Sourabh Arora | University of Alberta (original) (raw)

Papers by Sourabh Arora

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2016

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2014

The optic nerve gray crescent can be of clinical significance if unrecognized during assessment f... more The optic nerve gray crescent can be of clinical significance if unrecognized during assessment for glaucoma. It has a characteristic appearance of a slate gray area of pigmentation within the disc margins and commonly appears along the inferotemporal or temporal neuroretinal rim areas. This type of disc rim pigmentation can create the impression of neuroretinal rim thinning, and thus lead to the misdiagnosis of glaucoma or "glaucoma suspect" with attendant implications for overtreatment or unnecessary close monitoring of such patients. The gray crescent is more common in African Americans than whites (prevalence rate 27% vs 7%) and is bilateral in at least 58% of cases. It has been reported in association with Kjer optic atrophy type 1. Suggested causes of the gray crescent include an accumulation of melanocytes, or retinal pigment epithelium cells partially located in the optic nerve head region if Bruch's membrane extends internal to the peripapillary scleral ring. Other causes of pigmentation that may resemble gray crescent are conus pigmentosus and variations of peripapillary atrophy. When a gray crescent is present, clinicians should endeavour to identify the true anatomical disc margins via the scleral lip and, if necessary, evaluate the patient further with imaging and visual field studies.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2016

2015 Annual IEEE India Conference (INDICON), 2015

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2016

Clinical and Investigative Medicine Medecine Clinique Et Experimentale, 2013

Purpose: ere are signi cant disparities in access to health care amongst Aboriginal Canadians. e ... more Purpose: ere are signi cant disparities in access to health care amongst Aboriginal Canadians. e purpose of this study was to determine whether tele-ophthalmology services, provided to Aboriginal Canadians in a culturally-sensitive community-based clinic, could overcome social and cultural barriers in ways that would be di cult in the traditional hospital-based setting.

Clinical and Investigative Medicine Medecine Clinique Et Experimentale, 2013

Purpose: e purpose of this study was to evaluate the results of probing, without uorescein irriga... more Purpose: e purpose of this study was to evaluate the results of probing, without uorescein irrigation, as a primary treatment for epiphora and/or mucous discharge, secondary to congenital nasolacrimal duct obstruction (CNLDO)

Journal of Clinical Neonatology, 2015

ABSTRACT Aim: To assess the role of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomo... more ABSTRACT Aim: To assess the role of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) in response assessment of patients with recurrent carcinoma cervix and evaluating the predictive value of metabolic response for progression free survival (PFS) and overall survival (OS). Methods: 40 patients with histopathologically or clinically evident recurrent cervical carcinoma underwent a baseline and a post-therapy FDG PET-CT for treatment response evaluation. PET-CT images were analysed by two experienced nuclear medicine physicians. Response was categorised using EORTC criteria into complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD) and progressive metabolic disease (PMD). Clinical/imaging follow-up (minimum 6 months) and/or histopathology were taken as reference standard. Patients were categorized into two groups, those with PMD and those without PMD (i.e. CMR, PMR and SMD). PFS and OS based on PET-CT response were measured from the date of post-therapy PET-CT to the first documentation of progression of disease and death respectively. Results: On the basis of metabolic response on post-therapy PET-CT, 7 patients had CMR, 13 patients had PMR, 8 patients had SMD and 12 patients had PMD. PFS for patients with cervical carcinoma ranged from 0.5 to 26.5 months (mean 6.7 ± 6.1 months). Median PFS for patients with PMD was 3.1 months while median PFS for those without PMD was not reached. Patients who did not show PMD on post-therapy PET-CT had a significantly better PFS than patients who showed PMD (p<0.0001, HR: 0.14). There was no statistically significant difference in OS between the two groups (p= 0.187; HR: 0.39). Conclusion: FDG PET-CT is an effective tool for response evaluation in recurrent carcinoma cervix. FDG PET-CT can prognosticate recurrent cervical cancer. Patients with metabolically progressive disease on post-therapy FDG PET-CT had a significantly shorter progression free survival.

Clinical and investigative medicine. Médecine clinique et experimentale, 2013

The purpose of this study was to evaluate the results of probing, without fluorescein irrigation,... more The purpose of this study was to evaluate the results of probing, without fluorescein irrigation, as a primary treatment for epiphora and/or mucous discharge, secondary to congenital nasolacrimal duct obstruction (CNLDO) METHODS: The medical records of nine-two children (127 eyes) with CNLDO who underwent a single probing without the use of fluorescein irrigation between January 2006 and December 2011 were reviewed retrospectively. Inclusion criteria were no prior nasolacrimal surgical procedure, history of epiphora and/or discharge since birth or shortly after birth in one or both eyes and at least one of the following clinical signs: epiphora, muco-purulent discharge and increased tear meniscus height. Children were investigated in two sub-groups based on age at time of probing; group 1 (51 eyes/40 children) included children who underwent probing at age ≤ 2 years and group 2 (76 eyes/52 children) included children who underwent probing at age > 2years. The primary outcome was ...

Clinical and investigative medicine. Médecine clinique et experimentale, 2013

There are significant disparities in access to health care amongst Aboriginal Canadians. The purp... more There are significant disparities in access to health care amongst Aboriginal Canadians. The purpose of this study was to determine whether tele-ophthalmology services, provided to Aboriginal Canadians in a culturally-sensitive community-based clinic, could overcome social and cultural barriers in ways that would be difficult in the traditional hospital-based setting. The Aboriginal Diabetes Wellness Program of Alberta incorporates culturally-sensitive health-related activities and rituals as a component of a diabetic retinopathy tele-ophthalmology screening program. Metrics of program attendance were collected while stakeholders participated in a survey to identify barriers to healthcare delivery. Aboriginal patients, cultural liaison, nurses and program administrators revealed economic, geographic, social and cultural barriers to healthcare faced by Aboriginal people. It was found that the introduction of culturally-sensitive programs led to increased appointment attendance; from ...

Journal of Cataract & Refractive Surgery, 2014

A 77-year-old woman with primary open-angle glaucoma was referred for surgical evaluation after f... more A 77-year-old woman with primary open-angle glaucoma was referred for surgical evaluation after failing to achieve target intraocular pressure (IOP) despite previous combined phacotrabeculectomy and Ahmed valve implantations. The IOP prior to surgery was 28 mm Hg on topical dorzolamide-timolol, latanoprost, and brimonidine. Trabecular bypass surgery with implantation of 2 iStents was performed. The IOP decreased by 11 mm Hg to 17 mm Hg after surgery and has remained stable for 2 years. This is the first published case reporting this magnitude of IOP reduction sustained for more than 2 years following insertion of 2 trabecular microbypass stents in a patient who had previous glaucoma-filtering surgeries. Further prospective studies are needed to establish expanded surgical indications for implantation of trabecular microbypass stents.

American Orthoptic Journal, 2011

Convergence paralysis is a rare entity that is usually associated with head trauma or mid-brain p... more Convergence paralysis is a rare entity that is usually associated with head trauma or mid-brain pathology. We describe a patient with idiopathic convergence paralysis that resolved without intervention. Idiopathic convergence paralysis is very rare and does not satisfy the criteria for diagnosis as described by Bielschowsky in 1936. Furthermore, this case demonstrates the possibility of spontaneous resolution of convergence paralysis.

Telemedicine and e-Health, 2014

To compare access time and cycle time between an &amp... more To compare access time and cycle time between an "in-house" teleglaucoma program and in-person glaucoma consultation. This was a prospective comparative study of 71 patients seen through the teleglaucoma program (eligible patients were glaucoma suspects or early-stage open-angle glaucoma) and 63 patients seen via a traditional in-person exam with a physician present. Access time was calculated as the time from the patient being referred to the date of a booked visit for either a teleglaucoma or in-person exam. Cycle time was defined as the time from registration until departure during the visit to the hospital; it was calculated for the subset of patients from each study group who completed activity logs on the day of their visit. The mean access time was significantly shorter for patients seen through teleglaucoma compared with in-person exam: 45±22 days (range, 13-121 days) (n=68) versus 88±47 days (range, 27-214 days) (n=63), respectively (p<0.0001). The cycle time was also reduced for patients seen through teleglaucoma, compared with in-person assessment: 78±20 min (range, 40-130 min) (n=39) versus 115±44 min (range, 51-216 min) (n=39), respectively (p<0.001). The mean percentage time spent in the waiting room was also significantly reduced for patients seen through teleglaucoma versus in-person assessments: 19±13% versus 41±24% (n=39), respectively (p<0.01). Teleglaucoma improves access to care and is a more efficient way of managing glaucoma suspects and patients with early-stage glaucoma compared with in-person assessment.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2016

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2014

The optic nerve gray crescent can be of clinical significance if unrecognized during assessment f... more The optic nerve gray crescent can be of clinical significance if unrecognized during assessment for glaucoma. It has a characteristic appearance of a slate gray area of pigmentation within the disc margins and commonly appears along the inferotemporal or temporal neuroretinal rim areas. This type of disc rim pigmentation can create the impression of neuroretinal rim thinning, and thus lead to the misdiagnosis of glaucoma or "glaucoma suspect" with attendant implications for overtreatment or unnecessary close monitoring of such patients. The gray crescent is more common in African Americans than whites (prevalence rate 27% vs 7%) and is bilateral in at least 58% of cases. It has been reported in association with Kjer optic atrophy type 1. Suggested causes of the gray crescent include an accumulation of melanocytes, or retinal pigment epithelium cells partially located in the optic nerve head region if Bruch's membrane extends internal to the peripapillary scleral ring. Other causes of pigmentation that may resemble gray crescent are conus pigmentosus and variations of peripapillary atrophy. When a gray crescent is present, clinicians should endeavour to identify the true anatomical disc margins via the scleral lip and, if necessary, evaluate the patient further with imaging and visual field studies.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2016

2015 Annual IEEE India Conference (INDICON), 2015

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2016

Clinical and Investigative Medicine Medecine Clinique Et Experimentale, 2013

Purpose: ere are signi cant disparities in access to health care amongst Aboriginal Canadians. e ... more Purpose: ere are signi cant disparities in access to health care amongst Aboriginal Canadians. e purpose of this study was to determine whether tele-ophthalmology services, provided to Aboriginal Canadians in a culturally-sensitive community-based clinic, could overcome social and cultural barriers in ways that would be di cult in the traditional hospital-based setting.

Clinical and Investigative Medicine Medecine Clinique Et Experimentale, 2013

Purpose: e purpose of this study was to evaluate the results of probing, without uorescein irriga... more Purpose: e purpose of this study was to evaluate the results of probing, without uorescein irrigation, as a primary treatment for epiphora and/or mucous discharge, secondary to congenital nasolacrimal duct obstruction (CNLDO)

Journal of Clinical Neonatology, 2015

ABSTRACT Aim: To assess the role of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomo... more ABSTRACT Aim: To assess the role of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) in response assessment of patients with recurrent carcinoma cervix and evaluating the predictive value of metabolic response for progression free survival (PFS) and overall survival (OS). Methods: 40 patients with histopathologically or clinically evident recurrent cervical carcinoma underwent a baseline and a post-therapy FDG PET-CT for treatment response evaluation. PET-CT images were analysed by two experienced nuclear medicine physicians. Response was categorised using EORTC criteria into complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD) and progressive metabolic disease (PMD). Clinical/imaging follow-up (minimum 6 months) and/or histopathology were taken as reference standard. Patients were categorized into two groups, those with PMD and those without PMD (i.e. CMR, PMR and SMD). PFS and OS based on PET-CT response were measured from the date of post-therapy PET-CT to the first documentation of progression of disease and death respectively. Results: On the basis of metabolic response on post-therapy PET-CT, 7 patients had CMR, 13 patients had PMR, 8 patients had SMD and 12 patients had PMD. PFS for patients with cervical carcinoma ranged from 0.5 to 26.5 months (mean 6.7 ± 6.1 months). Median PFS for patients with PMD was 3.1 months while median PFS for those without PMD was not reached. Patients who did not show PMD on post-therapy PET-CT had a significantly better PFS than patients who showed PMD (p<0.0001, HR: 0.14). There was no statistically significant difference in OS between the two groups (p= 0.187; HR: 0.39). Conclusion: FDG PET-CT is an effective tool for response evaluation in recurrent carcinoma cervix. FDG PET-CT can prognosticate recurrent cervical cancer. Patients with metabolically progressive disease on post-therapy FDG PET-CT had a significantly shorter progression free survival.

Clinical and investigative medicine. Médecine clinique et experimentale, 2013

The purpose of this study was to evaluate the results of probing, without fluorescein irrigation,... more The purpose of this study was to evaluate the results of probing, without fluorescein irrigation, as a primary treatment for epiphora and/or mucous discharge, secondary to congenital nasolacrimal duct obstruction (CNLDO) METHODS: The medical records of nine-two children (127 eyes) with CNLDO who underwent a single probing without the use of fluorescein irrigation between January 2006 and December 2011 were reviewed retrospectively. Inclusion criteria were no prior nasolacrimal surgical procedure, history of epiphora and/or discharge since birth or shortly after birth in one or both eyes and at least one of the following clinical signs: epiphora, muco-purulent discharge and increased tear meniscus height. Children were investigated in two sub-groups based on age at time of probing; group 1 (51 eyes/40 children) included children who underwent probing at age ≤ 2 years and group 2 (76 eyes/52 children) included children who underwent probing at age > 2years. The primary outcome was ...

Clinical and investigative medicine. Médecine clinique et experimentale, 2013

There are significant disparities in access to health care amongst Aboriginal Canadians. The purp... more There are significant disparities in access to health care amongst Aboriginal Canadians. The purpose of this study was to determine whether tele-ophthalmology services, provided to Aboriginal Canadians in a culturally-sensitive community-based clinic, could overcome social and cultural barriers in ways that would be difficult in the traditional hospital-based setting. The Aboriginal Diabetes Wellness Program of Alberta incorporates culturally-sensitive health-related activities and rituals as a component of a diabetic retinopathy tele-ophthalmology screening program. Metrics of program attendance were collected while stakeholders participated in a survey to identify barriers to healthcare delivery. Aboriginal patients, cultural liaison, nurses and program administrators revealed economic, geographic, social and cultural barriers to healthcare faced by Aboriginal people. It was found that the introduction of culturally-sensitive programs led to increased appointment attendance; from ...

Journal of Cataract & Refractive Surgery, 2014

A 77-year-old woman with primary open-angle glaucoma was referred for surgical evaluation after f... more A 77-year-old woman with primary open-angle glaucoma was referred for surgical evaluation after failing to achieve target intraocular pressure (IOP) despite previous combined phacotrabeculectomy and Ahmed valve implantations. The IOP prior to surgery was 28 mm Hg on topical dorzolamide-timolol, latanoprost, and brimonidine. Trabecular bypass surgery with implantation of 2 iStents was performed. The IOP decreased by 11 mm Hg to 17 mm Hg after surgery and has remained stable for 2 years. This is the first published case reporting this magnitude of IOP reduction sustained for more than 2 years following insertion of 2 trabecular microbypass stents in a patient who had previous glaucoma-filtering surgeries. Further prospective studies are needed to establish expanded surgical indications for implantation of trabecular microbypass stents.

American Orthoptic Journal, 2011

Convergence paralysis is a rare entity that is usually associated with head trauma or mid-brain p... more Convergence paralysis is a rare entity that is usually associated with head trauma or mid-brain pathology. We describe a patient with idiopathic convergence paralysis that resolved without intervention. Idiopathic convergence paralysis is very rare and does not satisfy the criteria for diagnosis as described by Bielschowsky in 1936. Furthermore, this case demonstrates the possibility of spontaneous resolution of convergence paralysis.

Telemedicine and e-Health, 2014

To compare access time and cycle time between an &amp... more To compare access time and cycle time between an "in-house" teleglaucoma program and in-person glaucoma consultation. This was a prospective comparative study of 71 patients seen through the teleglaucoma program (eligible patients were glaucoma suspects or early-stage open-angle glaucoma) and 63 patients seen via a traditional in-person exam with a physician present. Access time was calculated as the time from the patient being referred to the date of a booked visit for either a teleglaucoma or in-person exam. Cycle time was defined as the time from registration until departure during the visit to the hospital; it was calculated for the subset of patients from each study group who completed activity logs on the day of their visit. The mean access time was significantly shorter for patients seen through teleglaucoma compared with in-person exam: 45±22 days (range, 13-121 days) (n=68) versus 88±47 days (range, 27-214 days) (n=63), respectively (p<0.0001). The cycle time was also reduced for patients seen through teleglaucoma, compared with in-person assessment: 78±20 min (range, 40-130 min) (n=39) versus 115±44 min (range, 51-216 min) (n=39), respectively (p<0.001). The mean percentage time spent in the waiting room was also significantly reduced for patients seen through teleglaucoma versus in-person assessments: 19±13% versus 41±24% (n=39), respectively (p<0.01). Teleglaucoma improves access to care and is a more efficient way of managing glaucoma suspects and patients with early-stage glaucoma compared with in-person assessment.