Bio

Clinical Focus


  • pediatric ophthalmology and strabismus
  • Ophthalmology

Academic Appointments


Administrative Appointments


  • Ophthalmology Residency Program Director, Stanford University School of Medicine (2012 - Present)
  • Educator 4 CARE, SMS (2007 - Present)
  • Vice Chair for Clinical Affairs Department of Ophthalmology, Stanford University (2007 - Present)

Honors & Awards


  • Ophthalmology Faculty Teaching Award, Stanford Department of Ophthalmology (2009)
  • Arthur Blomfield Excellence in Clinical Teaching, Stanford Medical School (2009)
  • Honor Award, American Academy of Ophthalmology (2007)
  • Academic Senate Distinction in Teaching Award, UCSF School of Medicine (2004)

Professional Education


  • Residency:UCSF Dept of Ophthalmology (1990) CA
  • Internship:St Mary's Medical Center (1987) CA
  • Fellowship:Boston Children's Hospital - Pediatric Ophthalmology (1991) MA
  • Board Certification: Ophthalmology, American Board of Ophthalmology (1991)
  • Medical Education:Baylor College of Medicine (1986) TX
  • MD, Baylor College of Medicine, Medicine (1986)
  • BS, Santa Clara University, Combined Sciences (1982)

Community and International Work


  • Prevent Blindness Northern California

    Topic

    vision screening

    Populations Served

    children of northern california

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Prevention of Retinopathy of Prematurity in Vietnam, Vietnam

    Topic

    Teaching physicians in Vietnam to treat newborns with potentially blinding retinopathy

    Partnering Organization(s)

    ORBIS International

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Epidemiology of myopia
Therapeutic options for treatment of congenital cataracts
Innovative surgical techniques for surgical management of strabismus
Development of international programs to screen and treat retinopathy of prematurity in developing nations
Description of cortical visual impairment

Clinical Trials


  • Cancer Biology of Retinoblastoma Recruiting

    Many children with the childhood cancer, Retinoblastoma, have surgery to remove the tumor and sometimes the entire eye. The purpose of this study is to collect the extra tissue from patients who undergo tumor removal for laboratory experiments that will help us understand not only what occurs in retinoblastoma cells but also how cells normally function. Some of these studies will include an evaluation of how cells control the way that genes are expressed, how cells "know" to become retinal cells, how cells remain retinal cells, how cells lose their identity as retinal cells, what changes make retinoblastoma cells different from normal retinal cells, and what changes make some retinoblastomas worse than others.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Neovascularization in Purtscher's retinopathy. Clinical ophthalmology (Auckland, N.Z.) Chan, A., Fredrick, D. R., Leng, T. 2011; 5: 1585-1587

    Abstract

    We report a case of neovascularization secondary to Purtscher's retinopathy that showed minimal improvement with photocoagulation treatment. A 14-year-old boy with a history of cerebellar medulloblastoma presented with blurry vision and floaters after being struck by a motor vehicle while riding his bike. At presentation, visual acuity was 20/400 in his right eye and counting fingers in his left eye. Fundus examination showed disk edema, retinal whitening, and retinal hemorrhages in both eyes. Optical coherence tomography demonstrated thinning of the temporal retina and disruption of the inner segment-outer segment junction of the photoreceptor layer in the right eye and thickening and edema of the nasal macula, as well as a central foveal hyper-reflectivity, in the left eye. At the initial visit, there was no ischemia or neovascularization (NV). One month later, the patient developed NV of the disk and ischemia in the mid-periphery of the left eye. The patient underwent treatment with pan-retinal photocoagulation. The NV regressed, but visual outcome remained poor at his 5-month follow-up visit.

    View details for DOI 10.2147/OPTH.S26076

    View details for PubMedID 22125405

  • Detection of a congenital cystic eyeball by prenatal ultrasound in a newborn with Turner's syndrome BRITISH JOURNAL OF OPHTHALMOLOGY Kavanagh, M. C., Tam, D., Diehn, J. J., Agadzi, A., Howes, E. L., Fredrick, D. R. 2007; 91 (4): 559-560

    View details for DOI 10.1136/bjo.2006.096107

    View details for Web of Science ID 000245037700037

    View details for PubMedID 17372344

  • Genotype and phenotype correlations in congenital glaucoma: CYP1B1 mutations, goniodysgenesis, and clinical characteristics AMERICAN JOURNAL OF OPHTHALMOLOGY Hollander, D. A., Sarfarazi, M., Stoilov, I., Wood, I. S., Fredrick, D. R., Alvarado, J. A. 2006; 142 (6): 993-1004

    Abstract

    To determine whether there is a correlation among mutations in the cytochrome P4501B1 gene (CYP1B1), the degree of angle dysgenesis observed histologically, and disease severity in congenital glaucoma.Interventional case series.Direct DNA sequencing was used to screen six unrelated children with congenital glaucoma, each set of parents, and all siblings for CYP1B1 mutations. Specimens of the anterior chamber angle obtained at trabeculectomy were examined histologically to identify abnormalities of the aqueous outflow pathway. CYP1B1 mutations were correlated with both the degree of angle dysgenesis and the patients' disease severity (age at diagnosis, difficulty in achieving intraocular pressure [IOP]) control.Four (66.7%) of the six patients were compound heterozygotes for mutations in the CYP1B1 gene. Seven of the eight CYP1B1 mutations were identified, including two novel mutations (R117P, C209R) and five others previously described (G61E, R368H, R390H, E229K, 4340delG). The cases were divided on the basis of histological phenotype into categories of (1) severe goniodysgenesis highlighted by the agenesis of the canal of Schlemm (two patients), (2) moderate goniodysgenesis characterized by the presence of a band of collagenous tissue (CT) in the trabecular meshwork (TM) and/or the juxtacanalicular tissues (JXT) (three patients), and (3) mild goniodysgenesis with deposition of a mucopolysaccharide material in the JXT (one patient). CYP1B1 mutations were identified in both cases of severe angle dysgenesis and two of three cases of moderate dysgenesis. Disease severity closely correlated with the degree of angle dysgenesis.Most patients in our cohort had compound heterozygous CYP1B1 mutations. Specific CYP1B1 mutations may be associated with severe or moderate angle abnormalities.

    View details for DOI 10.1016/j.ajo.2006.07.054

    View details for Web of Science ID 000242671100014

    View details for PubMedID 17157584

  • Papilloedema secondary to otitic hydrocephalus BRITISH JOURNAL OF OPHTHALMOLOGY Vagefi, M. R., Fredrick, D. R. 2006; 90 (5): 646-646

    View details for DOI 10.1136/bjo.2005.083949

    View details for Web of Science ID 000236892900030

    View details for PubMedID 16622097

  • Genotype and phenotype correlations in congenital glaucoma. Transactions of the American Ophthalmological Society Hollander, D. A., Sarfarazi, M., Stoilov, I., Wood, I. S., Fredrick, D. R., Alvarado, J. A. 2006; 104: 183-195

    Abstract

    To determine whether there is a correlation among mutations in the cytochrome P450 1B1 gene (CYP1B1), the degree of angle dysgenesis observed histologically, and disease severity in congenital glaucoma.Direct DNA sequencing was utilized to screen six unrelated children with congenital glaucoma, each set of parents, and all siblings for CYP1B1 mutations. Specimens of the anterior chamber angle obtained at trabeculectomy were examined histologically to identify abnormalities of the aqueous outflow pathway. CYP1B1 mutations were correlated with both the degree of angle dysgenesis and the patient's disease severity (age at diagnosis, difficulty in achieving intraocular pressure control).Four of the six patients (66.7%) were compound heterozygotes for mutations in the CYP1B1 gene. Seven of the eight CYP1B1 mutations were identified, including two novel mutations (R117P, C209R) and five others previously described (G61E, R368H, R390H, E229K, 4340delG). The cases were divided based on histological phenotype into categories of (1) severe goniodysgenesis highlighted by the agenesis of Schlemm's canal (two patients), (2) moderate goniodysgenesis characterized by the presence of a band of collagenous tissue in the trabecular meshwork and/or the juxtacanalicular tissues (three patients), and (3) mild goniodysgenesis with deposition of a mucopolysaccharide material in the juxtacanalicular tissue (one patient). CYP1B1 mutations were identified in both cases of severe angle dysgenesis and two of three cases of moderate dysgenesis. Disease severity closely correlated with the degree of angle dysgenesis.The majority of cases in the cohort had compound heterozygous CYP1B1 mutations. Specific CYP1B1 mutations may be associated with severe or moderate angle abnormalities.

    View details for PubMedID 17471339

  • Alteration of cyclic frequency by botulinum toxin injection in adult onset cyclic esotropia BRITISH JOURNAL OF OPHTHALMOLOGY Lai, Y. H., Fredrick, D. R. 2005; 89 (11): 1540-1541

    View details for DOI 10.1136/bjo.2005.069021

    View details for Web of Science ID 000232652000045

    View details for PubMedID 16234476

  • Corticosteroid treatment of periorbital haemangioma of infancy: a review of the evidence BRITISH JOURNAL OF OPHTHALMOLOGY Ranchod, T. M., Frieden, I. J., Fredrick, D. R. 2005; 89 (9): 1134-1138

    Abstract

    To systematically review the literature for corticosteroid treatment of periorbital haemangioma of infancy (HOI) and determine the relative efficacy and safety of oral, topical and intralesional corticosteroids.PubMed and the Cochrane Library were queried using keywords, and further articles were obtained by reviewing bibliographies. Inclusion and exclusion criteria were applied to create a subset of literature for analysis.Systematic review revealed 81 original reports of periorbital HOI cases treated with steroids. Most studies and case series failed to document refractive error or visual acuity before and after treatment. Of cases meeting inclusion criteria, five patients received topical steroids and 25 patients received intralesional steroids. Patients receiving intralesional injections tended to demonstrate reduced astigmatism at follow up after treatment (21 of 28). The lack of studies with relevant objective ophthalmological end points prevented statistical meta-analysis.Intralesional injections may reduce refractive error, while the efficacy of topical steroids is unclear. Studies measuring objective ophthalmic data before and after treatment are sparse, and more studies are needed to determine the relative efficacy of different steroids. There are insufficient data to estimate the incidence of steroid side effects in patients treated with steroids for periorbital HOI or complications of intralesional injections in particular.

    View details for DOI 10.1136/bjo.2005.070508

    View details for Web of Science ID 000231313300019

    View details for PubMedID 16113367

  • Delayed-onset infantile cataracts in a case of Treacher Collins syndrome ARCHIVES OF OPHTHALMOLOGY Biebesheimer, J. B., Fredrick, D. R. 2004; 122 (11): 1721-1722

    View details for Web of Science ID 000224932300021

    View details for PubMedID 15534141

  • The pseudopapilledema of neonatal-onset multisystem inflammatory disease AMERICAN JOURNAL OF OPHTHALMOLOGY Hollander, D. A., Hoyt, W. F., Howes, E. L., Fredrick, D. R. 2004; 138 (5): 894-895

    Abstract

    To report a rare case of neonatal-onset multisystem inflammatory disease with serial photographs to characterize the optic nerve findings.Observational case report.A 6-year-old girl with neonatal-onset multisystem inflammatory disease, who had received systemic corticosteroid therapy for 5 years, had bilateral fibrillar opacities that surrounded the optic disks and extended into the peripapillary nerve fiber layer and vessels. A magnetic resonance imaging examination and lumbar puncture revealed elevated intracranial pressure.The elevated intracranial pressure returned to normal following a corticosteroid taper. Optic disk photographs, taken 4 years earlier, were subsequently obtained. The optic disk appearance had remained unchanged over the 4-year period, consistent with a pseudopapilledema.The optic disk appearance is not consistent with papilledema from increased intracranial pressure. The optic disk findings, in conjunction with the underlying inflammatory syndrome, suggest an infiltrative etiology for the atypical optic nerve findings in neonatal-onset multisystem inflammatory disease.

    View details for Web of Science ID 000225083100042

    View details for PubMedID 15531344

  • Myopia BRITISH MEDICAL JOURNAL Fredrick, D. R. 2002; 324 (7347): 1195-1199

    View details for Web of Science ID 000175763200023

    View details for PubMedID 12016188

  • Needle aspiration of a traumatic subperiosteal haematoma of the orbit BRITISH JOURNAL OF OPHTHALMOLOGY Rojas, M. C., Eliason, J. A., Fredrick, D. R. 2002; 86 (5): 593-594

    View details for Web of Science ID 000175313400024

    View details for PubMedID 11973260

  • Grand rounds #67. A case of a right sixth nerve paralysis and a left third nerve paralysis. Binocular vision & strabismus quarterly Kushner, B. J., Weiss, A. H., McKeown, C. A., Kennedy, R., Fredrick, D. R., Enzenauer, R. W. 2002; 17 (3): 216-222

    View details for PubMedID 12171594

  • Myopia: was mother right about reading in the dark? BRITISH JOURNAL OF OPHTHALMOLOGY Fredrick, D. R. 2001; 85 (5): 509-510

    View details for Web of Science ID 000168325900001

    View details for PubMedID 11316701

  • Ophthalmic features of primary oxalosis after combined liver/kidney transplantation BRITISH JOURNAL OF OPHTHALMOLOGY Alcorn, D. M., Fredrick, D. R. 2000; 84 (11): 1326-1327

    View details for Web of Science ID 000165079400033

    View details for PubMedID 11203176

  • Raccoon roundworm (Baylisascaris procyonis) encephalitis: Case report and field investigation PEDIATRICS Park, S. Y., Glaser, C., Murray, W. J., Kazacos, K. R., Rowley, H. A., Fredrick, D. R., Bass, N. 2000; 106 (4)

    Abstract

    Baylisascaris procyonis is a common and widespread parasite of raccoons in the United States and Canada. With large raccoon populations occurring in many areas, the potential risk of human infection with B procyonis is high. We report a case of severe raccoon roundworm (B procyonis) encephalitis in a young child to illustrate the unique clinical, diagnostic, and treatment aspects, as well as public health concerns of B procyonis infection. Acute and convalescent serum and cerebrospinal fluid samples from the patient were tested for antibodies against B procyonis to assist in documenting infection. An extensive field survey of the patient's residence and the surrounding community was performed to investigate raccoon abundance and to determine the extent of raccoon fecal contamination and B procyonis eggs in the environment. The patient evidenced serologic conversion, and the field investigation demonstrated a raccoon population far in excess of anything previously reported. There was abundant evidence of B procyonis eggs associated with numerous sites of raccoon defecation around the patient's residence and elsewhere in the community. Because B procyonis can produce such severe central nervous system disease in young children, it is important that pediatricians are familiar with this infection. The public should be made aware of the hazards associated with raccoons and B procyonis to hopefully prevent future cases of B procyonis infection.

    View details for Web of Science ID 000089623100013

    View details for PubMedID 11015551

  • Progressive neurological deterioration and MRI changes in cblC methylmalonic acidaemia treated with hydroxocobalamin JOURNAL OF INHERITED METABOLIC DISEASE Enns, G. M., Barkovich, A. J., Rosenblatt, D. S., Fredrick, D. R., Weisiger, K., Ohnstad, C., Packman, S. 1999; 22 (5): 599-607

    Abstract

    Cobalamin C (cblC) defects result in decreased activity of both methylmalonyl-CoA mutase and N5-methyltetrahydrofolate:homocysteine methyltransferase (methionine synthase), with subsequent methylmalonic acid-uria and homocystinuria. Patients typically show failure to thrive, developmental delay and megaloblastic anaemia. Vitamin B12 therapy has been beneficial in some cases. We report a now 4-year-old Hispanic girl with cblC disease documented by complementation analysis, with progressive neurological deterioration and worsening head MRI changes while on intramuscular hydroxocobalamin begun at age 3 weeks. Oral carnitine and folic acid were added at age 1 year. Blood levels of methylmalonic acid were reduced to treatment ranges. In the absence of acute metabolic crises, she developed microcephaly, progressive hypotonia and decreased interactiveness. Funduscopic examination was normal at age 13 months. At age 19 months, she developed nystagmus, and darkly pigmented fundi and sclerotic retinal vessels were observed on examination. Her neonatal head MRI was normal. By age 1 year, the MRI showed diffuse white-matter loss with secondary third and lateral ventricle enlargement, a thin corpus callosum, and normal basal ganglia. At age 15 months, progression of the white-matter loss, as well as hyperintense globi pallidi, were present. Interval progression of both grey- and white-matter loss was seen at age 27 months. We therefore caution that progressive neurological deterioration and head MRI abnormalities may still occur in cblC disease, despite early initiation of hydroxocobalamin therapy and improvement in toxic metabolite concentrations in physiological fluids.

    View details for Web of Science ID 000080750600004

    View details for PubMedID 10399092

  • Cortically visually impaired children: a need for more study BRITISH JOURNAL OF OPHTHALMOLOGY Hoyt, C. S., Fredrick, D. R. 1998; 82 (11): 1225-1226

    View details for Web of Science ID 000076973300001

    View details for PubMedID 9924320

  • Complex limbal choristomas in linear nevus sebaceous syndrome OPHTHALMOLOGY Duncan, J. L., Golabi, M., Frederick, D. R., Hoyt, C. S., Hwang, D. G., Kramer, S. G., Howes, E. L., Cunningham, E. T. 1998; 105 (8): 1459-1465

    Abstract

    This study aimed to describe the clinical and histopathologic findings in four patients with complex limbal choristomas associated with linear nevus sebaceous syndrome (LNSS), a rare disorder including nevus sebaceous, seizures, and mental retardation, and often accompanied by ocular anomalies.Small observational case series.A retrospective review of the clinical and histopathologic records of four patients.Each of four patients had complex limbal choristomas in the setting of clinical and histopathologic LNSS. The limbal choristomas were multiple in three patients and bilateral in two patients. Most choristomas involved the superotemporal limbus (6 of 10), although nasal (3 of 10) and inferior (1 of 10) limbal tumors also were present. Three patients had significant corneal astigmatism or involvement of the central cornea requiring surgical removal of their choristomas, one accompanied by a lamellar keratoplasty and another accompanied by two consecutive penetrating keratoplasties. Each graft eventually vascularized, reducing vision. One patient's vision was limited by amblyopia and another by occipital cortical dysgenesis with visual impairment. Histopathologic examination of the excised choristomas showed foci of lacrimal gland (3 of 4 patients), adipose tissue (3 of 4), neural tissue (1 of 4), cartilage (1 of 4), lymphoid follicles (1 of 4), skin adnexal tissue (1 of 4), and smooth muscle (1 of 4). Other associated ocular findings included an eyelid mass (1 of 4), colobomas of the eyelid (3 of 4), colobomas of the choroid and retina (2 of 4), nonparalytic strabismus (2 of 4), scleral ectasia (1 of 4), partial oculomotor palsy with ptosis and anisocoria (1 of 4), microphthalmia (1 of 4), hypertelorism (1 of 4), and cortical visual impairment (1 of 4).Complex limbal choristomas, although rare, can occur in the setting of LNSS and can be associated with multiple ocular and systemic abnormalities. Visual prognosis appears poor in most cases despite aggressive management.

    View details for Web of Science ID 000075231500030

    View details for PubMedID 9709758

  • OCULAR MANIFESTATIONS OF DEFORMATIONAL FRONTAL PLAGIOCEPHALY JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Fredrick, D. R., Mulliken, J. B., Robb, R. M. 1993; 30 (2): 92-95

    Abstract

    Frontal plagiocephaly can be caused by two mechanisms: craniosynostosis and external deformational pressure. Synostotic plagiocephaly is known to be associated with vertical strabismus and contralateral head tilt. Thirteen patients with deformational frontal plagiocephaly were examined to evaluate head position, ocular motility, and alignment. Nine of the patients (70%) were found to have ipsilateral torticollis, but only one patient had strabismus and this was a horizontal deviation not obviously associated with head position. The clinical features of synostotic and deformational plagiocephaly are discussed to distinguish the two conditions, which have a different treatment and outcome.

    View details for Web of Science ID A1993KY86000005

    View details for PubMedID 8501624

  • SOLITARY INTRAOCULAR LYMPHOMA AS AN INITIAL PRESENTATION OF WIDESPREAD DISEASE ARCHIVES OF OPHTHALMOLOGY Fredrick, D. R., Char, D. H., Ljung, B. M., Brinton, D. A. 1989; 107 (3): 395-397

    Abstract

    A patient presented with a large peripapillary choroidal mass as the initial manifestation of widespread, poorly differentiated, large cell lymphoma. The choroidal tumor had clinical and ultrasonographic characteristics of a uveal malignant melanoma. A systemic evaluation and fine-needle aspiration biopsy specimens of the abdomen and choroid established the diagnosis of a lymphoma. On rare occasion, other neoplasms can simulate the diagnostic pattern of uveal melanoma, and fine-needle aspiration biopsy can be crucial in establishing the correct diagnosis.

    View details for Web of Science ID A1989T597500027

    View details for PubMedID 2647068

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