Nadim Rayess - Academia.edu (original) (raw)

Papers by Nadim Rayess

Ophthalmic surgery, lasers & imaging retina, 2015

The authors report a case of bilateral chorioretinitis sclopetaria in a 31-year-old man who susta... more The authors report a case of bilateral chorioretinitis sclopetaria in a 31-year-old man who sustained a perforating gunshot trauma. On presentation, best corrected visual acuity was light perception in the right eye and counting fingers at 5 feet in the left eye. Funduscopic examination demonstrated bilateral peripapillary fibrogliotic lesions with associated pigmentation in the posterior pole. Spectral-domain optical coherence tomography scans revealed bilateral full-thickness hyperreflectivity consistent with chorioretinal disruption. The patient was closely monitored, and his vision remained stable at 6-week follow-up.

Investigative Ophthalmology & Visual Science, Apr 30, 2014

To determine the influence of vitreomacular adhesion (VMA) on treatment outcomes in patients with... more To determine the influence of vitreomacular adhesion (VMA) on treatment outcomes in patients with neovascular age-related macular degeneration who were treated with anti-vascular endothelial growth factor agents using a treat and extend treatment regimen. Methods: A retrospective consecutive case series of 204 eyes from 181 patients with a minimum of 1 year of follow-up at Wills Eye Hospital Retina Service. Vitreomacular interface characteristics were determined by spectral domain optical coherence tomography. One hundred and fifty-three eyes (75%) had no signs of VMA (non-VMA), and 51 (25%) had VMA. Results: Baseline mean visual acuity was 20/133 with a mean central retinal thickness of 350.5 mm in the non-VMA group and was 20/145 with 371.8 mm in the VMA group. Mean visual acuity in the non-VMA group was 20/83 and 20/64 at Years 1 and 2, respectively (P , 0.01 to baseline). Mean visual acuity in the VMA group was 20/81 and 20/85 at Years 1 and 2, respectively (P , 0.01 to baseline). The central retinal thickness was 289.71 mm and 267 mm at Years 1 and 2, respectively (P , 0.01 to baseline) in the non-VMA group and was 305.3 mm and 289.24 mm (P , 0.01 to baseline) in the VMA group. The mean total number of injections at Year 1 for non-VMA was 7.4 compared with 8.4 in VMA (P = 0.001) and 5.5 versus 6.7 for the 2 groups in Year 2 (P = 0.027). The mean longest extension at Year 1 was 11.8 weeks compared with 10.1 week (P = 0.005) and for Year 2 was 14.1 weeks compared with 12 weeks (P = 0.041). Conclusion: The vitreomacular interface seems to have a significant influence on antivascular endothelial growth factor treatment intervals but not visual acuity or exudative control outcomes. Eyes with VMA on spectral domain optical coherence tomography at baseline may require more intensive treatment with decreased ability to extend treatment intervals.

Investigative Ophthalmology & Visual Science, Jun 11, 2015

ABSTRACT To compare the 6-line radial versus the 25-line raster spectral-domain optical coherence... more ABSTRACT To compare the 6-line radial versus the 25-line raster spectral-domain optical coherence tomography (SD-OCT) acquisition patterns at detecting intraretinal fluid, subretinal fluid, vitreomacular traction, and full-thickness macular hole (MH).

To evaluate the association between initial subfoveal choroidal thickness and response to anti-va... more To evaluate the association between initial subfoveal choroidal thickness and response to anti-vascular endothelial growth factor (anti-VEGF) therapy in central retinal vein occlusion (CRVO) eyes. Design: Retrospective cohort study. Methods: 43 eyes from 42 patients with treatment-naïve CRVO. All patients included were treated with a standard algorithm of 3 monthly anti-VEGF injections. Serial enhanced depth imaging optical coherence tomography scans were used to measure subfoveal choroidal thickness and central macular thickness (CMT). Baseline predictors (particularly choroidal thickness) for functional response (best-corrected visual acuity gain ≥2 lines) were assessed at 3 months follow-up using univariate and multivariate analyses. Results: 43 eyes from 42 patients were included. Initial choroidal thickness in CRVO eyes (246 ± 102 µm) was greater than their fellow eye (197 ± 86 µm; P=0.023). In addition, mean choroidal thickness at baseline for functional responders (272.2 ± 107.3 µm) was greater than non-responders (209.6 ± 85.8 µm; P=0.039). A higher baseline choroidal thickness (for every 100 µm increase in choroidal thickness) was found to be a positive predictor for functional response (regression coefficient: 0.7; P=0.04) on univariate analysis, whereas age (< 70 years old) was the only positive predictor for functional response with an odds ratio of 6.49 (95% CI: 1.11-38.1; P=0.03) on multivariate regression analysis. Conclusion: Baseline choroidal thickness and age may help predict which patients with CRVO have favorable visual outcomes following short-term anti-VEGF therapy.

Ophthalmic surgery, lasers & imaging retina, Apr 1, 2020

BACKGROUND AND OBJECTIVE: The purpose of this article is to review the role of anti-vascular endo... more BACKGROUND AND OBJECTIVE: The purpose of this article is to review the role of anti-vascular endothelial growth factor (VEGF) therapy in treating patients with radiation retinopathy (RR). PATIENTS AND METHODS: RR can be associated with a significant decrease in visual acuity (VA) related to the development of cystoid macular edema, macular ischemia, and proliferative retinopathy leading to neovascular glaucoma. RESULTS: Anti-VEGF therapy is effective at stabilizing VA in around 80% of patients and achieving reductions in central macular thickness when it is administered using a constant algorithm. Furthermore, consistent prophylactic anti-VEGF therapy reduces the risk of development of RR, neovascularization of the iris, and neovascularization glaucoma. CONCLUSION: Future studies are needed to determine the optimal regimen for anti-VEGF therapy according to patient risk factors and likelihood of developing RR. [ Ophthalmic Surg Lasers Imaging Retina. 2020;51:S44–S49.]

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Investigative Ophthalmology & Visual Science, Jun 11, 2015

Ophthalmic surgery, lasers & imaging retina, Apr 1, 2022

To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting f... more To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting findings. An ocular examination of a 4-month-old male infant with poor vision revealed punched-out macular and perivascular chorioretinal fibrosis and atrophy with peripheral retinal nonperfusion. Subsequently, he was hospitalized for recurrent infections and was diagnosed with CGD. Repeated examination demonstrated enlargement of the chorioretinal lesions without evidence of active inflammation or neovascularization. CGD causes recurrent, severe, life-threatening infections in children and should be considered in the differential diagnosis of chorioretinal lesions with peripheral retinal nonperfusion. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53(4):234–238.]

Ophthalmology, Sep 1, 2015

Figure 1. Enhanced vitreous imaging in spontaneous acute posterior vitreous detachment for a pati... more Figure 1. Enhanced vitreous imaging in spontaneous acute posterior vitreous detachment for a patient (A) with a retinal tear and associated hyperreflective dots (“falling ash” sign) in the vitreous and subhyaloid region and for a patient (B) without a retinal tear with absence of hyperreflective dots in the vitreous/subhyaloid region. Posterior vitreous detachment (PVD) is a physiologic process that occurs with aging, having a reported incidence of 53% in patients >50 years old. With advancing age, the vitreous progressively liquefies and its extracellular matrix undergoes remodeling, facilitating the eventual formation of a PVD. Although usually a benign event, complications such as macular traction, macular hole, vitreous hemorrhage, retinal tears, and retinal detachment may arise. The primary objective of our study was to describe spectraldomain optical coherence tomography (SD OCT) characteristics in patients who develop acute spontaneous PVD. Specifically, we sought to determine whether any vitreoretinal abnormalities could be identified on SD OCT imaging in these patients and whether these findings could be related to sequelae, such as retinal tear formation. Institutional review board approval for this prospective study of patients with symptomatic acute PVD was obtained through Wills Eye Hospital. Research adhered to the tenets of the Declaration of Helsinki and was conducted in accordance with regulations set forth by the Health Insurance Portability and Accountability Act. The inclusion criteria consisted of patients who had PVD symptoms (e.g., flashes and floaters) of <2 weeks’ duration that was confirmed by SD OCT imaging to be a complete (stage 4) PVD. An enhanced vitreous imaging OCT (EVI-OCT) protocol was implemented on the Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) platform similar to that described by Pang et al. Patients underwent a 6-line radial and 7-line raster scan centered on the fovea using a 30 scanning width. At least 1 raster scan traversed both the optic nerve and fovea. The scans constituted 30 averaged images by automatic real-time function. Furthermore, the high-resolution scan type was implemented and the zero delay line was displaced anteriorly to improve resolution of the vitreous. The symptomatic and fellow eyes were scanned using this protocol. Two experienced OCT examiners (N.R., E.R.) interpreted the images. Forty eyes of 40 patients were enrolled (24 females and 16 males), with a mean age of 59 10 years. In all cases, a complete PVD was visualized as a region of hyaloid separation from the retina and optic disc by EVI-OCT. The external limiting membrane and ellipsoid zone were intact in all eyes with acute spontaneous PVD, as well as in the fellow eye. No instances of macular edema or subretinal fluid were observed. Funduscopic examination revealed an associated retinal tear in 9 (22.5%) eyes. The corresponding EVI-OCT scans revealed hyperreflective dots creating a “falling ash” appearance in the vitreous or subhyaloid region in 7 of the eyes (Fig 1), representing a sensitivity of 77.8%. Eight patients with acute spontaneous PVD had the “falling ash” sign, of which 7 had a retinal tear, corresponding with a positive predictive value of 87.5% for detecting a tear when the finding was present on SD OCT. The hyperreflective dots (“falling ash” sign) likely represent red blood cells from vitreous hemorrhage or clumps of retinal pigment epithelial cells emanating from the retinal break, similar to the ophthalmoscopic finding of Shafer’s sign (“tobacco dust”) in the anterior vitreous. Given this, eye care physicians may want to consider obtaining SD OCT imaging in select patients with acute PVD in which a scleral depressed examination is suboptimal or a retinal tear is not detected on examination, but the clinician remains highly suspicious of an occult break. If the “falling ash” sign is subsequently detected, a repeat examination of the patient or referral to a retina specialist may be indicated. Although encouraging, the reliability of this finding should be assessed in a larger study, because only a minority of our patients had retinal tears. With the United States Food and Drug Administration approval of intravitreal ocriplasmin injections to induce a PVD in patients with symptomatic vitreomacular adhesion (VMA), reports have surfaced of outer ellipsoid zone changes resulting in acute visual loss that occurs more commonly in patients with VMA resolution. There are 2 proposed explanations for the ellipsoid zone changes. First, because ocriplasmin is a recombinant protease, it may also be cleaving the outer retinal layers. Alternatively, it may be due to a transient increase in mechanical traction on the retina at the time of vitreous separation. Although patients receiving ocriplasmin constitute a different patient population (i.e., have symptomatic VMA) from those in the current study, ellipsoid zone disruption does not seem to occur shortly…

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Investigative Ophthalmology & Visual Science, Jun 11, 2015

Canadian journal of ophthalmology, Oct 1, 2015

Investigative Ophthalmology & Visual Science, Jun 10, 2020

Investigative Ophthalmology & Visual Science, 2015

BMJ, 1977

One hundred patients with symmetrical proliferative diabetic retinopathy had one eye randomly cho... more One hundred patients with symmetrical proliferative diabetic retinopathy had one eye randomly chosen for treatment with xenonarc photocoagulation while the other was left untreated as a control. Patients were subdivided into those with new vessels on both optic discs and those with only peripheral new vessels. In patients with new vessels on the optic discs the vision of the untreated eyes deteriorated more than that of the treated eyes and the difference in deterioration was significant after one, two, and three years. There was no such difference in patients who had only peripheral new vessels. Eighteen patients had become blind in one or both eyes by the last assessment, but only one patient became blind in the treated eye without concomitant blindness in the untreated eye. Thirteen were blind only in the untreated eye. Both photographic and ophthalmoscopic examinations showed that new vessels on the disc regressed more in the treated eyes than in the untreated ones. As some forms of diabetic retinopathy are now treatable, early diagnosis and evaluation is increasingly important.

Ophthalmic Surgery, Lasers and Imaging Retina

To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting f... more To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting findings. An ocular examination of a 4-month-old male infant with poor vision revealed punched-out macular and perivascular chorioretinal fibrosis and atrophy with peripheral retinal nonperfusion. Subsequently, he was hospitalized for recurrent infections and was diagnosed with CGD. Repeated examination demonstrated enlargement of the chorioretinal lesions without evidence of active inflammation or neovascularization. CGD causes recurrent, severe, life-threatening infections in children and should be considered in the differential diagnosis of chorioretinal lesions with peripheral retinal nonperfusion. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53(4):234–238.]

Ophthalmology Retina

Enrollees with PDR with or without DME were identified from 2012 to 2019. We observed a decline i... more Enrollees with PDR with or without DME were identified from 2012 to 2019. We observed a decline in the utilization of PRP and an increase in anti-VEGF utilization.

European Journal of Ophthalmology

Background: Aicardi syndrome is an X-linked condition that is associated with multiple ophthalmic... more Background: Aicardi syndrome is an X-linked condition that is associated with multiple ophthalmic malformations. Here, we report the first published fluorescein angiography (FA) study of a morning glory optic nerve in a patient with Aicardi syndrome and contralateral persistent fetal vasculature (PFV). Case description: A 12-day old full-term baby girl with a normal neurological exam was referred for evaluation of microphthalmia. The posterior segment of the right eye demonstrated chorioretinal lacunae typical of Aicardi syndrome and microphthalmos with a stalk consistent with PFV. The right eye imaging could not be captured due to the severe microphthalmos and cataract, however, fluorescein angioscopy was performed. The left eye demonstrated a morning glory appearing optic disc with peripapillary chorioretinal lacunae. Fluorescein angiography of the eye showed and late staining in the areas of ellipsoid chorioretinal lacunae emanating from the optic nerve and extensive peripapillar...

Journal of VitreoRetinal Diseases

Purpose: This work aims to assess the quality, accountability, readability, accessibility, and pr... more Purpose: This work aims to assess the quality, accountability, readability, accessibility, and presence of Spanish translation in online material through a Google search of “macular degeneration”. Methods: In this retrospective cross-sectional analysis of website results from a Google search of “macular degeneration”, the quality and accountability for each website were assessed using the DISCERN criteria and the Health on the Net Foundation Code of Conduct (HONcode) principles. All 31 sites were independently graded by 2 ophthalmologists. Readability was evaluated using an online tool. The presence of accessibility features on the website and Spanish translation was recorded. The primary outcome measure was the DISCERN and HONcode quality and accountability scores of each website. Secondary outcome measures included the readability, accessibility, and presence of Spanish translation. Results: The mean ± SD of each criterion across all 15 DISCERN questions was 2.761 ± 0.666 (out of ...

Ophthalmic surgery, lasers & imaging retina, 2015

The authors report a case of bilateral chorioretinitis sclopetaria in a 31-year-old man who susta... more The authors report a case of bilateral chorioretinitis sclopetaria in a 31-year-old man who sustained a perforating gunshot trauma. On presentation, best corrected visual acuity was light perception in the right eye and counting fingers at 5 feet in the left eye. Funduscopic examination demonstrated bilateral peripapillary fibrogliotic lesions with associated pigmentation in the posterior pole. Spectral-domain optical coherence tomography scans revealed bilateral full-thickness hyperreflectivity consistent with chorioretinal disruption. The patient was closely monitored, and his vision remained stable at 6-week follow-up.

Investigative Ophthalmology & Visual Science, Apr 30, 2014

To determine the influence of vitreomacular adhesion (VMA) on treatment outcomes in patients with... more To determine the influence of vitreomacular adhesion (VMA) on treatment outcomes in patients with neovascular age-related macular degeneration who were treated with anti-vascular endothelial growth factor agents using a treat and extend treatment regimen. Methods: A retrospective consecutive case series of 204 eyes from 181 patients with a minimum of 1 year of follow-up at Wills Eye Hospital Retina Service. Vitreomacular interface characteristics were determined by spectral domain optical coherence tomography. One hundred and fifty-three eyes (75%) had no signs of VMA (non-VMA), and 51 (25%) had VMA. Results: Baseline mean visual acuity was 20/133 with a mean central retinal thickness of 350.5 mm in the non-VMA group and was 20/145 with 371.8 mm in the VMA group. Mean visual acuity in the non-VMA group was 20/83 and 20/64 at Years 1 and 2, respectively (P , 0.01 to baseline). Mean visual acuity in the VMA group was 20/81 and 20/85 at Years 1 and 2, respectively (P , 0.01 to baseline). The central retinal thickness was 289.71 mm and 267 mm at Years 1 and 2, respectively (P , 0.01 to baseline) in the non-VMA group and was 305.3 mm and 289.24 mm (P , 0.01 to baseline) in the VMA group. The mean total number of injections at Year 1 for non-VMA was 7.4 compared with 8.4 in VMA (P = 0.001) and 5.5 versus 6.7 for the 2 groups in Year 2 (P = 0.027). The mean longest extension at Year 1 was 11.8 weeks compared with 10.1 week (P = 0.005) and for Year 2 was 14.1 weeks compared with 12 weeks (P = 0.041). Conclusion: The vitreomacular interface seems to have a significant influence on antivascular endothelial growth factor treatment intervals but not visual acuity or exudative control outcomes. Eyes with VMA on spectral domain optical coherence tomography at baseline may require more intensive treatment with decreased ability to extend treatment intervals.

Investigative Ophthalmology & Visual Science, Jun 11, 2015

ABSTRACT To compare the 6-line radial versus the 25-line raster spectral-domain optical coherence... more ABSTRACT To compare the 6-line radial versus the 25-line raster spectral-domain optical coherence tomography (SD-OCT) acquisition patterns at detecting intraretinal fluid, subretinal fluid, vitreomacular traction, and full-thickness macular hole (MH).

To evaluate the association between initial subfoveal choroidal thickness and response to anti-va... more To evaluate the association between initial subfoveal choroidal thickness and response to anti-vascular endothelial growth factor (anti-VEGF) therapy in central retinal vein occlusion (CRVO) eyes. Design: Retrospective cohort study. Methods: 43 eyes from 42 patients with treatment-naïve CRVO. All patients included were treated with a standard algorithm of 3 monthly anti-VEGF injections. Serial enhanced depth imaging optical coherence tomography scans were used to measure subfoveal choroidal thickness and central macular thickness (CMT). Baseline predictors (particularly choroidal thickness) for functional response (best-corrected visual acuity gain ≥2 lines) were assessed at 3 months follow-up using univariate and multivariate analyses. Results: 43 eyes from 42 patients were included. Initial choroidal thickness in CRVO eyes (246 ± 102 µm) was greater than their fellow eye (197 ± 86 µm; P=0.023). In addition, mean choroidal thickness at baseline for functional responders (272.2 ± 107.3 µm) was greater than non-responders (209.6 ± 85.8 µm; P=0.039). A higher baseline choroidal thickness (for every 100 µm increase in choroidal thickness) was found to be a positive predictor for functional response (regression coefficient: 0.7; P=0.04) on univariate analysis, whereas age (< 70 years old) was the only positive predictor for functional response with an odds ratio of 6.49 (95% CI: 1.11-38.1; P=0.03) on multivariate regression analysis. Conclusion: Baseline choroidal thickness and age may help predict which patients with CRVO have favorable visual outcomes following short-term anti-VEGF therapy.

Ophthalmic surgery, lasers & imaging retina, Apr 1, 2020

BACKGROUND AND OBJECTIVE: The purpose of this article is to review the role of anti-vascular endo... more BACKGROUND AND OBJECTIVE: The purpose of this article is to review the role of anti-vascular endothelial growth factor (VEGF) therapy in treating patients with radiation retinopathy (RR). PATIENTS AND METHODS: RR can be associated with a significant decrease in visual acuity (VA) related to the development of cystoid macular edema, macular ischemia, and proliferative retinopathy leading to neovascular glaucoma. RESULTS: Anti-VEGF therapy is effective at stabilizing VA in around 80% of patients and achieving reductions in central macular thickness when it is administered using a constant algorithm. Furthermore, consistent prophylactic anti-VEGF therapy reduces the risk of development of RR, neovascularization of the iris, and neovascularization glaucoma. CONCLUSION: Future studies are needed to determine the optimal regimen for anti-VEGF therapy according to patient risk factors and likelihood of developing RR. [ Ophthalmic Surg Lasers Imaging Retina. 2020;51:S44–S49.]

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Investigative Ophthalmology & Visual Science, Jun 11, 2015

Ophthalmic surgery, lasers & imaging retina, Apr 1, 2022

To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting f... more To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting findings. An ocular examination of a 4-month-old male infant with poor vision revealed punched-out macular and perivascular chorioretinal fibrosis and atrophy with peripheral retinal nonperfusion. Subsequently, he was hospitalized for recurrent infections and was diagnosed with CGD. Repeated examination demonstrated enlargement of the chorioretinal lesions without evidence of active inflammation or neovascularization. CGD causes recurrent, severe, life-threatening infections in children and should be considered in the differential diagnosis of chorioretinal lesions with peripheral retinal nonperfusion. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53(4):234–238.]

Ophthalmology, Sep 1, 2015

Figure 1. Enhanced vitreous imaging in spontaneous acute posterior vitreous detachment for a pati... more Figure 1. Enhanced vitreous imaging in spontaneous acute posterior vitreous detachment for a patient (A) with a retinal tear and associated hyperreflective dots (“falling ash” sign) in the vitreous and subhyaloid region and for a patient (B) without a retinal tear with absence of hyperreflective dots in the vitreous/subhyaloid region. Posterior vitreous detachment (PVD) is a physiologic process that occurs with aging, having a reported incidence of 53% in patients >50 years old. With advancing age, the vitreous progressively liquefies and its extracellular matrix undergoes remodeling, facilitating the eventual formation of a PVD. Although usually a benign event, complications such as macular traction, macular hole, vitreous hemorrhage, retinal tears, and retinal detachment may arise. The primary objective of our study was to describe spectraldomain optical coherence tomography (SD OCT) characteristics in patients who develop acute spontaneous PVD. Specifically, we sought to determine whether any vitreoretinal abnormalities could be identified on SD OCT imaging in these patients and whether these findings could be related to sequelae, such as retinal tear formation. Institutional review board approval for this prospective study of patients with symptomatic acute PVD was obtained through Wills Eye Hospital. Research adhered to the tenets of the Declaration of Helsinki and was conducted in accordance with regulations set forth by the Health Insurance Portability and Accountability Act. The inclusion criteria consisted of patients who had PVD symptoms (e.g., flashes and floaters) of <2 weeks’ duration that was confirmed by SD OCT imaging to be a complete (stage 4) PVD. An enhanced vitreous imaging OCT (EVI-OCT) protocol was implemented on the Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) platform similar to that described by Pang et al. Patients underwent a 6-line radial and 7-line raster scan centered on the fovea using a 30 scanning width. At least 1 raster scan traversed both the optic nerve and fovea. The scans constituted 30 averaged images by automatic real-time function. Furthermore, the high-resolution scan type was implemented and the zero delay line was displaced anteriorly to improve resolution of the vitreous. The symptomatic and fellow eyes were scanned using this protocol. Two experienced OCT examiners (N.R., E.R.) interpreted the images. Forty eyes of 40 patients were enrolled (24 females and 16 males), with a mean age of 59 10 years. In all cases, a complete PVD was visualized as a region of hyaloid separation from the retina and optic disc by EVI-OCT. The external limiting membrane and ellipsoid zone were intact in all eyes with acute spontaneous PVD, as well as in the fellow eye. No instances of macular edema or subretinal fluid were observed. Funduscopic examination revealed an associated retinal tear in 9 (22.5%) eyes. The corresponding EVI-OCT scans revealed hyperreflective dots creating a “falling ash” appearance in the vitreous or subhyaloid region in 7 of the eyes (Fig 1), representing a sensitivity of 77.8%. Eight patients with acute spontaneous PVD had the “falling ash” sign, of which 7 had a retinal tear, corresponding with a positive predictive value of 87.5% for detecting a tear when the finding was present on SD OCT. The hyperreflective dots (“falling ash” sign) likely represent red blood cells from vitreous hemorrhage or clumps of retinal pigment epithelial cells emanating from the retinal break, similar to the ophthalmoscopic finding of Shafer’s sign (“tobacco dust”) in the anterior vitreous. Given this, eye care physicians may want to consider obtaining SD OCT imaging in select patients with acute PVD in which a scleral depressed examination is suboptimal or a retinal tear is not detected on examination, but the clinician remains highly suspicious of an occult break. If the “falling ash” sign is subsequently detected, a repeat examination of the patient or referral to a retina specialist may be indicated. Although encouraging, the reliability of this finding should be assessed in a larger study, because only a minority of our patients had retinal tears. With the United States Food and Drug Administration approval of intravitreal ocriplasmin injections to induce a PVD in patients with symptomatic vitreomacular adhesion (VMA), reports have surfaced of outer ellipsoid zone changes resulting in acute visual loss that occurs more commonly in patients with VMA resolution. There are 2 proposed explanations for the ellipsoid zone changes. First, because ocriplasmin is a recombinant protease, it may also be cleaving the outer retinal layers. Alternatively, it may be due to a transient increase in mechanical traction on the retina at the time of vitreous separation. Although patients receiving ocriplasmin constitute a different patient population (i.e., have symptomatic VMA) from those in the current study, ellipsoid zone disruption does not seem to occur shortly…

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Investigative Ophthalmology & Visual Science, Jun 11, 2015

Canadian journal of ophthalmology, Oct 1, 2015

Investigative Ophthalmology & Visual Science, Jun 10, 2020

Investigative Ophthalmology & Visual Science, 2015

BMJ, 1977

One hundred patients with symmetrical proliferative diabetic retinopathy had one eye randomly cho... more One hundred patients with symmetrical proliferative diabetic retinopathy had one eye randomly chosen for treatment with xenonarc photocoagulation while the other was left untreated as a control. Patients were subdivided into those with new vessels on both optic discs and those with only peripheral new vessels. In patients with new vessels on the optic discs the vision of the untreated eyes deteriorated more than that of the treated eyes and the difference in deterioration was significant after one, two, and three years. There was no such difference in patients who had only peripheral new vessels. Eighteen patients had become blind in one or both eyes by the last assessment, but only one patient became blind in the treated eye without concomitant blindness in the untreated eye. Thirteen were blind only in the untreated eye. Both photographic and ophthalmoscopic examinations showed that new vessels on the disc regressed more in the treated eyes than in the untreated ones. As some forms of diabetic retinopathy are now treatable, early diagnosis and evaluation is increasingly important.

Ophthalmic Surgery, Lasers and Imaging Retina

To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting f... more To describe a case of chronic granulomatous disease (CGD) with ocular lesions as the presenting findings. An ocular examination of a 4-month-old male infant with poor vision revealed punched-out macular and perivascular chorioretinal fibrosis and atrophy with peripheral retinal nonperfusion. Subsequently, he was hospitalized for recurrent infections and was diagnosed with CGD. Repeated examination demonstrated enlargement of the chorioretinal lesions without evidence of active inflammation or neovascularization. CGD causes recurrent, severe, life-threatening infections in children and should be considered in the differential diagnosis of chorioretinal lesions with peripheral retinal nonperfusion. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53(4):234–238.]

Ophthalmology Retina

Enrollees with PDR with or without DME were identified from 2012 to 2019. We observed a decline i... more Enrollees with PDR with or without DME were identified from 2012 to 2019. We observed a decline in the utilization of PRP and an increase in anti-VEGF utilization.

European Journal of Ophthalmology

Background: Aicardi syndrome is an X-linked condition that is associated with multiple ophthalmic... more Background: Aicardi syndrome is an X-linked condition that is associated with multiple ophthalmic malformations. Here, we report the first published fluorescein angiography (FA) study of a morning glory optic nerve in a patient with Aicardi syndrome and contralateral persistent fetal vasculature (PFV). Case description: A 12-day old full-term baby girl with a normal neurological exam was referred for evaluation of microphthalmia. The posterior segment of the right eye demonstrated chorioretinal lacunae typical of Aicardi syndrome and microphthalmos with a stalk consistent with PFV. The right eye imaging could not be captured due to the severe microphthalmos and cataract, however, fluorescein angioscopy was performed. The left eye demonstrated a morning glory appearing optic disc with peripapillary chorioretinal lacunae. Fluorescein angiography of the eye showed and late staining in the areas of ellipsoid chorioretinal lacunae emanating from the optic nerve and extensive peripapillar...

Journal of VitreoRetinal Diseases

Purpose: This work aims to assess the quality, accountability, readability, accessibility, and pr... more Purpose: This work aims to assess the quality, accountability, readability, accessibility, and presence of Spanish translation in online material through a Google search of “macular degeneration”. Methods: In this retrospective cross-sectional analysis of website results from a Google search of “macular degeneration”, the quality and accountability for each website were assessed using the DISCERN criteria and the Health on the Net Foundation Code of Conduct (HONcode) principles. All 31 sites were independently graded by 2 ophthalmologists. Readability was evaluated using an online tool. The presence of accessibility features on the website and Spanish translation was recorded. The primary outcome measure was the DISCERN and HONcode quality and accountability scores of each website. Secondary outcome measures included the readability, accessibility, and presence of Spanish translation. Results: The mean ± SD of each criterion across all 15 DISCERN questions was 2.761 ± 0.666 (out of ...