the drug in the treatment of pediatric glaucoma. The study also confirms latanoprost's IOP-lowering ability in older children with juvenile open-angle glaucoma and in some children with aphakic glaucoma. Prospective studies are needed to better define the optimal role of latanoprost in the treatment of pediatric glaucoma, especially congenital glaucoma.

Research paper thumbnail of The accuracy of vision screening at detecting treatable ocular conditions in children with Down syndrome

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

Research paper thumbnail of An intravitreal device providing sustained release of cyclosporine and dexamethasone

Current Eye Research, 1996

A device that releases cyclosporine and dexamethasone into the eye for extended periods of time m... more A device that releases cyclosporine and dexamethasone into the eye for extended periods of time might be beneficial in diseases such as proliferative vitreoretinopathy and uveitis. In this study we examine the pharmacokinetics and toxicity of cyclosporine and dexamethasone combined in an intravitreal sustained-release device and the toxicity of a similar device containing only dexamethasone in rabbits. Rabbits were divided into three groups for (1) evaluation of the drug tissue levels and device release kinetics following implantation of a device containing 100 micrograms of cyclosporine labeled with 2 microCi of 3H-cyclosporine and 2 mg of dexamethasone; (2) evaluation of the toxicity of this intravitreal device; and (3) evaluation of the toxicity of a similar device containing 2 mg of dexamethasone only. Cyclosporine was measured using a scintillation counter and dexamethasone was measured by high pressure liquid chromatography (HPLC). Toxicity was evaluated by electroretinography, clinical examination, and light microscopy. Vitreous concentrations of cyclosporine (+/- standard deviation) averaged 0.06 (+/- 0.02) microgram/ml over 10 weeks. The average dexamethasone concentration over the 10 week period was 2.9 (+/- 0.9) micrograms/ml. Devices containing cyclosporine and dexamethasone released each drug at rates similar to devices containing cyclosporine or dexamethasone alone. Devices containing both cyclosporine and dexamethasone caused reversible depressions in the b-wave amplitude of photopic and scotopic electroretinograms (ERG's). There was no evidence of toxicity associated with the devices containing dexamethasone only. There was no drug-related toxicity evident on clinical or histopathologic examination of eyes with devices containing the combination of cyclosporine and dexamethasone or dexamethasone alone. We conclude that the device maintains potentially therapeutic levels of both cyclosporine and dexamethasone in the vitreous. Reversible electroretinographic abnormalities are attributable to cyclosporine. A sustained-release device containing cyclosporine and dexamethasone may be useful for reducing inflammation in diseases such as proliferative vitreoretinopathy and uveitis.

Research paper thumbnail of Caring for the Uninsured and Underinsured

Archives of Neurology, 1991

Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for th... more Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the ...

Research paper thumbnail of Parents’ expectations regarding their children’s eye care: interview results

American Journal of Ophthalmology, 2003

To determine a relevant set of concerns that parents express as expectations regarding their chil... more To determine a relevant set of concerns that parents express as expectations regarding their children's eye care. Qualitative, cross-sectional, pilot study. A total of 48 interviews were conducted with parents of pediatric ophthalmology patients at Duke University Eye Center and the McGovern Davidson Children's Health Center at Duke University to elicit parents' expectations regarding their children's eye care. Interviews were audiotaped, transcribed, and coded for parent expectations. Content analysis of transcripts from the 48 interviews yielded 35 different expectation areas for eye care, which were further classified into six groups: (1) Communication, (2) Interpersonal Manner, (3) Doctor's Skill, (4) Examination and Testing, (5) Logistics, and (6) Other. The six expectation areas most frequently identified by parents as the single "most important" expectation were the following: (1) Clinical Competence, (2) Interaction with Child, (3) Education/Training, (4) Explanation in Clear Language, (5) Information about Diagnosis, and (6) Personal Connection. Parents of pediatric ophthalmology patients expressed expectation areas in the Communication group more frequently than any other group. However, when asked to identify their single most important expectation area, more than half of parents identified Clinical Competence.

Research paper thumbnail of Retinal Morphologic Features in Shaken Baby Syndrome Evaluated by Optical Coherence Tomography

American Journal of Ophthalmology, 2009

Research paper thumbnail of Refractive changes after pediatric intraocular lens implantation

American Journal of Ophthalmology, 1998

PURPOSE: To report refractive changes after cataract surgery and intraocular lens implantation in... more PURPOSE: To report refractive changes after cataract surgery and intraocular lens implantation in infants and children.

Research paper thumbnail of Macular and retinal nerve fiber layer analysis of normal and glaucomatous eyes in children using optical coherence tomography

American Journal of Ophthalmology, 2005

PURPOSE: To evaluate macular and nerve fiber layer (NFL) thickness in normal and glaucomatous eye... more PURPOSE: To evaluate macular and nerve fiber layer (NFL) thickness in normal and glaucomatous eyes of children 3 to 17 years old using optical coherence tomography (OCT-3).

Research paper thumbnail of Imaging the Infant Retina with a Hand-held Spectral-Domain Optical Coherence Tomography Device

American Journal of Ophthalmology, 2009

PURPOSE: To evaluate and treat infant retina through the use of a hand-held spectral-domain optic... more PURPOSE: To evaluate and treat infant retina through the use of a hand-held spectral-domain optical coherence tomography (SD OCT) device in selected cases of Shaken Baby syndrome (SBS).

Research paper thumbnail of Parents’ expectations regarding their children’s eye care: interview results

To determine a relevant set of concerns that parents express as expectations regarding their chil... more To determine a relevant set of concerns that parents express as expectations regarding their children's eye care. Qualitative, cross-sectional, pilot study. A total of 48 interviews were conducted with parents of pediatric ophthalmology patients at Duke University Eye Center and the McGovern Davidson Children's Health Center at Duke University to elicit parents' expectations regarding their children's eye care. Interviews were audiotaped, transcribed, and coded for parent expectations. Content analysis of transcripts from the 48 interviews yielded 35 different expectation areas for eye care, which were further classified into six groups: (1) Communication, (2) Interpersonal Manner, (3) Doctor's Skill, (4) Examination and Testing, (5) Logistics, and (6) Other. The six expectation areas most frequently identified by parents as the single "most important" expectation were the following: (1) Clinical Competence, (2) Interaction with Child, (3) Education/Training, (4) Explanation in Clear Language, (5) Information about Diagnosis, and (6) Personal Connection. Parents of pediatric ophthalmology patients expressed expectation areas in the Communication group more frequently than any other group. However, when asked to identify their single most important expectation area, more than half of parents identified Clinical Competence.

Research paper thumbnail of A comparison of the Marcus Gunn and alternating light tests for afferent pupillary defects

Research paper thumbnail of Safety and Efficacy of Silicone Rod Frontalis Suspension Surgery for Childhood Ptosis Repair

Journal of Pediatric Ophthalmology & Strabismus, 2008

To evaluate the safety and efficacy of silicone rod frontalis suspension surgery for childhood pt... more To evaluate the safety and efficacy of silicone rod frontalis suspension surgery for childhood ptosis. The authors retrospectively studied 89 consecutive children (110 eyelids) who had silicone rod frontalis suspension surgery for ptosis at Duke University Eye Center from 1983 to 2004. Marginal reflex distance1 (MRD1) elevation of 2 mm or more (vs preoperative MRD1) was considered satisfactory. MRD1 was measured as the vertical distance from the corneal light reflex in primary gaze to the upper eyelid margin. The postoperative eyelid symmetry (< or = 1 mm = satisfactory) was the difference between the MRD1 of the surgical and fellow eyelid. Median age at surgery was 45 months (range: 3 to 223 months) and median follow-up was 17 months (range: 1 to 88 months). Ptosis types (number of eyelids) were unilateral congenital (53), bilateral congenital (30), third nerve palsy (16), Marcus Gunn jaw wink (7), trauma (2), and myasthenia gravis (2). Median MRD1 elevation was 2 mm or greater for all ptosis types, whereas satisfactory postoperative symmetry occurred in 60% of unilateral and 100% of bilateral congenital ptosis cases (last follow-up). Complications occurred in 10 eyelids (9%) and reoperation occurred in 10 eyelids (9%). The use of silicone rod frontalis suspension surgery for ptosis repair in pediatric patients is modestly effective, with few complications and easy removal and adjustment.

Research paper thumbnail of Central Corneal Thickness in Children: Racial Differences (Black vs. White) and Correlation With Measured Intraocular Pressure

Journal of Glaucoma, 2006

To test the hypotheses that the mean central corneal thickness (CCT) of healthy black children is... more To test the hypotheses that the mean central corneal thickness (CCT) of healthy black children is thinner than that of healthy white children and to confirm the relationship between increased CCT and measured intraocular pressure (IOP) in children. This prospective observational case series included 178 eyes of 92 children aged 9 months to 17 years without anterior segment abnormalities or a clinical diagnosis of glaucoma. CCT was measured by ultrasonic pachymetry and IOP was measured by Goldmann or Tono-pen technique. The mean CCT for the 102 eyes of 52 white children was 562+/-35 microm versus 543+/-37 microm for the 66 eyes of 35 black children (P = 0.02). There was a positive relationship between CCT and IOP (P = 0.0002). For every 100 mum increase in CCT, the IOP increased by 2.2+/-0.6 mm Hg. The mean CCT of black children is thinner than that of white children. There is a positive relationship between increasing measured IOP and CCT among children with normal corneas and anterior segments. The interpretation of elevated IOP in eyes with abnormal anterior segment anatomy and thickened corneas awaits further study.

Research paper thumbnail of The effectiveness of latanoprost for the treatment of pediatric glaucoma

Journal of American Association for Pediatric Ophthalmology and Strabismus, 1999

atanoprost (Xalatan, Pharmacia & Upjohn, Kalamazoo, Mich) is a newly FDA-approved prostaglandin F... more atanoprost (Xalatan, Pharmacia & Upjohn, Kalamazoo, Mich) is a newly FDA-approved prostaglandin F 2α analogue that has been shown to reduce mean intraocular pressure (IOP) in adult glaucoma patients by 13% to 35%. 1-10 Latanoprost reduces IOP via enhancement of uveoscleral outflow ; this drug's IOPlowering effect has been shown to be additive in combined therapy with other ocular hypotensive agents. In adults, latanoprost is well tolerated and has an excellent systemic and ocular safety profile. There have been no documented systemic side effects, and the most common ocular side effects, conjunctival hyperemia and irritation and increased iris pigmentation, are relatively mild.

Research paper thumbnail of Combined superior oblique muscle recession and inferior oblique muscle advancement and transposition for cyclotorsion associated with macular translocation surgery

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2000

The purpose of this study was to evaluate the effects of oblique muscle surgery on the large-angl... more The purpose of this study was to evaluate the effects of oblique muscle surgery on the large-angle incyclotorsion resulting from macular translocation surgery for severe age-related macular degeneration. Patients undergoing macular translocation (superiorly) at our institution from May 1996 until November 1998 were included. In the Staged Group, strabismus surgery for symptomatic incyclotorsion was performed after the macular translocation, and in the Combined Group, it was performed simultaneous with the macular translocation. Cyclotorsion was quantified using Maddox rod testing. Surgery for incyclotorsion included superior oblique muscle recession combined with inferior oblique muscle advancement and transposition in the affected eyes. The minimum follow-up time was 6 weeks. Fifteen patients (15 eyes) were included (ages 66-89 years). Nine eyes (Baseline Group) had macular translocation surgery before any strabismus surgery; the mean postoperative incylotorsional angle was 33.4 +/- 18.3 degrees (range, 20-80 degrees) after a mean follow-up of 6.6 months. Four of these eyes (Staged Group) underwent oblique muscle surgery for symptomatic incyclotorsion, which reduced the mean incyclotorsion from 26.9 +/- 6.9 degrees (range, 20-35 degrees) to 9. 9 +/- 7.9 degrees (range, 2.5-20 degrees)-a mean reduction of 16.9 +/- 1.3 degrees (P =.00012), after a mean follow-up of 4.6 months. Six additional eyes (Combined Group) had simultaneous macular translocation and oblique muscle surgery, with a mean postoperative cyclotorsional angle of 14.0 +/- 6.7 degrees (range, 4-22.5 degrees), after a mean follow-up of 3.75 months. Oblique muscle surgery is effective at reducing the large degree of incyclotorsion resulting from macular translocation surgery and may be used either following or simultaneous with retinal surgery.

Research paper thumbnail of 126: Success rates of adjustable and nonadjustable strabismus surgery in adults

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Research paper thumbnail of The accuracy of photoscreening at detecting treatable ocular conditions in children with Down syndrome

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

Background-Children with Down syndrome (DS) have an increased prevalence of ocular disorders, inc... more Background-Children with Down syndrome (DS) have an increased prevalence of ocular disorders, including amblyopia, strabismus, and refractive error. Health maintenance guidelines from the DS Medical Interest Group recommend ophthalmologic examinations every 1 to 2 years for these children. Photoscreening may be a cost-effective option for subsequent examinations after an initial complete examination, but no study has evaluated the accuracy of photoscreening in children with DS. The purpose of this study is to determine the sensitivity, specificity, and positive and negative predictive values of photoscreening in detecting treatable ocular conditions in children with DS.

Research paper thumbnail of 041: Latanoprost in pediatric glaucoma—pediatric exposure over a decade

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Research paper thumbnail of Travoprost in children: Adverse effects and intraocular pressure response

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Because of the limited ability to perform controlled, randomized studies in children, the safety ... more Because of the limited ability to perform controlled, randomized studies in children, the safety and effectiveness of topical medications in pediatric glaucoma is sometimes difficult to determine. Although travoprost has been commercially available since 2001, there are no published reports on its use in children. This retrospective study found travoprost to have minimal adverse events in children and to reduce IOP in select cases of pediatric glaucoma.

Research paper thumbnail of Travoprost in pediatric glaucoma—safety and effectiveness

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2007

all conjugate eye movement systems, but spares vergence eye movements. In the five patients with ... more all conjugate eye movement systems, but spares vergence eye movements. In the five patients with presurgical recordings, such eye movement abnormalities were not seen.

Research paper thumbnail of Latanoprost in pediatric glaucoma—pediatric exposure over a decade

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

Although numerous studies of latanoprost in adult glaucoma have shown it to be an effective hypot... more Although numerous studies of latanoprost in adult glaucoma have shown it to be an effective hypotensive agent with a low incidence of side effects, these issues have not been well studied in pediatric glaucomas. The purpose of the current study is to evaluate the safety and intraocular pressure (IOP) lowering effect of latanoprost in various pediatric glaucomas over a long period. This retrospective study included all children treated with latanoprost at our institution from 1996 to 2007. Demographic, glaucoma-related, and side-effect information was recorded for each subject. Duration of latanoprost exposure was calculated in child-months (1 child exposed for 1 month). If interpretable IOP data were available, the presence or absence of a treatment response (IOP reduction > or =15% from baseline) was determined for each subject. A total of 115 subjects with latanoprost exposure were identified, with a collective exposure of 2,325 child-months. Exposure for > or =1 year occurred in 52 subjects. Side effects were mild and infrequently reported. Of the 115 subjects, 63 had interpretable IOP data, and 22 (35%) were treatment responders. Predictors of a response included a diagnosis of juvenile open-angle glaucoma, monotherapy, and older age. This large study of latanoprost-treated children confirms the excellent safety profile of the drug in the treatment of pediatric glaucoma. The study also confirms latanoprost's IOP-lowering ability in older children with juvenile open-angle glaucoma and in some children with aphakic glaucoma. Prospective studies are needed to better define the optimal role of latanoprost in the treatment of pediatric glaucoma, especially congenital glaucoma.

Research paper thumbnail of The accuracy of vision screening at detecting treatable ocular conditions in children with Down syndrome

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

Research paper thumbnail of An intravitreal device providing sustained release of cyclosporine and dexamethasone

Current Eye Research, 1996

A device that releases cyclosporine and dexamethasone into the eye for extended periods of time m... more A device that releases cyclosporine and dexamethasone into the eye for extended periods of time might be beneficial in diseases such as proliferative vitreoretinopathy and uveitis. In this study we examine the pharmacokinetics and toxicity of cyclosporine and dexamethasone combined in an intravitreal sustained-release device and the toxicity of a similar device containing only dexamethasone in rabbits. Rabbits were divided into three groups for (1) evaluation of the drug tissue levels and device release kinetics following implantation of a device containing 100 micrograms of cyclosporine labeled with 2 microCi of 3H-cyclosporine and 2 mg of dexamethasone; (2) evaluation of the toxicity of this intravitreal device; and (3) evaluation of the toxicity of a similar device containing 2 mg of dexamethasone only. Cyclosporine was measured using a scintillation counter and dexamethasone was measured by high pressure liquid chromatography (HPLC). Toxicity was evaluated by electroretinography, clinical examination, and light microscopy. Vitreous concentrations of cyclosporine (+/- standard deviation) averaged 0.06 (+/- 0.02) microgram/ml over 10 weeks. The average dexamethasone concentration over the 10 week period was 2.9 (+/- 0.9) micrograms/ml. Devices containing cyclosporine and dexamethasone released each drug at rates similar to devices containing cyclosporine or dexamethasone alone. Devices containing both cyclosporine and dexamethasone caused reversible depressions in the b-wave amplitude of photopic and scotopic electroretinograms (ERG's). There was no evidence of toxicity associated with the devices containing dexamethasone only. There was no drug-related toxicity evident on clinical or histopathologic examination of eyes with devices containing the combination of cyclosporine and dexamethasone or dexamethasone alone. We conclude that the device maintains potentially therapeutic levels of both cyclosporine and dexamethasone in the vitreous. Reversible electroretinographic abnormalities are attributable to cyclosporine. A sustained-release device containing cyclosporine and dexamethasone may be useful for reducing inflammation in diseases such as proliferative vitreoretinopathy and uveitis.

Research paper thumbnail of Caring for the Uninsured and Underinsured

Archives of Neurology, 1991

Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for th... more Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the Uninsured and Underinsured Caring for the ...

Research paper thumbnail of Parents’ expectations regarding their children’s eye care: interview results

American Journal of Ophthalmology, 2003

To determine a relevant set of concerns that parents express as expectations regarding their chil... more To determine a relevant set of concerns that parents express as expectations regarding their children's eye care. Qualitative, cross-sectional, pilot study. A total of 48 interviews were conducted with parents of pediatric ophthalmology patients at Duke University Eye Center and the McGovern Davidson Children's Health Center at Duke University to elicit parents' expectations regarding their children's eye care. Interviews were audiotaped, transcribed, and coded for parent expectations. Content analysis of transcripts from the 48 interviews yielded 35 different expectation areas for eye care, which were further classified into six groups: (1) Communication, (2) Interpersonal Manner, (3) Doctor's Skill, (4) Examination and Testing, (5) Logistics, and (6) Other. The six expectation areas most frequently identified by parents as the single "most important" expectation were the following: (1) Clinical Competence, (2) Interaction with Child, (3) Education/Training, (4) Explanation in Clear Language, (5) Information about Diagnosis, and (6) Personal Connection. Parents of pediatric ophthalmology patients expressed expectation areas in the Communication group more frequently than any other group. However, when asked to identify their single most important expectation area, more than half of parents identified Clinical Competence.

Research paper thumbnail of Retinal Morphologic Features in Shaken Baby Syndrome Evaluated by Optical Coherence Tomography

American Journal of Ophthalmology, 2009

Research paper thumbnail of Refractive changes after pediatric intraocular lens implantation

American Journal of Ophthalmology, 1998

PURPOSE: To report refractive changes after cataract surgery and intraocular lens implantation in... more PURPOSE: To report refractive changes after cataract surgery and intraocular lens implantation in infants and children.

Research paper thumbnail of Macular and retinal nerve fiber layer analysis of normal and glaucomatous eyes in children using optical coherence tomography

American Journal of Ophthalmology, 2005

PURPOSE: To evaluate macular and nerve fiber layer (NFL) thickness in normal and glaucomatous eye... more PURPOSE: To evaluate macular and nerve fiber layer (NFL) thickness in normal and glaucomatous eyes of children 3 to 17 years old using optical coherence tomography (OCT-3).

Research paper thumbnail of Imaging the Infant Retina with a Hand-held Spectral-Domain Optical Coherence Tomography Device

American Journal of Ophthalmology, 2009

PURPOSE: To evaluate and treat infant retina through the use of a hand-held spectral-domain optic... more PURPOSE: To evaluate and treat infant retina through the use of a hand-held spectral-domain optical coherence tomography (SD OCT) device in selected cases of Shaken Baby syndrome (SBS).