Publications

Khizer Khaderi MD, MPH
Khizer Khaderi MD, MPH
Clinical Associate Professor of Ophthalmology

Ahmed SF, McDermott KC, Burge WK, Ahmed IIK, Varma DK, Liao YJ, Crandall AS, Khaderi SKR. Visual function, digital behavior and the vision performance index. Clin Ophthalmol. 2018;12:2553-2561
https://doi.org/10.2147/OPTH.S187131

Ocular Tolerance of Contemporary Electronic Display Devices Andrew J. Clark, PhD; Paul Yang, BS; Khizer R. Khaderi, MD, MPH; Andrew A. Moshfeghi, MD, MBA. Ophthalmic Surgery, Lasers and Imaging Retina. 2018;49(5):346-354 https://doi.org/10.3928/23258160-20180501-08

Yuan J, Mansouri B, Pettey JH, Ahmed SF, Khaderi SK (2018) The Visual Effects Associated with Head-Mounted Displays. Int J Ophthalmol Clin Res 5:085. doi.org/10.23937/2378-346X/1410085

Y. Joyce Liao, MD, PhD
Y. Joyce Liao, MD, PhD
Professor of Ophthalmology and of Neurology

Publications

  • High Altitude as a Risk Factor for the Development of Nonarteritic Anterior Ischemic Optic Neuropathy. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Liu, Y. A., Mesentier-Louro, L. A., Shariati, M. A., Moss, H. E., Beres, S. J., Liao, Y. J. 2022

    Abstract

    Episodic high-altitude exposure leads to optic disc edema and retinopathy. It is uncertain whether high-altitude exposure is a risk factor for nonarteritic anterior ischemic optic neuropathy (NAION).We performed a single-center, retrospective, cross-sectional case study of 5 patients with high-altitude-associated NAION (HA-NAION) from April 2014 to April 2019. Main study parameters included known vascular risk factors for NAION, evolution of visual acuity, visual field, optic disc, and macula measurements.We studied 5 eyes of 5 patients with HA-NAION that occurred at 7,000-9,000 ft above sea level, 28 patients with classic NAION that developed at sea level (normal altitude NAION or NA-NAION), and 40 controls. All 5 patients with HA-NAION had clinically confirmed NAION by a neuro-ophthalmologist within 3-21 days of onset and comprehensive follow-up evaluations (average follow-up of 23 months). Other than high-altitude exposure, 4 of 5 patients had undiagnosed obstructive sleep apnea (OSA, apnea-hypopnea index 5.4-22.2) and 1 had systemic vascular risk factors. All patients had disc-at-risk in the contralateral eye. The best-corrected distance visual acuity was 20/20 to 20/70 (median logMAR 0) at presentation and 20/70 to counting finger (median logMAR 0) at ≥6 months. Automated static perimetry revealed average mean deviation of -18.6 dB at presentation and -22.1 dB at ≥6 months. The average retinal nerve fiber layer was 244 µm (80-348 µm) at onset and 59 µm (55-80 µm) at ≥6 months. The average ganglion cell complex thickness was 50 µm (43-54 µm) at onset and 52 µm (50-55 µm) at ≥6 months. The patients with OSA were started on home continuous positive airway pressure treatment. Visual outcomes were similar in patients with HA-NAION and NA-NAION. - After addressing all NAION risk factors, no new events occurred in the HA-NAION group within 2-8 years with or without repeat high-altitude exposure.NAION can occur under high-altitude conditions. HA-NAION is associated with relatively younger age at onset, disc-at-risk, and OSA. These patients exhibit a relatively progressive course of vision loss after initial onset and severe thinning of optic nerves on optical coherence tomography. Treatment for OSA is recommended, especially with repeated high-altitude exposure.

    View details for DOI 10.1097/WNO.0000000000001629

    View details for PubMedID 36166787

  • Multimodal Imaging Features of Optic Disc Drusen. American journal of ophthalmology Yan, Y., Ludwig, C. A., Liao, Y. J. 2021

    Abstract

    PURPOSE: Identify key en face multimodal imaging features of optic disc drusen (ODD).DESIGN: Retrospective cross-sectional study.METHODS: .SETTING: Single academic center.PATIENT OR STUDY POPULATION: 786 patients (age 10-82 years) with diagnostic codes for ODD or the term "optic disc drusen" in clinical notes extracted using natural language processing.INTERVENTION OR OBSERVATION PROCEDURES: Color fundus image, green-light and blue-light fundus autofluorescence (FAF), near-infrared reflectance (NIR), and enhanced-depth imaging optical coherence tomography (EDI-OCT).MAIN OUTCOME MEASURES: Ophthalmic imaging characteristics and sensitivity of en face imaging compared with EDI-OCT.RESULTS: 38 (61 eyes) of 786 patients had high-quality EDI-OCT and en face multimodal imaging. Green-light FAF had the highest sensitivity (96.8%) and showed homogeneously hyperautofluorescence while blue-light FAF differentiated superficial and deep ODD by the heterogeneous brightness of FAF. Blue-light FAF (93.5%) and NIR (91.8%) were also sensitive and provided important features including the location, size, and depth of ODD and morphology of the optic disc and ODD-associated features such as horizontal hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures (PHOMS), respectively. Color fundus imaging had the lowest sensitivity (82%). There was good inter-rater reliability for all en face imaging modalities (P < .0001 for all).CONCLUSIONS: Green-light FAF had the highest sensitivity in diagnosis of ODD, while blue-light FAF and NIR provided more information regarding the severity, location, depth, and size of ODD. In eyes that are negative on green-light FAF, EDI-OCT can be performed and provides the highest-resolution characterization of the entire optic disc to rule out ODD.

    View details for DOI 10.1016/j.ajo.2020.12.023

    View details for PubMedID 33485838

  • Vision loss in optic disc drusen correlates with increased macular vessel diameter and flux and reduced peripapillary vascular density American Journal of Ophthalmology Yan, Y., Zhou, X., Chu, Z., Stell, L., Shariati, M. A., Wang, R. K., Liao, Y. J. 2020
  • Vision loss in optic disc drusen correlates with increased macular vessel diameter and flux and reduced peripapillary vascular density. American journal of ophthalmology Yan, Y. n., Zhou, X. n., Chu, Z. n., Stell, L. n., Shariati, M. A., Wang, R. K., Liao, Y. J. 2020

    Abstract

    To determine the key optical coherence tomography (OCT) and OCT angiography (OCTA) parameters that correlate with visual field loss in optic disc drusen (ODD).Retrospective cross-sectional study..Single academic center.17 patients with ODD (29 eyes) and 35 age-matched controls (53 eyes) INTERVENTION OR OBSERVATION PROCEDURES: Static perimetry, OCT and OCTA imaging of optic disc and macula.static perimetry, OCT, and OCTA measurements.We investigated the relationship between static perimetry and 14 OCT/OCTA measurements in patients with ODD vs. age-matched controls and found 5 key measurements that most correlated with visual field loss included: peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell complex (GCC), peripapillary vessel area density (VAD), macular vessel diameter (VD) and flux. Hierarchical clustering of these 5 measurements vs. all clinical characteristics revealed 3 distinct clusters. ODD and control eyes with no visual field loss (mean deviation (MD) > -2.0 dB) had high RNFL, GCC, and low macular VD and flux. ODD eyes with mild visual field loss (MD -2.0 to -5.0 dB) had high RNFL, GCC, and increased macular VD and flux. ODD eyes with moderate/severe visual field loss (MD < -5.0 dB) had decreased RNFL, GCC, peripapillary VAD, and increased macular VD and flux.OCT and OCTA provided objective measurements that can help predict visual field loss in ODD. Our data suggest that increased macular flow may be an early biomarker of visual field loss in ODD, while decreased peripapillary vessel density and RNFL thickness are late biomarkers of visual field loss in ODD.

    View details for DOI 10.1016/j.ajo.2020.04.019

    View details for PubMedID 32360344

  • The Project Baseline Health Study: A Step Towards a Broader Mission to Map Human Health npj Digital Medicine Gambhir, S., ..., Liao, Y. J., et al., et al 2020
Tawna L. Roberts, OD, PhD
Tawna L. Roberts, OD, PhD
Assistant Professor of Ophthalmology

Publications

  • Long-term test and retest reliability of clinical vergence testing. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Scheiman, M., Raghuram, A., Master, C., Robich, M. L., Toole, A., Shelton, E. R., Srinivasan, G., Marusic, S., Meiyeppen, S., Jordan, L. A., Roberts, T. L., EPICC Study Group, Roberts, T. L., Jordan, L. A., Dalton, K. N., Grant, G. A., Liao, Y. J., Porter, J., Purcell, L. K., Scheiman, M., Swanson, M. A., Viswanathan, S., Jordan, L. A., Sinnott, L. T., Robich, M. L., Shaw, K. J., Myers, J. A., Choi, S. S., Porter, J., Patel, N., Koutures, C., Platt, J., Raghuram, A., O'Brien, M., Vyas, N., Wiecek, E., Marusic, S., Ghosh, D., Wu, C., Master, C., Calandra, L., Easby, K., Mozel, A., Podolak, O., Rownd, K., Godfrey, M., McGinnis, I., Ford, C., Stenger, K., Pollock, K., Housel, K., Chen, A., Han, S., Huang, K., Parker, S. M., Youngerman, J., Bansal, S., Breau, N., Wu, J., Burgher, A., Law, C. L., Posey, A., Sayani, A., Issac, L., Bennett, R., Green, K., Riaz, A., Scheiman, M., Meiyeppen, S., Roberts, T., Grant, G., Kraus, E., Beres, S., Moss, H., Wan, A., Slinger, K., Leonen, J., Hu, A., Srinivasan, G., Baah, C., Grieb, E. M., Lew, C., Vandiver, T., Clewes, K., Bansal, S., Lumba-Brown, A., Balaji, A., Viswanathan, S., Modica, P. A., Pothiadia-Irungovel, A. B., Vaughn, M., McDaniel, C., Morrison, A., Widmer, D., Buckland, M., Shelton, E., Toole, A. J., Stevens, N., Swanson, M. W., Gould, S., Montejo, J., Ferrill, L., Swanson-Kimani, E., Weise, K. K., Cardona, Z., Dalton, K. N., Purcell, L. K., Labreche, T., Shalhoub, J., Abuleil, D. 2025

    Abstract

    PURPOSE: To establish long-term reliability measures for vergence testing in a control population of adolescents.METHODS: Healthy participants between 12 and 17.5years with normal binocular vision were recruited from 10 clinical sites. Cover test, near point of convergence (NPC), positive and negative fusional vergences, vergence facility (12∆ base-out/3∆ base-in) and vergence jumps (using the Oculomotor Assessment Tool) were performed at the initial visit and repeated at 90days. The mean and standard deviation were calculated for the overall group for NPC, vergence facility and vergence jumps and by prism dioptre step value for PFV and NFV (1Delta or 2Delta if below 20∆ or 5Delta above 20∆). Agreement was assessed using Bland-Altman plots and 95% limits of agreement (LOA).RESULTS: Ninety-three participants (mean age 14.3±1.7years, 52% female) were enrolled and 91 (98%) completed the initial and 90-day outcome evaluation. The mean differences were significantly greater than zero for vergence facility (p<0.05) and the first and second 30s of vergence jumps (p<0.01). The 95% LOA were narrow for NPC (±2.5) and negative fusional vergence (±5.9), suggesting good repeatability. LOA were larger for positive fusional vergence (±17.8), vergence facility (±9.8) and vergence jumps (±16.2). Analysis of the positive fusional vergence data indicates that the different step sizes (1∆ or 2∆ vs. 5∆) in the horizontal prism bar contribute to considerably larger variability in these measures.CONCLUSIONS: In participants with normal binocular vision and no concussion history, good reliability yielded comparable results 90days apart for all vergence measures. The results provide values that can be used to interpret the effect of intervention for vergence disorders in clinical practice and research studies. An important outcome of this study is the understanding that 5∆ steps on the typical horizontal prism bar contribute to high variability in positive fusional vergence measures when findings are ≥20∆.

    View details for DOI 10.1111/opo.70022

    View details for PubMedID 41048201

  • Post-concussion clinical findings of oculomotor function in paediatric patients with persisting symptoms compared to healthy controls. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Wu, C. H., Marusic, S., Haensel, J. X., Oke, I., Slinger, K. E., Vyas, N., Ameyaw Baah, C. A., Hu, A., Leonen, J., Lew, C. Y., Srinivasan, G., Norouzpour, A., Jenewein, E., Meiyeppen, S., Scheiman, M., Roberts, T. L., Raghuram, A. 2025

    Abstract

    Oculomotor deficits in vergence and accommodation can arise in paediatric patients with persistent concussion symptoms, although the profile is not well established. This study aimed to describe the frequency of these deficits in persistently symptomatic concussed paediatric patients and identify effective screening tools.This was a prospective cohort study conducted at three clinical sites across the United States. Participants aged 8-18 years with diagnosed concussion were recruited within 9 months of injury through concussion clinics or referral to a vision provider. Participants without concussion were recruited through the local community and eye clinics. Clinical measures of ocular alignment, vergence and accommodation were collected. Group comparisons were assessed using Welch's t-test, Mann-Whitney U test and Fisher's exact test with Bonferroni correction. The diagnostic value of near point of convergence (NPC) and accommodative amplitude (AA) for identifying persistently symptomatic concussed participants was evaluated using logistic regression and receiver operating characteristic curve analysis.Seventy-one participants were recruited, including 34 concussed participants (mean age 14.3 [SD 2.4] years; 74% female, 26% male; median time since concussion 107 [IQR 80-118] days) and 32 controls (mean age, 12.7 [SD 2.1] years; 56% female, 44% male). Concussed participants scored significantly worse or had higher failure rates than controls on all vergence and accommodative tests (p < 0.05) except ocular alignment and monocular accommodative facility. Concussed participants had a higher frequency of diagnoses (vergence: 62% vs. 3%; accommodation: 76% vs. 3%; p < 0.001). NPC and AA were significant predictors for concussion in individual models (NPC: OR = 2.16 [95% CI: 1.52-3.61], p < 0.001, mean AUC [SD] = 0.88 [0.13]; AA: OR = 0.46 [95% CI: 0.29-0.64], p < 0.001, mean AUC [SD] = 0.88 [0.15]).The oculomotor profile of persistently symptomatic concussed paediatric participants shows a high frequency of vergence and accommodative deficits, for which NPC and AA are effective screening tools. Further investigation should examine oculomotor deficits in acutely concussed paediatric patients.

    View details for DOI 10.1111/opo.70010

    View details for PubMedID 40905935

  • Accommodative responses in children with high and low levels of astigmatism. Optometry and vision science : official publication of the American Academy of Optometry Haensel, J. X., Chen, A. M., Cotter, S. A., Raghuram, A., Manh, V. M., Han, S., Jones-Jordan, L. A., Lorenzana, I., Huang, K., Patel, R., Lytle, A. A., Retnasothie, D., Roberts, T. L. 2025

    Abstract

    Children with uncorrected astigmatism are often assumed to accommodate to the circle of least confusion. However, empirical evidence in children without a history of refractive correction is lacking. This study found that most children accommodate toward the anterior focal plane, with both focal planes exhibiting a lag of accommodation.To examine accommodative responses by measuring refractive states of the eye during near viewing in children with uncorrected astigmatism without a history of refractive correction.Participants aged 3 to <10 years with no history of refractive correction monocularly viewed a 20/250 letter at a 3-D demand (33 cm) while accommodative responses were measured using open-field autorefraction. Responses were classified based on the focal plane closest to the stimulus: anterior or posterior focal plane, or circle of least confusion. Cycloplegic autorefraction was used to classify participants as having low astigmatism (≤1.50 D) or high astigmatism (>1.50 D). Participants were further subdivided as having hyperopia (≥2.00 D), myopia (≥0.75 D), or emmetropia (less than 0.75 D myopia and 2.00 D hyperopia) based on their spherical cycloplegic refractive error. Chi-square analyses and Fisher exact tests were used to assess the association between accommodative response and cycloplegic refractive error classification.Of the 352 participants, 316 (89.8%) had low astigmatism and 36 (10.2%) had high astigmatism. In both groups, significantly more participants were classified as being focused at the anterior focal plane (low: 98.7%; high: 83.3%) than the posterior focal plane (low: 0.6%; high: 0.0%) or circle of least confusion (low: 0.6%; high: 16.7%; p<0.001). Almost all nonhyperopic participants in the low astigmatism group (99.2%) and hyperopic participants irrespective of astigmatism magnitude (low: 100%; high: 95.2%) accommodated closer to the anterior focal plane with accommodative lags in both meridians. Most nonhyperopic participants with high astigmatism also accommodated to the anterior focal plane (66.7%) and a third to the circle of least confusion (33.3%).In contrast to the assumption that children with astigmatism accommodate to the circle of least confusion, our findings show that most children accommodated to the anterior focal plane during near-viewing tasks, with accommodative lags in both meridians.

    View details for DOI 10.1097/OPX.0000000000002286

    View details for PubMedID 40833971

  • Optical correction of hyperopia in school-aged children: a scoping review protocol. BMJ open Srinivasan, G., Kerber, K. L., Liu, S. H., Manh, V. M., Huang, K., Williamson, A., Sadhu, S., Ollinger, M. C., Tajbakhsh, Z., Fisher, J. H., Cheung, N. L., Junge, J., Chan, K. C., Hussaindeen, J. R., Simard, P., Trast, K. R., Morettin, C. E., Krueger, S., Nti, A. N., Lee Chen, D. M., Roberts, T. L. 2025; 15 (8): e103546

    Abstract

    Prescribing patterns for hyperopia in children vary widely among eye care providers worldwide. This scoping review aims to identify and map the current literature on optical correction and catalogue outcomes reported, particularly in the domains of vision, vision-related functional outcomes and quality of life (QoL) in school-aged children with hyperopia.This protocol was developed in accordance with the Joanna Briggs Institute's Manual for Evidence Synthesis. We will include studies involving school-aged children with hyperopia without restrictions on sex, gender, race, ethnicity, type of optical correction, length of intervention, publication date or country of origin. We will include studies with internal or external comparison groups. We will exclude studies associated with myopia control treatments, ocular and visual pathway pathologies affecting vision or visual function. We will search Cochrane CENTRAL, Embase.com and PubMed. Examples of data to be extracted include population demographics, visual acuity, study-specific definitions for refractive error, treatment regimens for optical correction, vision and vision-related functional outcomes and QoL (general or vision-related) as quantified by validated instruments.Informed consent and Institutional Review Board approval will not be required, as this scoping review will only use published data. The results from the scoping review will be disseminated by publication in a peer-reviewed scientific journal and at professional conferences.

    View details for DOI 10.1136/bmjopen-2025-103546

    View details for PubMedID 40819922

  • Characterizing vision-related symptoms in pediatric and adolescent concussion patients with the convergence insufficiency symptom survey. Optometry and vision science : official publication of the American Academy of Optometry Vyas, N., Haensel, J. X., Marusic, S., Wu, C. H., Roberts, T. L., Raghuram, A. 2025

    Abstract

    The Convergence Insufficiency Symptom Survey (CISS) effectively characterizes vision-related symptoms post-concussion and can aid in triaging patients for comprehensive eye examinations, ensuring timely and appropriate care for vision-related issues post-concussion.This study aimed to characterize the symptom profile of pediatric and adolescent concussion patients using the CISS and determine if symptom reporting is impacted by age, sex, time since concussion, clinic type, and visual function.A retrospective chart review was conducted for patients aged 7 to <18 years with a concussion diagnosis of <1 year at Boston Children's Hospital Department of Ophthalmology between July 2014 and December 2021 through two clinic types: the Multidisciplinary Concussion Clinic or direct referral. Patients had no ocular disease, strabismus, or amblyopia. Multidisciplinary Concussion Clinic patients self-reported the CISS while referred patients responded verbally to a clinician-administered CISS. The CISS included five performance-, seven somatic-, and three vision-related questions. Participant's visual function status was classified as abnormal if near point of convergence was >7 cm and/or accommodative amplitude was two diopters below their age-expected value (15-0.25 × [age]) for at least one eye. Mann-Whitney U tests compared total CISS scores between sex, time since concussion, clinic type, and visual function. Multiple regression analyses evaluated total scores and subscores.Among 210 concussed patients (68% female, 32% male; 15.3 [13.7 to 16.8] years), the median CISS score was 28 (17 to 37). Total CISS scores differed significantly for clinic type (p=0.0011), while vision-related subscores differed significantly by visual function status (p=0.025). Regression analysis showed that age (p=0.00092), time since concussion (p=0.027), clinic type (p<0.0001), and visual function (p=0.049) significantly increased total CISS scores. Time since concussion (p=0.00053), clinic type (p<0.0001), and visual function (p=0.0013), significantly increased vision-related subscores.Concussed patients report high symptom scores on the CISS. Total scores and vision-related subscores could help screen for abnormal visual function following concussion.

    View details for DOI 10.1097/OPX.0000000000002275

    View details for PubMedID 40622843