Bio

Academic Appointments


Honors & Awards


  • Hodson Trust Scholar, Johns Hopkins University (2004-2008)
  • ESPN Academic All-American, NCAA - Volleyball (Nov 2008)

Publications

All Publications


  • Birth-related subconjunctival and retinal haemorrhages in the Newborn Eye Screening Test (NEST) Cohort. Eye (London, England) Ji, M. H., Ludwig, C. A., Callaway, N. F., Moshfeghi, D. M. 2019

    View details for DOI 10.1038/s41433-019-0523-y

    View details for PubMedID 31285570

  • A Spectrum of Regression Following Intravitreal Bevacizumab in Retinopathy of Prematurity AMERICAN JOURNAL OF OPHTHALMOLOGY Chen, T. A., Shields, R. A., Bodnar, Z. H., Callaway, N. F., Schachar, I. H., Moshfeghi, D. M. 2019; 198: 63–69
  • Bilateral Endophthalmitis after Immediately Sequential Bilateral Cataract Surgery. Ophthalmology. Retina Callaway, N. F., Ji, M. H., Mahajan, V. B., Moshfeghi, D. M. 2019

    View details for DOI 10.1016/j.oret.2019.04.007

    View details for PubMedID 31153851

  • Lipid-Lowering Medications are Associated with Lower Risk of Retinopathy and Ophthalmic Interventions among U.S. Patients with Diabetes. American journal of ophthalmology Vail, D., Callaway, N. F., Ludwig, C. A., Saroj, N., Moshfeghi, D. M. 2019

    Abstract

    To evaluate the impact of lipid-lowering medications on diabetic retinopathy and diabetic complications requiring intervention in the U.S.Retrospective cohort analysis.Administrative insurance claims drawn from the Truven MarketScan Commercial Claims and Encounters database.Beneficiaries with Type 2 diabetes mellitus (T2DM).Any signs of diabetic retinopathy, as measured by diagnosis codes for non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), and procedure codes for retinopathy treatments (anti-VEGF injections, laser therapy, and vitrectomy).We analyzed a population of 269,782 patients diagnosed with T2DM between 2008 and 2015. 99,233 (37%) of patients were undergoing treatment with lipid-lowering medications. Approximately 6% of patients on lipid-lowering medications had a diagnosis code for NPDR, PDR, or DME, or a procedural code for intravitreal injections, PPV, or laser in their record following diagnosis with diabetes, compared to 6.5% of patients who did not take lipid-lowering medications (p<0.01). In adjusted time-to-event analyses, patients who took lipid-lowering medications prior to diagnosis with T2DM were less likely to progress to any retinopathy diagnosis (HR 0.60, 95% CI 0.55-0.65) and less likely to receive any treatment for retinopathy (HR 0.81, 95% CI 0.78-0.84). These findings were significant at the aggregate level, as well as at the level of individual diagnosis (NPDR HR 0.63, 95% CI 0.57-0.69; PDR HR 0.45, 95% CI 0.37-0.54; DME HR 0.39, 95% CI 0.33-0.45), and at the level of each treatment category (anti-VEGF injection HR 0.81, 95% CI 0.78-0.84; laser HR 0.62, 95% CI 0.47-0.81; vitrectomy HR 0.71, 95% CI 0.59-0.85).We find consistent evidence that patients on lipid-lowering medications are less likely to develop NPDR, PDR, or DME, and modest evidence that these patients are less likely to receive intravitreal injections of anti-VEGF medication, laser treatments, or vitrectomy. Our study validates the findings of studies that have used claims databases in East Asia in relatively homogeneous populations to estimate an association between statin use and retinopathy, replicating them in a U.S. context in a large commercial claims database.

    View details for DOI 10.1016/j.ajo.2019.05.029

    View details for PubMedID 31194953

  • A Prospective Randomized Comparative Clinical Trial to Analyze Pain and Surgical Outcomes Between Frontal Nerve Blocks and Subconjunctival Anesthesia for Conjunctival Mullerectomy Resection OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Zatezalo, C. C., Tavakoli, M., Ayala-Haedo, J., Callaway, N. F., Ko, M. J., Anagnostopoulos, A. G., Vanner, E. A., Lee, W. W. 2018; 34 (6): 575–78

    Abstract

    Conjunctival Müller's muscle resection (CMMR) is a posterior approach surgical technique to correct blepharoptosis. The purpose of this study is to compare patient-reported pain scores and surgical outcomes for patients who received 2 different anesthetic techniques during CMMR, frontal nerve block and subconjunctival injection.A prospective randomized comparative clinical trial enrolled 33 CMMR subjects from one tertiary eye center. Patients undergoing unilateral CMMR were randomized to receive either frontal nerve block or subconjunctival injection. For patients undergoing bilateral CMMR, each side was randomized to one of the injection techniques. Upper eyelid margin reflex distance was measured and recorded for each eye before and after surgery. Patients' pain scores were quantified using the Wong Baker Pain Scale. Subjects quantified their pain during, immediately after, 12 and 24 hours after surgery.Twenty-four bilateral and 9 unilateral cases were enrolled in the study. Twenty-two (92%) subjects were female, and the mean patient age was 69 ± 12 years. The mean margin reflex distance was 1.1 mm preoperatively, which increased to 3.5 and 3.6 mm 2 months postoperatively in frontal nerve block and subconjunctival injection groups, respectively (p value <0.0001). Both paired and nonpaired analyses demonstrated no significant difference in the pain score reported by the patients or the surgical outcomes between the 2 anesthesia techniques at any time during or after the surgery. There were no anesthetic-related complications.There was no statistically significant difference in pain scores or surgical outcomes in patients receiving frontal nerve block compared with those receiving subconjunctival injection during CMMR surgery.

    View details for PubMedID 29634604

  • A spectrum of regression following intravitreal bevacizumab in retinopathy of prematurity. American journal of ophthalmology Chen, T. A., Shields, R. A., Bodnar, Z. H., Callaway, N., Schachar, I. H., Moshfeghi, D. M. 2018

    Abstract

    PURPOSE: To describe an improved understanding of the regression patterns following off-label intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP).DESIGN: Retrospective cohort study. MethodsAll infants treated with IVB for Type 1 ROP at a single institution from June 2013 to March 2018 were retrospectively reviewed and the amount of retinal non-perfusion on fluorescein angiogram was calculated. ResultsOnly 3 eyes (3.3%) reached full vascular maturity in the 92 eyes of 46 patients analyzed. Of the 89 eyes not reaching maturity, 39 eyes (43.8%) had vascular arrest alone (VAA), 34 eyes (38.2%) had vascular arrest with persistent tortuosity (VAT), and 16 (18.0%) had ROP reactivation. Those eyes that reactivated were more likely to be initially classified as aggressive posterior ROP (p = 0.004) and of Asian ethnicity (p = 0.008). There were greater areas of ischemia in eyes with reactivation as compared to VAT and VAA (112.1 mm2 vs 72.5 mm2 vs. 56.6 mm2, respectively, p = 0.007). Younger gestational age at birth was found to be an independent predictor of persistent tortuosity (VAT vs. VAA) in a logistic regression model. ConclusionsIncomplete vascularization following IVB is very common and is associated with a younger gestational age at birth, Asian ethnicities, and aggressive posterior ROP. The presence of tortuosity following IVB may be indicative of persistently elevated VEGF levels and an early indicator of potential reactivation.

    View details for PubMedID 30312578

  • INTERNAL LIMITING MEMBRANE PEELING DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT Cost Analysis, Review of the Literature, and Meta-analysis RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Yannuzzi, N. A., Callaway, N. F., Sridhar, J., Smiddy, W. E. 2018; 38 (10): 2081–87
  • Retinal Anatomy and Electrode Array Position in Retinitis Pigmentosa Patients After Argus II Implantation: An International Study AMERICAN JOURNAL OF OPHTHALMOLOGY Gregori, N. Z., Callaway, N. F., Hoeppner, C., Yuan, A., Rachitskaya, A., Feuer, W., Ameri, H., Arevalo, J., Augustin, A. J., Birch, D. G., Dagnelie, G., Grisanti, S., Davis, J. L., Hahn, P., Handa, J. T., Ho, A. C., Huang, S. S., Humayun, M. S., Iezzi, R., Jayasundera, K., Kokame, G. T., Lam, B. L., Lim, J. I., Mandava, N., Montezuma, S. R., de Koo, L., Szurman, P., Vajzovic, L., Wiedemann, P., Weiland, J., Yan, J., Zacks, D. N. 2018; 193: 87–99
  • INTERNAL LIMITING MEMBRANE PEELING DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: Cost Analysis, Review of the Literature, and Meta-analysis. Retina (Philadelphia, Pa.) Yannuzzi, N. A., Callaway, N. F., Sridhar, J., Smiddy, W. E. 2018

    Abstract

    PURPOSE: To evaluate the visual and potential economic impact of primary internal limiting membrane (ILM) peeling in primary treatment of rhegmatogenous retinal detachment.METHODS: A PubMed search was performed to extract data regarding the rate of epiretinal membrane formation and the rate of secondary pars plana vitrectomy with membrane peel after repair of rhegmatogenous retinal detachment with or without ILM peeling. Data were aggregated and analyzed in a meta-analysis. This information was used to perform a cost analysis to determine the economic ramifications of primary ILM peeling.RESULTS: Six included studies compared the outcomes of eyes receiving pars plana vitrectomy for rhegmatogenous retinal detachment repair with and without primary ILM peel. The cumulative rate of epiretinal membrane formation was 29% (86/295) in the eyes without ILM peel and 3% (8/289) in the eyes with ILM peel. The cumulative rate of secondary pars plana vitrectomy/membrane peel was 16% (22/141) in the eyes without ILM peel and 0% (0/158) in the eyes with ILM peel. The weighted summary point estimate odds ratio was 0.083 (95% confidence interval 0.042-0.164), indicating a statistically significant protective effect across the 6 studies of ILM peeling and the development of epiretinal membrane. Based on published data, the average dollars saved by conducting a primary ILM peel was $615 in a facility setting and $364 in an ambulatory surgical center.CONCLUSION: Published, mainly retrospective, data suggest that primary ILM peel in rhegmatogenous retinal detachment repair may have a significant reduction in the rate of postoperative epiretinal membrane and may lessen the need for secondary pars plana vitrectomy/membrane peel. Furthermore, from an economic perspective, the reduction in the need for secondary surgery may justify the higher cost with primary ILM peel.

    View details for PubMedID 29994905

  • Retinal Anatomy and Electrode Array Position in Retinitis Pigmentosa Patients After Argus II Implantation: An International Study. American journal of ophthalmology Gregori, N. Z., Callaway, N. F., Hoeppner, C., Yuan, A., Rachitskaya, A., Feuer, W., Ameri, H., Arevalo, J. F., Augustin, A. J., Birch, D. G., Dagnelie, G., Grisanti, S., Davis, J. L., Hahn, P., Handa, J. T., Ho, A. C., Huang, S. S., Humayun, M. S., Iezzi, R. J., Jayasundera, K. T., Kokame, G. T., Lam, B. L., Lim, J. I., Mandava, N., Montezuma, S. R., Olmos de Koo, L., Szurman, P., Vajzovic, L., Wiedemann, P., Weiland, J., Yan, J., Zacks, D. N. 2018; 193: 87–99

    Abstract

    PURPOSE: To assess the retinal anatomy and array position in Argus II retinal prosthesis recipients.DESIGN: Prospective, noncomparative cohort study.METHODS: Setting: International multicenter study.PATIENTS: Argus II recipients enrolled in the Post-Market Surveillance Studies.PROCEDURES: Spectral-domain optical coherence tomography images collected for the Surveillance Studies (NCT01860092 and NCT01490827) were reviewed. Baseline and postoperative macular thickness, electrode-retina distance (gap), optic disc-array overlap, and preretinal membrane presence were recorded at 1, 3, 6, and 12months.MAIN OUTCOME MEASURES: Axial retinal thickness and axial gap along the array's long axis (a line between the tack and handle); maximal retinal thickness and maximal gap along a B-scan near the tack, midline, and handle.RESULTS: Thirty-three patients from 16 surgical sites in the United States and Germany were included. Mean axial retinal thickness increased from month 1 through month 12 at each location, but reached statistical significance only at the array midline (P= .007). The rate of maximal thickness increase was highest near the array midline (slope= 6.02, P= .004), compared to the tack (slope= 3.60, P < .001) or the handle (slope= 1.93, P= .368). The mean axial and maximal gaps decreased over the study period, and the mean maximal gap size decrease was significant at midline (P= .032). Optic disc-array overlap was seen in the minority of patients. Preretinal membranes were common before and after implantation.CONCLUSIONS: Progressive macular thickening under the array was common and corresponded to decreased electrode-retina gap over time. By month 12, the array was completely apposed to the macula in approximately half of the eyes.

    View details for PubMedID 29940167

  • Wnt-Spectrum Vitreoretinopathy Masquerading as Congenital Toxoplasmosis OPHTHALMIC SURGERY LASERS & IMAGING RETINA Callaway, N. F., Berrocal, A. M. 2018; 49 (6): 446–50

    Abstract

    Wnt-spectrum vitreoretinopathies are a group of rare inherited disorders of retinal angiogenesis that include familial exudative vitreoretinopathy/Norrie disease and are most commonly autosomal dominant; however, they can rarely present with other inheritance patterns that are more difficult to diagnose. The authors describe a case of an uncle misdiagnosed as congenital toxoplasmosis for decades and his 2-month-old nephew presenting with bilateral retinal detachments. Genetic analysis revealed an NDP gene mutation in the child and the uncle, as well as heterozygosity of the mother confirming a Wnt-spectrum vitreoretinopathy. This report describes the evaluation, diagnosis, and importance of early laser stabilization of this disorder. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:446-450.].

    View details for DOI 10.3928/23258160-20180601-10

    View details for Web of Science ID 000436108300010

    View details for PubMedID 29927473

  • Validity of the Red Reflex Exam in the Newborn Eye Screening Test Cohort. Ophthalmic surgery, lasers & imaging retina Ludwig, C. A., Callaway, N. F., Blumenkranz, M. S., Fredrick, D. R., Moshfeghi, D. M. 2018; 49 (2): 103–10

    Abstract

    The validity of the red reflex exam has yet to be tested against new methods of wide-angle imaging that may improve early detection of neonatal ocular pathology. The authors aimed to determine the validity of the pediatrician's red reflex exam using 130° wide-angle external and fundus digital imaging as a gold standard.This was a prospective cohort study of 194 healthy, term newborns enrolled in the Newborn Eye Screening Test study at Lucile Packard Children's Hospital from July 25, 2013, to July 25, 2014. Red reflex screening was performed by a pediatrician in the newborn nursery and wide-angle fundus digital imaging was performed by a neonatal intensive care unit-certified nurse. The main outcome measure was the validity of the pediatrician's red reflex exam (unweighted kappa [κ] statistic, sensitivity, specificity).Compared to no subjects with abnormal red reflex exams reported in the pediatrician's notes, 49 subjects demonstrated one or multiple ocular abnormalities on 130° wide-angle fundus imaging (κ = 0.00). The pediatrician's red reflex exam had a sensitivity of 0.0% (95% CI, 0.0%-7.3%) and specificity of 100.0% (95% CI, 97.5%-100.0%) for the detection of ocular abnormalities.This study demonstrates the ability of wide-angle fundus imaging to detect fundus abnormalities not otherwise identified by standard newborn red reflex screening prior to hospital discharge. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:103-110.].

    View details for DOI 10.3928/23258160-20180129-04

    View details for PubMedID 29443359

  • OUTCOMES OF PARS PLANA VITRECTOMY FOR MACULAR HOLE IN PATIENTS WITH UVEITIS. Retina (Philadelphia, Pa.) Callaway, N. F., Gonzalez, M. A., Yonekawa, Y., Faia, L. J., Mandelcorn, E. D., Khurana, R. N., Saleh, M. G., Lin, P., Sobrin, L., Albini, T. A. 2017

    Abstract

    PURPOSE: Inflammatory macular hole is a rare complication of uveitis, and data on surgical outcomes of closure are scarce. The purpose of this study is to evaluate the anatomical and visual outcomes of conventional pars plana vitrectomy for patients with uveitis.METHODS: Noncomparative, interventional, and consecutive case series from 6 vitreoretinal surgical centers from 2007 to 2015. Twenty eyes of 19 patients were included with 4 patients separated as viral retinitis. The primary outcome was change in best-corrected visual acuity at Month 3. Secondary outcomes were closure of the macular hole and postoperative optical coherence tomography characteristics.RESULTS: All eyes underwent conventional three-port pars plana vitrectomy with indocyanine green-assisted internal limiting membrane peeling. Mean Snellen best-corrected visual acuity improved from 20/200 to 20/63 (P = 0.01 for a difference in logarithm of the minimum angle of resolution) at Month 3. Twelve (75%) of patients achieved 2 or more lines of visual acuity improvement by postoperative Month 3. Surgery resulted in decreased epiretinal membrane (P = 0.002), intraretinal fluid (P < 0.001), subretinal fluid (P = 0.029), central subfield thickness (P < 0.001), and central cube volume (P = 0.041). Surgical intervention achieved anatomical success, as measured by macular hole closure, in 13 (81%) of patients at postoperative Month 3.CONCLUSION: Patients with inflammatory macular hole respond well to conventional surgery, with good anatomical and visual acuity outcomes.

    View details for PubMedID 29117067

  • OCT Characteristics Among Subjects Implanted with the Argus II Retinal Prosthesis System; the Argus II OCT Study Group Hoeppner, C., Callaway, N. F., Gregori, N., Lam, B. L., Ameri, H., Augustin, A. J., Ho, A., Iezzi, R., Jayasundera, T., Kokame, G., Lim, J. I., Szurman, P., Vajzovic, L., Wiedemann, P. H., Yan, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Trends in Hospitalization and Incidence Rate for Syphilitic Uveitis in the United States from 1998-2009. American journal of ophthalmology Albini, T., Callaway, N. F., Pershing, S., Wang, S. K., Moshfeghi, A. A., Moshfeghi, D. M. 2017

    Abstract

    This study evaluates the annual incidence of syphilitic uveitis in the US and trends in hospital admissions over time.Retrospective, longitudinal incidence rate analysis of the National Inpatient Sample (NIS) data from 1998 to 2009.The NIS is a de-identified, random sample dataset of inpatient hospitalizations from 46 states. The number of cases of syphilitic uveitis was defined by (1) International Classification of Diseases, 9th Revision (ICD-9) code for syphilis and uveitis or (2) ICD-9 code for syphilitic uveitis. Annual case count, incidence rate, and trend over time were calculated. Multivariate logistic regression was used to evaluate associated factors for a syphilitic uveitis diagnosis.The study included 455 310 286 hospitalizations during a 12-year study period with a mean of 37 942 524 patients annually. Syphilis and uveitis was recorded for 1861 patients (155 annually) and syphilitic uveitis was diagnosed in 204 subjects (average of 17 cases annually). There was no change in the incidence of syphilitic uveitis, using either definition, over the study period (P for trend = .46). The mean annual incidence of syphilis and uveitis was 0.0004%, or 4 per million. Syphilitic uveitis had an annual incidence of 0.000045%, or 0.45 per million. The odds of syphilitic uveitis were lower among women (odds ratio [OR] 0.40, CI 0.28-0.57) and increased with comorbid acquired immunodeficiency syndrome (OR 4.52, CI 3.01-6.79).We report the first incidence of syphilitic uveitis in the United States. Fortunately, this remains a rare condition. The results demonstrate no change in the number of inpatient admissions for syphilitic uveitis during the study period.

    View details for DOI 10.1016/j.ajo.2017.05.013

    View details for PubMedID 28549847

  • Reply re: "Diplopia and Symblepharon Following Muller's Muscle Conjunctival Resection in Patients on Long-Term Multiple Antiglaucoma Medications" OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Callaway, N. F., Sayed, M. S., Lee, W. W. 2017; 33 (2): 152

    View details for DOI 10.1097/IOP.0000000000000881

    View details for Web of Science ID 000396014700033

    View details for PubMedID 28272172

  • What colour are newborns' eyes? Prevalence of iris colour in the Newborn Eye Screening Test (NEST) study. Acta ophthalmologica Ludwig, C. A., Callaway, N. F., Fredrick, D. R., Blumenkranz, M. S., Moshfeghi, D. M. 2016; 94 (5): 485-488

    Abstract

    This study aims to assess the birth prevalence of iris colour among newborns in a prospective, healthy, full-term newborn cohort.The Newborn Eye Screening Test (NEST) study is a prospective cohort study conducted at Lucile Packard Children's Hospital at Stanford University School of Medicine. A paediatric vitreoretinal specialist (DMM) reviewed images sent to the Byers Eye Institute telemedicine reading centre and recorded eye colour for every infant screened. Variables were graphed to assess for normality, and frequencies per subject were reported for eye colour, sex, ethnicity and race.Among 192 subjects screened in the first year of the NEST study with external images of appropriate quality for visualization of the irides, the birth prevalence of iris colour was 63.0% brown, 20.8% blue, 5.7% green/hazel, 9.9% indeterminate and 0.5% partial heterochromia. The study population was derived from a quaternary care children's hospital. We report the birth prevalence of iris colour among full-term newborns in a diverse prospective cohort.The study demonstrates a broad range of iris colour prevalence at birth with a predominance of brown iris coloration. Future studies with the NEST cohort will assess the change in iris colour over time and whether the frequencies of eye colour change as the child ages.

    View details for DOI 10.1111/aos.13006

    View details for PubMedID 27061128

  • Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study. Ophthalmology Callaway, N. F., Ludwig, C. A., Blumenkranz, M. S., Jones, J. M., Fredrick, D. R., Moshfeghi, D. M. 2016; 123 (5): 1043-1052

    Abstract

    To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.Prospective cohort study at Stanford University School of Medicine.All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant.Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

    View details for DOI 10.1016/j.ophtha.2016.01.004

    View details for PubMedID 26875004

  • Retinal and Optic Nerve Hemorrhages in the Newborn Infant OPHTHALMOLOGY Callaway, N. F., Ludwig, C. A., Blumenkranz, M. S., Jones, J. M., Fredrick, D. R., Moshfeghi, D. M. 2016; 123 (5): 1043-1052

    Abstract

    To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.Prospective cohort study at Stanford University School of Medicine.All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant.Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

    View details for DOI 10.1016/j.ophtha.2016.01.004

    View details for Web of Science ID 000375942300026

  • THINKING LEAN: Improving Vitreoretinal Clinic Efficiency by Decentralizing Optical Coherence Tomography. Retina (Philadelphia, Pa.) Callaway, N. F., Park, J. H., Maya-Silva, J., Leng, T. 2016; 36 (2): 335-341

    Abstract

    Patients in vitreoretinal clinic have long wait times that could be reduced by improving the efficiency of patient flow. The objective of this study was to determine whether decentralizing optical coherence tomography (OCT) into the technicians' room would reduce patient wait times and improve clinic efficiency.Randomized, single-center, clinical trial for 1 month without follow-up at Byers Eye Institute at Stanford. Subjects were return patients of three vitreoretinal specialists in March 2013. The intervention consisted of decentralizing OCT devices from the central photography suite into the technician screening rooms. Total clinic times and total wait times throughout subject appointments were recorded and compared with the control group (centralized photography suite). Secondary outcomes included frequency of injections, procedures, and primary diagnosis codes.Decentralized OCT reduced patient wait times by 74% and reduced total clinic appointment time by 36%. Subjects in the intervention arm experienced significantly reduced total wait time (mean difference = 15.9 minutes, P < 0.0001) and total time in clinic (mean difference = 22.9 minutes, P < 0.0001).Decentralized OCT represents the application of lean process concepts to improve vitreoretinal clinic efficiency. Decentralized OCT reduced both the total wait time and total time in clinic for return patients in a vitreoretinal clinic.

    View details for DOI 10.1097/IAE.0000000000000712

    View details for PubMedID 26815931

  • Newborn Retinal Hemorrhages: One-year Results of the Newborn Eye Screening Test (NEST) Study Callaway, N., Ludwig, C., Moshfeghi, D. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015
  • Fundus Hemorrhages in a Term Newborn and Preterm Population: Does Examination Timing Influence Findings? Moshfeghi, D. M., Ludwig, C. A., Callaway, N. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015
  • Validity of the Newborn Eye Exam in the Newborn Eye Screening Test (NEST) Cohort Ludwig, C. A., Callaway, N., Moshfeghi, D. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015
  • SUNDROP: six years of screening for retinopathy of prematurity with telemedicine. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Wang, S. K., Callaway, N. F., Wallenstein, M. B., Henderson, M. T., Leng, T., Moshfeghi, D. M. 2015; 50 (2): 101-106

    Abstract

    To report the 6-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) initiative in the context of telemedicine screening initiatives for retinopathy of prematurity (ROP).A retrospective analysis.Premature newborns requiring ROP screening at 6 neonatal intensive care units from December 1, 2005, to November 30, 2011.Infants were evaluated via remote retinal photography by an ROP specialist. A total of 608 preterm infants meeting ROP examination criteria were screened with the RetCam II/III (Clarity Medical Systems, Pleasanton, Calif.). Primary outcomes were treatment-warranted ROP (TW-ROP) and adverse anatomical events.During the 6 years, 1216 total eyes were screened during 2169 examinations, generating 26 970 retinal images, an average of 3.56 examinations and 44.28 images per patient. Twenty-two (3.6%) of the infants screened met criteria for TW-ROP. Compared with bedside binocular ophthalmoscopy, remote interpretation of RetCam II/III images had a sensitivity of 100%, specificity of 99.8%, positive predicative value of 95.5%, and negative predicative value of 100% for the detection of TW-ROP. No adverse anatomical outcomes were observed for any enrolled patient.The 6-year results for the SUNDROP telemedicine initiative were highly favourable with respect to diagnostic accuracy. Telemedicine appears to be a safe, reliable, and cost-effective complement to the efforts of ROP specialists, capable of increasing patient access to screening and focusing the resources of the current ophthalmic community on infants with potentially vision-threatening disease.

    View details for DOI 10.1016/j.jcjo.2014.11.005

    View details for PubMedID 25863848

  • Ambulatory surgery center utilization by vitreoretinal surgeons: 1999-2011. Ophthalmic surgery, lasers & imaging retina Vaziri, K., Moshfeghi, D. M., Hernandez-Boussard, T., Callaway, N. F., Moshfeghi, A. A. 2015; 46 (3): 355-361

    Abstract

    To evaluate the utilization rates of ambulatory surgery centers (ASCs) in the state of Florida for vitreoretinal, cataract, and glaucoma surgical procedures over a 13-year period from 1999 through 2011.Retrospective analysis utilizing the State Ambulatory Surgery Databases (SASD) for Florida from 1999 through 2011. ICD-9 codes for vitreoretinal, cataract, and glaucoma procedures were queried. Joinpoint regression was used to calculate average annual percent change (APC) in ASC utilization by these procedures over the 13-year study period and also separately for the years 2007 to 2011.From 1999 through 2011, APC in ambulatory surgery center utilization was +26.4% (P = .0039) for vitreoretinal, +21.3% (P = .012) for cataract, and +20.9% (P = .0063) for glaucoma surgery. The APC from 2007 through 2011 was -1.2% for vitreoretinal (P = .47), -9.2% for cataract (P = .0039), and -17.3% for glaucoma surgery (P = .008).A significant overall increase in ASC utilization by vitreoretinal, cataract, and glaucoma surgeons over the study period was seen; however, the most recent 5-year data show that these trends may have begun to reverse. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:355-361.].

    View details for DOI 10.3928/23258160-20150323-10

    View details for PubMedID 25856823

  • Mediastinal Kaposiform Hemangioendothelioma and Kasabach-Merritt Phenomenon in a Patient with no Skin Changes and a Normal Chest CT. Pediatric hematology and oncology Wallenstein, M. B., Hole, M. K., McCarthy, C., Fijalkowski, N., Jeng, M., Wong, W. B. 2014; 31 (6): 563-567

    Abstract

    A 16-month-old previously healthy boy was admitted to the hospital with respiratory distress and thrombocytopenia. Initial workup demonstrated large pleural and pericardial effusions. The patient had no cutaneous abnormality on physical examination, and his initial chest CT (computed tomography) was nondiagnostic. He required multiple platelet transfusions, chest tube placement, and pericardiocentesis. Sixteen days after admission, a chest MRI (magnetic resonance imaging) revealed a large infiltrative mass of the superior mediastinum, consistent with kaposiform hemangioendothelioma (KHE). The patient's thrombocytopenia was due to associated Kasabach-Merritt phenomenon (KMP). The patient now has complete resolution of KMP after medical treatment with prednisolone, aminocaproic acid, vincristine, and aspirin.

    View details for DOI 10.3109/08880018.2013.825356

    View details for PubMedID 24047193

  • Gender differences in compensation in academic medicine: the results from four neurological specialties within the University of California Healthcare System SCIENTOMETRICS Henderson, M. T., Fijalkowski, N., Wang, S. K., Maltenfort, M., Zheng, L. L., Ratliff, J., Moshfeghi, A. A., Moshfeghi, D. M. 2014; 100 (1): 297-306
  • Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): five years of screening with telemedicine. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wang, S. K., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2014; 45 (2): 106-113

    Abstract

    To report the 5-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.Infants requiring retinopathy of prematurity (ROP) screening at six neonatal intensive care units from December 1, 2005, to November 30, 2010, were evaluated with remote retinal photography by an ROP specialist. Every infant received outpatient binocular indirect ophthalmoscope examinations until termination criteria were achieved or until treatment. Outcomes were treatment-warranted ROP (TW-ROP, ETROP type 1) and adverse anatomical events.Five hundred eleven infants (1,022 eyes) were screened. Fifteen infants had TW-ROP and underwent laser photocoagulation. The TW-ROP cohort had significantly lower birth weight and gestational age (both P < .001). No patient progressed to adverse anatomical outcomes and no case of TW-ROP was missed. Tele-medicine had 100% sensitivity, 99.8% specificity, 93.8% positive predictive value, and 100% negative predictive value for detection of TW-ROP.Telemedicine demonstrates high diagnostic accuracy for detection of TW-ROP and can complement ROP screening. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:106-113.].

    View details for DOI 10.3928/23258160-20140122-01

    View details for PubMedID 24444469

  • Active aspiration of suprachoroidal hemorrhage using a guarded needle. Ophthalmic surgery, lasers & imaging retina Mandelcorn, E. D., Kitchens, J. W., Fijalkowski, N., Moshfeghi, D. M. 2014; 45 (2): 150-152

    Abstract

    To describe a novel technique using a guarded needle to drain suprachoroidal hemorrhage.A guarded needle is used to drain suprachoroidal hemorrhage under direct microscope visualization. A scleral buckling sleeve is used to create a guarded 26-gauge needle to avoid over-penetration of the needle beyond the suprachoroidal space. Active extrusion can be used to drain suprachoroidal blood.The authors report two cases in which active aspiration using a guarded needle was successful in draining suprachoroidal hemorrhage without complications. In both cases, the vitreous cavity could be restored, allowing for subsequent pars plana vitrectomy.The technique of active aspiration using a guarded needle optimizes surgeon control of suprachoroidal hemorrhage drainage and also has the added benefit of easy transition to secondary vitrectomy after drainage has been completed. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:150-152.].

    View details for DOI 10.3928/23258160-20140306-09

    View details for PubMedID 24635157

  • Parallel rarebits: A novel, large-scale visual field screening method. Clinical & experimental optometry : journal of the Australian Optometrical Association Lin, S. R., Fijalkowski, N., Lin, B. R., Li, F., Singh, K., Chang, R. T. 2014; 97 (6): 528–33

    Abstract

    Rarebit perimetry (RBP) is a computer-based perimetric testing program with sensitivity and specificity for detection of visual field defects comparable to traditional automated perimetry. To make large-scale screening more efficient, we developed a parallel rarebit perimetric method to screen groups of subjects simultaneously. We then used this method to report the mean hit rate (MHR) among subjects aged 13 to 19 years.Rarebit perimetry was installed on computers in an existing school computer laboratory. All subjects provided medical and demographic information and underwent a basic visual examination. Testing instructions were provided to groups of up to 35 subjects and rarebit perimetry was subsequently administered. Two or three test supervisors answered questions and ensured that subjects were well aligned with their test screens. Mean hit rate, reaction times, error rates and testing time were calculated, and time estimates for rarebit, frequency doubling perimetry and Humphrey 24-2 Swedish Interactive Thresholding Algorithm (SITA) fast test were compared.A total of 364 rarebit perimetric tests were conducted on 182 subjects. Of these, 154 subjects met our inclusion criteria for the reference range (three testing errors or less and visual acuity 6/9 or better). The average mean hit rate was 94.3 ± 4.63 per cent. Screening of 500 subjects using this parallel rarebit perimetric method would require approximately nine hours, which is far less than an estimated 77 hours required for frequency doubling perimetry C-20 screening tests or an estimated 127 hours required for Humphrey 24-2 SITA fast tests.Using our methods, rarebit perimetry can be administered in parallel to groups of subjects. The mean hit rate was comparable to that reported in previously published studies. This parallel technique may improve the efficiency of large-scale visual field screenings.

    View details for PubMedID 25331077

  • Academic productivity and its relationship to physician salaries in the University of California Healthcare System. Southern medical journal Fijalkowski, N., Zheng, L. L., Henderson, M. T., Moshfeghi, A. A., Maltenfort, M., Moshfeghi, D. M. 2013; 106 (7): 415-421

    Abstract

    To evaluate whether physicians with higher academic productivity, as measured by the number of publications in Scopus and the Scopus Hirsch index (h-index), earn higher salaries.This was a cross-sectional study. Participants were ophthalmologists, otolaryngologists, neurosurgeons, and neurologists classified as "top earners" (>$100,000 annually) within the University of California (UC) healthcare system in 2008. Bibliometric searches on Scopus were conducted to retrieve the total number of publications and Hirsch indices (h-index), a measure of academic productivity. The association between the number of publications and h-index on physicians' total compensation was determined with multivariate regression models after controlling for the four specialties (ophthalmology, otolaryngology, neurosurgery, and neurology), the five institutions (UC San Francisco, UC Los Angeles, UC San Diego, UC Irvine, and UC Davis), and academic rank (assistant professor, associate professor, and professor).The UC healthcare system departments reported 433 faculty physicians among the four specialties, with 71.6% (n = 310) earning more than $100,000 in 2008 and classifying as top earners. After controlling for the specialty, institution, and ranking, there was a significant association between the number of publications on salary (P < 0.000001). Scopus number of publications and h-index were correlated (P < 0.001). Scopus h-index was of borderline significance in predicting physician salary (P = 0.12). Physicians with higher Scopus publications had higher total salaries across all four specialties. Every 10 publications were associated with a 2.40% increase in total salary after controlling for specialty, institution, rank, and chair.Ophthalmologists, otolaryngologists, neurosurgeons, and neurologists in the UC healthcare system who are more academically productive receive greater remuneration.

    View details for DOI 10.1097/SMJ.0b013e31829b9dae

    View details for PubMedID 23820322

  • Validation of a grading system for lateral nasal wall insufficiency. Allergy & rhinology (Providence, R.I.) Tsao, G. J., Fijalkowski, N., Most, S. P. 2013; 4 (2): e66-8

    Abstract

    This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.

    View details for DOI 10.2500/ar.2013.4.0054

    View details for PubMedID 24124639

  • Ambulatory Surgery Center (ASC) Utilization by three Ophthalmic Sub-specialists: 1999-2011 Vaziri, K., Moshfeghi, A., Hernandez-Boussard, T., Fijalkowski, N., Moshfeghi, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013
  • Decreased membrane complement regulators in the retinal pigmented epithelium contributes to age-related macular degeneration JOURNAL OF PATHOLOGY Ebrahimi, K. B., Fijalkowski, N., Cano, M., Handa, J. T. 2013; 229 (5): 729-742

    Abstract

    Dysregulated complement is thought to play a central role in age-related macular degeneration (AMD) pathogenesis, but the specific mechanisms have yet to be determined. In maculae of AMD specimens, we found that the complement regulatory protein, CD59, was increased in regions of uninvolved retinal pigmented epithelium (RPE) of early AMD, but decreased in the RPE overlying drusen and in geographic atrophy, an advanced form of AMD. While CD46 immunostaining was basolaterally distributed in the RPE of unaffected controls, it was decreased in diseased areas of early AMD samples. Since oxidized low-density lipoproteins (oxLDL) collect in drusen of AMD and are a known complement trigger, we treated ARPE-19 cells with oxLDL and found that cellular CD46 and CD59 proteins were decreased by 2.9- and nine-fold (p < 0.01), respectively. OxLDLs increased complement factor B mRNA and Bb protein, but not factor D, I or H. OxLDLs increased C3b, but not C3a, C5 or C5b-9. C5b-9 was increased by 27% (p < 0.01) when the medium was supplemented with human serum, which was sufficient to induce poly(ADP-ribose) polymerase cleavage, a marker of apoptosis. The decreased levels of CD46 and CD59 were in part explained by their release in exosomal and apoptotic membranous particles. In addition, CD59 was partially degraded through activation of IRE1?. Collectively, these results suggest that a combination of impaired complement regulators results in inadequately controlled complement by the RPE in AMD that induces RPE damage.

    View details for DOI 10.1002/path.4128

    View details for Web of Science ID 000316326100009

    View details for PubMedID 23097248

  • Fever Literacy and Fever Phobia CLINICAL PEDIATRICS Wallenstein, M. B., Schroeder, A. R., Hole, M. K., Ryan, C., Fijalkowski, N., Alvarez, E., Carmichael, S. L. 2013; 52 (3): 254-259

    Abstract

    To identify the percentage of parents who define the threshold for fever between 38.0°C and 38.3°C, which has not been reported previously, and to describe parental attitudes toward fever and antipyretic use.Thirteen-question survey study of caregivers.Overall, 81% of participants defined the threshold for fever as <38.0°C, 0% correctly defined fever between 38.0°C and 38.3°C, and 19% defined fever as >38.3°C. Twenty percent of children brought to clinic for a chief complaint of fever were never truly febrile. Ninety-three percent of participants believed that high fever can cause brain damage. For a comfortable-appearing child with fever, 89% of caregivers reported that they would give antipyretics and 86% would schedule a clinic visit.Our finding that 0% of parents correctly defined fever is both surprising and unsettling, and it should inform future discussions of fever between parents and clinicians.

    View details for DOI 10.1177/0009922812472252

    View details for Web of Science ID 000317849900007

    View details for PubMedID 23349363

  • The importance of keeping a broad differential in retina clinic: the spectrum of ophthalmic disease seen by retina specialists in a tertiary outpatient clinic setting. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Pershing, S., Moshfeghi, D. M. 2013; 44 (2): 133-139

    Abstract

    To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States.Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011.Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%).Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.

    View details for DOI 10.3928/23258160-20130313-06

    View details for PubMedID 23510039

  • Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Four-years of Screening with Telemedicine CURRENT EYE RESEARCH Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2013; 38 (2): 283-291

    Abstract

    To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP).A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes.The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome.The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.

    View details for DOI 10.3109/02713683.2012.754902

    View details for Web of Science ID 000314900400008

    View details for PubMedID 23330739

  • More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's Isotopic response in an Asian female More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's Isotopic response in an Asian female Fijalkowski N, Wysong A, Kuu P, Chang A 2012; 3 (2): 24-28
  • Advanced Glycation Endproduct Changes to Bruch's Membrane Promotes Lipoprotein Retention by Lipoprotein Lipase AMERICAN JOURNAL OF PATHOLOGY Cano, M., Fijalkowski, N., Kondo, N., Dike, S., Handa, J. 2011; 179 (2): 850-859

    Abstract

    Lipoprotein particles accumulate in Bruch's membrane before the development of basal deposits and drusen, two histopathologic lesions that define age-related macular degeneration (AMD). We therefore, sought to determine which molecules could participate in lipoprotein retention. Wild-type or lipoprotein lipase-deficient mice were injected with low-dose D-galactose or PBS subcutaneously for 8 weeks to induce advanced glycation endproduct (AGE) formation. Some mice were also injected with the AGE breaker phenacylphiazolium bromide and D-galactose. Rhodamine-labeled low-density lipoproteins were injected into mice, and the fluorescence was measured up to 72 hours later. AGEs, proteoglycans, and other lipid-retaining molecules were evaluated by IHC. Lipoprotein lipase distribution was assessed in AMD samples by IHC. D-galactose-treated mice retained lipoproteins in the retinal pigment epithelial and Bruch's membrane to a greater extent than either PBS- or phenacylphiazolium bromide/D-galactose-treated mice at 24 and 72 hours after injection (P ? 0.04). Immunolabeling for carboxymethyllysine, biglycan, and lipoprotein lipase was found in D-galactose-treated mice only. Mice deficient for lipoprotein lipase treated with D-galactose did not retain lipoproteins to any measureable extent. Human AMD samples had lipoprotein lipase labeling within drusen, basal deposits, and the choroid. Mice treated with D-galactose to induce AGE formation in Bruch's membrane retain intravenously injected lipoproteins. Our results suggest that lipoprotein retention in Bruch's membrane is mediated by lipoprotein lipase.

    View details for DOI 10.1016/j.ajpath.2011.04.010

    View details for Web of Science ID 000298307200031

    View details for PubMedID 21801873