Sharon Freedman - Academia.edu (original) (raw)

Papers by Sharon Freedman

Journal of Aapos, Feb 1, 2010

Journal of Aapos, Feb 1, 2012

BACKGROUND Although intraocular pressure (IOP) is known to vary with the circadian cycle in nongl... more BACKGROUND Although intraocular pressure (IOP) is known to vary with the circadian cycle in nonglaucomatous and glaucomatous eyes of adults, the clinical assessment of IOP often relies on periodic measurements obtained at office visits during daytime hours. Little has been reported on diurnal IOP patterns in healthy children. The purpose of this study was to evaluate diurnal IOP in normal eyes of healthy children with the Icare rebound tonometer and when recorded by a parent at home. METHODS This was a prospective study of IOP in normal eyes of healthy children. Children were recruited from a pediatric eye clinic. A parent was instructed on the use of the Icare rebound tonometer by a study physician and demonstrated proficiency its use in the clinic, at which time a masked IOP reading was also made with Goldmann applanation by a different study clinician. Home IOPs were then obtained and recorded 6 times daily at 2-to 3-hours intervals during 2 consecutive days by a parent. RESULTS A total of 22 normal eyes (of 11 children) were included. We found that children without glaucoma demonstrate mean diurnal IOP fluctuation of 4-6 mm Hg, with similar IOP between right and left eyes, fair repeatability between consecutive days, and a tendency for higher early morning and lower late evening IOP. CONCLUSIONS Healthy children without glaucoma demonstrate some diurnal fluctuation in IOP, comparable with that reported in nonglaucomatous eyes of adults. This information should prove as comparative for assessment of IOP fluctuation in children with known or suspected glaucoma.

American Journal of Ophthalmology, Sep 1, 2011

Journal of Aapos, Apr 1, 2011

BACKGROUND Accurate intraocular pressure (IOP) measurement, important in managing pediatric glauc... more BACKGROUND Accurate intraocular pressure (IOP) measurement, important in managing pediatric glaucoma, often presents challenges. The Icare rebound tonometer shows promise for screening healthy children and has been reported comparable with Goldmann applanation in adults with glaucoma. The purpose of this study was to evaluate the Icare tonometer against Goldmann applanation for clinic IOP measurement in pediatric glaucoma. METHODS This was a prospective study comparing Icare versus Goldmann tonometry in pediatric glaucoma. Children with known or suspected glaucoma were recruited from scheduled clinic visits. IOP was measured with the Icare tonometer by a clinician and subsequently measured with Goldmann applanation tonometry (GAT) by a different single masked clinician. RESULTS A total of 71 eyes of 71 children with known or suspected glaucoma were included. IOP by GAT ranged from 9 to 36 mm Hg. Icare readings ranged from 11 to 44 mm Hg. Mean difference between Icare and GAT was 2.3 AE SD 3.7 mm Hg, p \ 0.0001. Icare IOPs were within AE 3 mm Hg of GAT in 63%. Icare IOPs were $GAT IOPs in 75%. The following factors were not associated with Icare IOPs greater than GAT: child's age, glaucoma diagnosis, strabismus, nystagmus, central corneal thickness, Icare instrument-reported reliability, number of glaucoma surgeries or medications, corneal abnormalities, and visual acuity. CONCLUSIONS IOP by Icare tonometry was within 3 mm Hg of IOP by GAT in 63% and greater than GAT in 75%. This device may be reasonable to estimate IOP in selected children with known or suspected glaucoma whose IOP cannot otherwise be obtained in clinic; however, correlation of Icare IOPs with clinical findings must continue to be considered in each case.

Journal of American Association for Pediatric Ophthalmology and Strabismus

Journal of cataract and refractive surgery, 2017

Glaucoma develops in about 20-30% of patients after surgery for congenital cataracts, with increa... more Glaucoma develops in about 20-30% of patients after surgery for congenital cataracts, with increasing risk over time following cataract removal. 1 While the pathogenesis has been debated, factors that have been studied include age at cataract detection 2 , age and corneal size at surgery, type of cataract, the presence of persistent fetal vasculature (PFV), the use of an IOL, the need for additional surgeries, and the time elapsed since surgery. 1,3-5 Parks et al. proposed that fetal nuclear cataracts were associated with a higher risk of glaucoma. 6 Chak and Rahi, found a strong univariant association between age of detection of congenital cataracts and the risk of open angle glaucoma. 2 Since congenital fetal nuclear cataracts are often detected during infancy, age at detection may have been a confounding factor in Parks series. We reviewed the type of cataract in patients enrolled in the Infant Aphakia Treatment Study (IATS) to evaluate whether fetal nuclear involvement was correlated with the development of glaucoma-related adverse events following early unilateral cataract surgery.

C hildhood glaucomas are infrequently encountered by many eye care providers and can therefore be... more C hildhood glaucomas are infrequently encountered by many eye care providers and can therefore be challenging to diagnose. Because this heterogeneous group of diseases can cause a rapid loss of vision or even blindness, however, the timely recognition and optimal treatment of pediatric glaucoma is critical. Fortunately, ophthalmologists often have at their disposal the tools needed to diagnose and begin to manage these children. Usually, the ideal care of patients with pedi-atric glaucoma involves the efforts of more than one oph-thalmologist, unless a pediatric glaucoma specialist is located near the child's home. BACKGROUND The most common form of pediatric glaucoma, primary congenital glaucoma, occurs in approximately one in 10,000 individuals. 1 As with adult forms of the disease, pediatric glaucoma may be primary or secondary. The former involves intrinsic disease of the aqueous outflow system and often has a genetic basis, such as with primary congenital glaucoma. Secondar...

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

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. Long-term changes in the cylinder power of hypermetropic children with and without accommodative esotropia. Tamara Wygnanski-Jaffe, Beatrice Zwilling, Hana Leiba Introduction: Lambert and Lynn suggested that cylinder power increases in children with accommodative esotropia treated with spectacles. We analyzed the changes in cylinder power of spectacle-wearing hypermetropic children with and without esotropia. Methods: Refractive errors were followed in 108 children with hypermetropia with and without esotropia for a mean of 3.9 years. Cycloplegic refractions were performed by retinoscopy. The refractive data were analyzed for the entire group and according to age of spectacle prescription, and ocular alignment. Results: The mean cylinder power increased on average by 0.16 D. In the youngest age group (0 Ͻ 2 years) the mean increase was 0.3 D; in the second group (2 Ͻ 4 years) the mean increase was 0.2 D, and in the third group (Ͼ4 years) the mean increase was 0.08 D. There was a tendency toward a larger average increase in astigmatism in the accommodative esotropes. Discussion: Similar to the results reported by others, we found a slight increase in cylinder power, which was more substantial among patients under the age of two. Nevertheless, this change, although statistically significant, is probably of no clinical importance. Conclusions: In children wearing spectacles for hypermetropia with and without esotropia, astigmatism increases minimally. Cylinder power changes were more common in the accommodative esotrope group.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

financial impact to your practice, vendor selection, e-prescribing, and the 'meaningful use' clau... more financial impact to your practice, vendor selection, e-prescribing, and the 'meaningful use' clause. The participant will gain the knowledge necessary to begin an implementation of EHR for his or her practice.

American Journal of Ophthalmology, 2002

We describe a case of a 16 year old girl with Oculocutaneous albinism (OCA) who presented to us w... more We describe a case of a 16 year old girl with Oculocutaneous albinism (OCA) who presented to us with photophobia and blurring of vision. She showed typical features of OCA, blonde hair, refractive error, iris transillumination and foveal hypoplasia. Our report highlights the role of macular OCT in diagnosis of foveal hypoplasia which is an essential feature of OCA.

Archives of Ophthalmology, 2010

To validate the accuracy of ROPtool software in measuring retinal vascular width and tortuosity i... more To validate the accuracy of ROPtool software in measuring retinal vascular width and tortuosity in a large image set compared with expert diagnoses. Methods: Tortuosity and dilation indexes generated by ROPtool were compared with 3 expert consensus grades of normal, pre-plus, or plus disease for 368 quadrants in 92 RetCam (Clarity Medical Systems, Pleasanton, California) fundus images. Sensitivity and specificity of ROPtool software in diagnosing tortuosity and dilation sufficient for plus and pre-plus disease were calculated. These measures were compared with individual accuracies of 3 experienced pediatric ophthalmologists. Results: The mean tortuosity indexes for expert-diagnosed categories of normal, pre-plus, and plus disease were 7.04, 18.73, and 34.62, respectively (PϽ.001), and the mean dilation indexes were 9.63, 12.05, and 13.61, respectively (PϽ.001). When optimal tortuosity and dilation index thresholds (from receiver operating characteristic curves) were applied, resultant sensitivity and specificity were 0.913 and 0.863, respectively, for plus tortuosity and 0.782 and 0.840, respectively, for plus dilation. These values were comparable to the performance of examiners judged against the same expert panel. Conclusion: ROPtool version 2.1.5 accurately measures tortuosity and dilation of posterior pole blood vessels in RetCam images, corresponding well with expert diagnostic categories of normal, pre-plus, and plus disease and performing comparably to experienced examiners.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2019

PURPOSE To identify and analyze cases of postoperative infection following strabismus surgery at ... more PURPOSE To identify and analyze cases of postoperative infection following strabismus surgery at a large referral center and to report the incidence, risk factors, and outcomes. METHODS An electronic database search identified strabismus procedures at Duke Eye Center from July 1996 to October 2017. Diagnosis codes for periocular infections were used to further identify patients with possible infections following strabismus surgery. RESULTS Of 9,111 strabismus surgeries, 13 (0.14%) met criteria for probable infection, all occurring since October 2012 (0/6580 before vs 13/2531 [0.51%] after; P \ 0.0001). Mean age of infection cases was 11.4 years; 11 patients (85%) were under 18 years of age. Associated previous diagnoses were genetic abnormalities with associated developmental delay (n 5 5 [38%]), previous skin or ear infection (n 5 4 [31%]), and acute or chronic rhinitis (n 5 3 [23%]). Infection site cultures revealed methicillin-resistant Staphylococcus aureus (n 5 3 [23%]), methicillin-sensitive S. aureus (n 5 3 [23%]), and Streptococcus pyogenes/ group-A Streptococcus (n 5 2 [15%]). Only 1 case had bilateral infection. Infection remained extraocular in all cases, but one eye lost light perception secondary to optic atrophy. No common surgeon/procedure/preparation-related risks were identified. CONCLUSIONS A unifying explanation for the increase in post-strabismus surgery infections at Duke Eye Center was not identified. Potential risk factors include age \18 years, developmental delay, immune compromise, preceding nonocular infection, and bacterial colonization.

The open ophthalmology journal, 2017

The diagnosis of plus disease in retinopathy of prematurity (ROP) largely determines the need for... more The diagnosis of plus disease in retinopathy of prematurity (ROP) largely determines the need for treatment; however, this diagnosis is subjective. To make the diagnosis of plus disease more objective, semi-automated computer programs (e.g. ROPtool) have been created to quantify vascular dilation and tortuosity. ROPtool can accurately analyze blood vessels only in images with very good quality, but many still images captured by indirect ophthalmoscopy have insufficient image quality for ROPtool analysis. To evaluate the ability of an image fusion methodology (robust mosaicing) to increase the efficiency and traceability of posterior pole vessel analysis by ROPtool. We retrospectively reviewed video indirect ophthalmoscopy images acquired during routine ROP examinations and selected the best unenhanced still image from the video for each infant. Robust mosaicing was used to create an enhanced mosaic image from the same video for each eye. We evaluated the time required for ROPtool an...

Ophthalmology, 2016

Objective-To describe baseline characteristics, initial postoperative refractive errors, operativ... more Objective-To describe baseline characteristics, initial postoperative refractive errors, operative complications, and magnitude of the intraocular lens (IOL) prediction error for refractive outcome in children undergoing lensectomy largely in North America. Design-Prospective, registry study of children from birth to <13 years of age having undergone lensectomy for any reason within 45 days preceding enrollment. Participants-1,266 eyes of 994 children; 49% female and 59% white Testing-Measurement of refractive error, axial length, and complete ophthalmic examination

Investigative ophthalmology & visual science, Jan 13, 2015

We compared photoreceptor development from spectral domain optical coherence tomography (SD-OCT) ... more We compared photoreceptor development from spectral domain optical coherence tomography (SD-OCT) imaging in very preterm infants (VPT, <32 weeks gestational age) with those of term infants. The microanatomy of foveal SD-OCT images obtained at the bedside at 37 to 42 weeks term equivalent postmenstrual age (TEA) was reviewed with qualitative and quantitative analysis of retinal and especially photoreceptor layers in the macula. Measures of maturity included presence of the cone outer segment tips (COST) or the ellipsoid zone (EZ) at foveal center, distance from Bruch's membrane (BM) to the EZ at the foveal center, and radial distance from foveal center to first appearance of the EZ. The incidence of the EZ developed at the foveal center was lower in VPT infants (9/64, 14%) versus term infants (22/47, 47%, P < 0.001) and lower in VPT infants with macular edema (3/46) versus VPT without edema (6/18, P = 0.01). Mean ± SD distance from the foveal center to the visible EZ was 78...

Ophthalmology, 2011

Purpose-To determine the dynamic morphological development of the human fovea in-vivo utilizing p... more Purpose-To determine the dynamic morphological development of the human fovea in-vivo utilizing portable spectral domain optical coherence tomography (SDOCT). Design-Prospective, observational case series. Paticipants-31 prematurely born neonates, nine children and nine adults. Methods-Sixty-two neonates were enrolled in this study. SDOCT imaging was performed after examination for retinopathy of prematurity (ROP) at the bedside in non-sedated infants ages 31-41 weeks post-menstrual-age PMA (PMA=gestational age in weeks + chronological age) and at outpatient follow-up ophthalmic examinations. Thirty-one neonates met eligibility criteria. Nine children and nine adults without ocular pathology served as control groups. Semi-automatic retinal layer segmentation was performed. Central foveal thickness (CFT), foveal to parafoveal (FP) ratio (CFT divided by thickness 1000 μm from the foveal center), and 3D thickness maps were analyzed. Main Outcomes Measures-In-vivo determination of foveal morphology, layer segmentation, analysis of sub-cellular changes, spatio-temporal layer shifting. Results-In contrast to the adult fovea, we observed several signs of immaturity in the neonates: a shallow foveal pit, persistence of inner retinal layers (IRL), and a thin photoreceptor layer (PRL) that was thinnest at the foveal center. Three-dimensional mapping showed displacement of retinal layers out of the foveal center as the fovea matured and the progressive formation of the inner/ outer segment band in the opposite direction. The FP-IRL ratios decreased as IRL migrated prior to term and minimally after that, while FP-PRL ratios increased as PRL subcellular elements

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. Methods: 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. Results: The mean CCT for the 102 eyes of 52 white children was 562 ± 35 mm versus 543 ± 37 mm 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 mm increase in CCT, the IOP increased by 2.2 ± 0.6 mm Hg. Conclusions: 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.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

Journal of Aapos, Feb 1, 2010

Journal of Aapos, Feb 1, 2012

BACKGROUND Although intraocular pressure (IOP) is known to vary with the circadian cycle in nongl... more BACKGROUND Although intraocular pressure (IOP) is known to vary with the circadian cycle in nonglaucomatous and glaucomatous eyes of adults, the clinical assessment of IOP often relies on periodic measurements obtained at office visits during daytime hours. Little has been reported on diurnal IOP patterns in healthy children. The purpose of this study was to evaluate diurnal IOP in normal eyes of healthy children with the Icare rebound tonometer and when recorded by a parent at home. METHODS This was a prospective study of IOP in normal eyes of healthy children. Children were recruited from a pediatric eye clinic. A parent was instructed on the use of the Icare rebound tonometer by a study physician and demonstrated proficiency its use in the clinic, at which time a masked IOP reading was also made with Goldmann applanation by a different study clinician. Home IOPs were then obtained and recorded 6 times daily at 2-to 3-hours intervals during 2 consecutive days by a parent. RESULTS A total of 22 normal eyes (of 11 children) were included. We found that children without glaucoma demonstrate mean diurnal IOP fluctuation of 4-6 mm Hg, with similar IOP between right and left eyes, fair repeatability between consecutive days, and a tendency for higher early morning and lower late evening IOP. CONCLUSIONS Healthy children without glaucoma demonstrate some diurnal fluctuation in IOP, comparable with that reported in nonglaucomatous eyes of adults. This information should prove as comparative for assessment of IOP fluctuation in children with known or suspected glaucoma.

American Journal of Ophthalmology, Sep 1, 2011

Journal of Aapos, Apr 1, 2011

BACKGROUND Accurate intraocular pressure (IOP) measurement, important in managing pediatric glauc... more BACKGROUND Accurate intraocular pressure (IOP) measurement, important in managing pediatric glaucoma, often presents challenges. The Icare rebound tonometer shows promise for screening healthy children and has been reported comparable with Goldmann applanation in adults with glaucoma. The purpose of this study was to evaluate the Icare tonometer against Goldmann applanation for clinic IOP measurement in pediatric glaucoma. METHODS This was a prospective study comparing Icare versus Goldmann tonometry in pediatric glaucoma. Children with known or suspected glaucoma were recruited from scheduled clinic visits. IOP was measured with the Icare tonometer by a clinician and subsequently measured with Goldmann applanation tonometry (GAT) by a different single masked clinician. RESULTS A total of 71 eyes of 71 children with known or suspected glaucoma were included. IOP by GAT ranged from 9 to 36 mm Hg. Icare readings ranged from 11 to 44 mm Hg. Mean difference between Icare and GAT was 2.3 AE SD 3.7 mm Hg, p \ 0.0001. Icare IOPs were within AE 3 mm Hg of GAT in 63%. Icare IOPs were $GAT IOPs in 75%. The following factors were not associated with Icare IOPs greater than GAT: child's age, glaucoma diagnosis, strabismus, nystagmus, central corneal thickness, Icare instrument-reported reliability, number of glaucoma surgeries or medications, corneal abnormalities, and visual acuity. CONCLUSIONS IOP by Icare tonometry was within 3 mm Hg of IOP by GAT in 63% and greater than GAT in 75%. This device may be reasonable to estimate IOP in selected children with known or suspected glaucoma whose IOP cannot otherwise be obtained in clinic; however, correlation of Icare IOPs with clinical findings must continue to be considered in each case.

Journal of American Association for Pediatric Ophthalmology and Strabismus

Journal of cataract and refractive surgery, 2017

Glaucoma develops in about 20-30% of patients after surgery for congenital cataracts, with increa... more Glaucoma develops in about 20-30% of patients after surgery for congenital cataracts, with increasing risk over time following cataract removal. 1 While the pathogenesis has been debated, factors that have been studied include age at cataract detection 2 , age and corneal size at surgery, type of cataract, the presence of persistent fetal vasculature (PFV), the use of an IOL, the need for additional surgeries, and the time elapsed since surgery. 1,3-5 Parks et al. proposed that fetal nuclear cataracts were associated with a higher risk of glaucoma. 6 Chak and Rahi, found a strong univariant association between age of detection of congenital cataracts and the risk of open angle glaucoma. 2 Since congenital fetal nuclear cataracts are often detected during infancy, age at detection may have been a confounding factor in Parks series. We reviewed the type of cataract in patients enrolled in the Infant Aphakia Treatment Study (IATS) to evaluate whether fetal nuclear involvement was correlated with the development of glaucoma-related adverse events following early unilateral cataract surgery.

C hildhood glaucomas are infrequently encountered by many eye care providers and can therefore be... more C hildhood glaucomas are infrequently encountered by many eye care providers and can therefore be challenging to diagnose. Because this heterogeneous group of diseases can cause a rapid loss of vision or even blindness, however, the timely recognition and optimal treatment of pediatric glaucoma is critical. Fortunately, ophthalmologists often have at their disposal the tools needed to diagnose and begin to manage these children. Usually, the ideal care of patients with pedi-atric glaucoma involves the efforts of more than one oph-thalmologist, unless a pediatric glaucoma specialist is located near the child's home. BACKGROUND The most common form of pediatric glaucoma, primary congenital glaucoma, occurs in approximately one in 10,000 individuals. 1 As with adult forms of the disease, pediatric glaucoma may be primary or secondary. The former involves intrinsic disease of the aqueous outflow system and often has a genetic basis, such as with primary congenital glaucoma. Secondar...

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2009

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. Long-term changes in the cylinder power of hypermetropic children with and without accommodative esotropia. Tamara Wygnanski-Jaffe, Beatrice Zwilling, Hana Leiba Introduction: Lambert and Lynn suggested that cylinder power increases in children with accommodative esotropia treated with spectacles. We analyzed the changes in cylinder power of spectacle-wearing hypermetropic children with and without esotropia. Methods: Refractive errors were followed in 108 children with hypermetropia with and without esotropia for a mean of 3.9 years. Cycloplegic refractions were performed by retinoscopy. The refractive data were analyzed for the entire group and according to age of spectacle prescription, and ocular alignment. Results: The mean cylinder power increased on average by 0.16 D. In the youngest age group (0 Ͻ 2 years) the mean increase was 0.3 D; in the second group (2 Ͻ 4 years) the mean increase was 0.2 D, and in the third group (Ͼ4 years) the mean increase was 0.08 D. There was a tendency toward a larger average increase in astigmatism in the accommodative esotropes. Discussion: Similar to the results reported by others, we found a slight increase in cylinder power, which was more substantial among patients under the age of two. Nevertheless, this change, although statistically significant, is probably of no clinical importance. Conclusions: In children wearing spectacles for hypermetropia with and without esotropia, astigmatism increases minimally. Cylinder power changes were more common in the accommodative esotrope group.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010

financial impact to your practice, vendor selection, e-prescribing, and the 'meaningful use' clau... more financial impact to your practice, vendor selection, e-prescribing, and the 'meaningful use' clause. The participant will gain the knowledge necessary to begin an implementation of EHR for his or her practice.

American Journal of Ophthalmology, 2002

We describe a case of a 16 year old girl with Oculocutaneous albinism (OCA) who presented to us w... more We describe a case of a 16 year old girl with Oculocutaneous albinism (OCA) who presented to us with photophobia and blurring of vision. She showed typical features of OCA, blonde hair, refractive error, iris transillumination and foveal hypoplasia. Our report highlights the role of macular OCT in diagnosis of foveal hypoplasia which is an essential feature of OCA.

Archives of Ophthalmology, 2010

To validate the accuracy of ROPtool software in measuring retinal vascular width and tortuosity i... more To validate the accuracy of ROPtool software in measuring retinal vascular width and tortuosity in a large image set compared with expert diagnoses. Methods: Tortuosity and dilation indexes generated by ROPtool were compared with 3 expert consensus grades of normal, pre-plus, or plus disease for 368 quadrants in 92 RetCam (Clarity Medical Systems, Pleasanton, California) fundus images. Sensitivity and specificity of ROPtool software in diagnosing tortuosity and dilation sufficient for plus and pre-plus disease were calculated. These measures were compared with individual accuracies of 3 experienced pediatric ophthalmologists. Results: The mean tortuosity indexes for expert-diagnosed categories of normal, pre-plus, and plus disease were 7.04, 18.73, and 34.62, respectively (PϽ.001), and the mean dilation indexes were 9.63, 12.05, and 13.61, respectively (PϽ.001). When optimal tortuosity and dilation index thresholds (from receiver operating characteristic curves) were applied, resultant sensitivity and specificity were 0.913 and 0.863, respectively, for plus tortuosity and 0.782 and 0.840, respectively, for plus dilation. These values were comparable to the performance of examiners judged against the same expert panel. Conclusion: ROPtool version 2.1.5 accurately measures tortuosity and dilation of posterior pole blood vessels in RetCam images, corresponding well with expert diagnostic categories of normal, pre-plus, and plus disease and performing comparably to experienced examiners.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2019

PURPOSE To identify and analyze cases of postoperative infection following strabismus surgery at ... more PURPOSE To identify and analyze cases of postoperative infection following strabismus surgery at a large referral center and to report the incidence, risk factors, and outcomes. METHODS An electronic database search identified strabismus procedures at Duke Eye Center from July 1996 to October 2017. Diagnosis codes for periocular infections were used to further identify patients with possible infections following strabismus surgery. RESULTS Of 9,111 strabismus surgeries, 13 (0.14%) met criteria for probable infection, all occurring since October 2012 (0/6580 before vs 13/2531 [0.51%] after; P \ 0.0001). Mean age of infection cases was 11.4 years; 11 patients (85%) were under 18 years of age. Associated previous diagnoses were genetic abnormalities with associated developmental delay (n 5 5 [38%]), previous skin or ear infection (n 5 4 [31%]), and acute or chronic rhinitis (n 5 3 [23%]). Infection site cultures revealed methicillin-resistant Staphylococcus aureus (n 5 3 [23%]), methicillin-sensitive S. aureus (n 5 3 [23%]), and Streptococcus pyogenes/ group-A Streptococcus (n 5 2 [15%]). Only 1 case had bilateral infection. Infection remained extraocular in all cases, but one eye lost light perception secondary to optic atrophy. No common surgeon/procedure/preparation-related risks were identified. CONCLUSIONS A unifying explanation for the increase in post-strabismus surgery infections at Duke Eye Center was not identified. Potential risk factors include age \18 years, developmental delay, immune compromise, preceding nonocular infection, and bacterial colonization.

The open ophthalmology journal, 2017

The diagnosis of plus disease in retinopathy of prematurity (ROP) largely determines the need for... more The diagnosis of plus disease in retinopathy of prematurity (ROP) largely determines the need for treatment; however, this diagnosis is subjective. To make the diagnosis of plus disease more objective, semi-automated computer programs (e.g. ROPtool) have been created to quantify vascular dilation and tortuosity. ROPtool can accurately analyze blood vessels only in images with very good quality, but many still images captured by indirect ophthalmoscopy have insufficient image quality for ROPtool analysis. To evaluate the ability of an image fusion methodology (robust mosaicing) to increase the efficiency and traceability of posterior pole vessel analysis by ROPtool. We retrospectively reviewed video indirect ophthalmoscopy images acquired during routine ROP examinations and selected the best unenhanced still image from the video for each infant. Robust mosaicing was used to create an enhanced mosaic image from the same video for each eye. We evaluated the time required for ROPtool an...

Ophthalmology, 2016

Objective-To describe baseline characteristics, initial postoperative refractive errors, operativ... more Objective-To describe baseline characteristics, initial postoperative refractive errors, operative complications, and magnitude of the intraocular lens (IOL) prediction error for refractive outcome in children undergoing lensectomy largely in North America. Design-Prospective, registry study of children from birth to <13 years of age having undergone lensectomy for any reason within 45 days preceding enrollment. Participants-1,266 eyes of 994 children; 49% female and 59% white Testing-Measurement of refractive error, axial length, and complete ophthalmic examination

Investigative ophthalmology & visual science, Jan 13, 2015

We compared photoreceptor development from spectral domain optical coherence tomography (SD-OCT) ... more We compared photoreceptor development from spectral domain optical coherence tomography (SD-OCT) imaging in very preterm infants (VPT, <32 weeks gestational age) with those of term infants. The microanatomy of foveal SD-OCT images obtained at the bedside at 37 to 42 weeks term equivalent postmenstrual age (TEA) was reviewed with qualitative and quantitative analysis of retinal and especially photoreceptor layers in the macula. Measures of maturity included presence of the cone outer segment tips (COST) or the ellipsoid zone (EZ) at foveal center, distance from Bruch's membrane (BM) to the EZ at the foveal center, and radial distance from foveal center to first appearance of the EZ. The incidence of the EZ developed at the foveal center was lower in VPT infants (9/64, 14%) versus term infants (22/47, 47%, P < 0.001) and lower in VPT infants with macular edema (3/46) versus VPT without edema (6/18, P = 0.01). Mean ± SD distance from the foveal center to the visible EZ was 78...

Ophthalmology, 2011

Purpose-To determine the dynamic morphological development of the human fovea in-vivo utilizing p... more Purpose-To determine the dynamic morphological development of the human fovea in-vivo utilizing portable spectral domain optical coherence tomography (SDOCT). Design-Prospective, observational case series. Paticipants-31 prematurely born neonates, nine children and nine adults. Methods-Sixty-two neonates were enrolled in this study. SDOCT imaging was performed after examination for retinopathy of prematurity (ROP) at the bedside in non-sedated infants ages 31-41 weeks post-menstrual-age PMA (PMA=gestational age in weeks + chronological age) and at outpatient follow-up ophthalmic examinations. Thirty-one neonates met eligibility criteria. Nine children and nine adults without ocular pathology served as control groups. Semi-automatic retinal layer segmentation was performed. Central foveal thickness (CFT), foveal to parafoveal (FP) ratio (CFT divided by thickness 1000 μm from the foveal center), and 3D thickness maps were analyzed. Main Outcomes Measures-In-vivo determination of foveal morphology, layer segmentation, analysis of sub-cellular changes, spatio-temporal layer shifting. Results-In contrast to the adult fovea, we observed several signs of immaturity in the neonates: a shallow foveal pit, persistence of inner retinal layers (IRL), and a thin photoreceptor layer (PRL) that was thinnest at the foveal center. Three-dimensional mapping showed displacement of retinal layers out of the foveal center as the fovea matured and the progressive formation of the inner/ outer segment band in the opposite direction. The FP-IRL ratios decreased as IRL migrated prior to term and minimally after that, while FP-PRL ratios increased as PRL subcellular elements

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. Methods: 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. Results: The mean CCT for the 102 eyes of 52 white children was 562 ± 35 mm versus 543 ± 37 mm 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 mm increase in CCT, the IOP increased by 2.2 ± 0.6 mm Hg. Conclusions: 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.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2010