Sohan Singh Hayreh

University of Iowa Children's Hospital, Iowa City, Iowa, United States

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Publications (263)898.12 Total impact

  • Sohan S Hayreh · M Bridget Zimmerman
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    ABSTRACT: To investigate systematically various fundus changes in branch retinal arteriolar occlusion (BRAO) and their natural history. The study comprised a cohort of 123 consecutive patients (135 eyes) with BRAO. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations, and at initial visit fluorescein fundus angiography. Probability estimates of retinal infarct still present were 89% 1 week after BRAO onset, 69% after 2 weeks, 67% after 3 weeks, 34% after 1 month, and 13% after 3 months. Optic disk pallor in the involved region developed in 21% within 1 month from onset, in 42% by 2 months, and in 65% by 3 months. Retinal arteriolar attenuation developed in 19% within 1 month from onset, and in 28% by 6 months. Arteriolar sheathing developed in 19% within 1 month and 25% within 12 months. Arteriolar emboli were found in 58%; 65% of those were at initial visit, in BRAO seen within 1 week of onset. Most common cause of BRAO is embolism from the heart or carotid arteries; emboli usually get impacted at the arteriolar bifurcation. Migration and disappearance of retinal emboli is a common finding. Evolution of the retinal and optic disk changes is described.
    Retina (Philadelphia, Pa.) 08/2015; DOI:10.1097/IAE.0000000000000585 · 3.18 Impact Factor
  • Sohan Singh Hayreh · M Bridget Zimmerman
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    ABSTRACT: To investigate systematically the retinal changes in branch retinal vein occlusion (BRVO) and their natural history. The study comprised 214 consecutive patients with BRVO (144 major BRVO and 72 macular BRVO eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Initially, retinal hemorrhages were moderate to severe in the perifovea and macula in at least 65% in major and 52% in macular BRVO; at the fovea, it was 51% in major and 36% in macular BRVO. Initially, macular edema was more marked in major BRVO than in macular BRVO (P = 0.007). Major BRVO had a significantly higher rate of development of serous macular detachment (P = 0.002), epiretinal membrane (P = 0.008), serous retinal detachment (P = 0.002), perivenous sheathing (P < 0.0001), optic disk pallor (P < 0.0001), and lipid deposit (P < 0.0001) compared with macular BRVO. Retinal and disk neovascularization was seen only in major BRVO. The time to resolution of BRVO was significantly longer for major BRVO compared with macular BRVO (P = 0.0002). Major and macular BRVOs are two distinct clinical entities. Initial and final fundus findings in the two types differ markedly.
    Retina (Philadelphia, Pa.) 01/2015; DOI:10.1097/IAE.0000000000000418 · 3.18 Impact Factor
  • Sohan Singh Hayreh
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    ABSTRACT: Amaurosis fugax is a transient brief blindness, dimming, fogging, or blurring of vision, lasting from a few seconds to minutes or even hours, depending upon the etiology. It has also been called transient visual obscuration or blackout. It occurs in many ocular vascular occlusive disorders, i.e., central retinal artery occlusion, branch retinal arteriole occlusion, central retinal vein occlusion alone, central retinal vein occlusion with cilioretinal artery occlusion, hemicentral retinal vein occlusion, branch retinal vein occlusion, ocular ischemic syndrome, and both non-arteritic and arteritic anterior ischemic optic neuropathy. There are a few reports about amaurosis fugax in giant cell arteritis [1–7]. Amaurosis fugax may be the presenting symptom and, if so, always requires urgent evaluation. No comprehensive study on amaurosis fugax in ocular vascular occlusive disorders had been published and no detailed discussion of its pathogeneses in those disorders. Therefore, I conducted a comprehensive, systematic study in a large cohort of patients dealing with prevalence of amaurosis fugax in central retinal artery occlusion, branch retinal arteriole occlusion, central retinal vein occlusion alone, central retinal vein occlusion with cilioretinal artery occlusion, hemicentral retinal vein occlusion, branch retinal vein occlusion, ocular ischemic syndrome, both non-arteritic and arteritic anterior ischemic optic neuropathy, and giant cell arteritis [8]. Various features of all these diseases are discussed in previous chapters. In this chapter, I shall discuss only the amaurosis fugax features in them. The findings of my study are discussed in detail elsewhere [8] and following are the main features.
    Ocular Vascular Occlusive Disorders, 01/2015: pages 839-851; , ISBN: 978-3-319-12780-4
  • Sohan Singh Hayreh
    Indian Journal of Ophthalmology 10/2014; 62(10):1025-1027. DOI:10.4103/0301-4738.146019 · 0.93 Impact Factor
  • Sohan Singh Hayreh · M Bridget Zimmerman
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    ABSTRACT: Purpose: To investigate systematically the retinal and optic disk changes in central retinal vein occlusion (CRVO) and their natural history. Methods: This study comprised 562 consecutive patients with CRVO (492 nonischemic [NI-CRVO] and 89 ischemic CRVO [I-CRVO] eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Results: Retinal and subinternal limiting membrane hemorrhages and optic disk edema in I-CRVO were initially more marked (P < 0.0001) and took longer to resolve (P < 0.015) than that in NI-CRVO. Initially, macular edema was more marked in I-CRVO than that in NI-CRVO (P < 0.0001) but did not significantly differ in resolution time (P = 0.238). Macular retinal epithelial pigment degeneration, serous macular detachment, and retinal perivenous sheathing developed at a higher rate in I-CRVO than that in NI-CRVO (P < 0.0001). Ischemic CRVO had more retinal venous engorgement than NI-CRVO (P = 0.003). Fluorescein fundus angiography showed significantly more fluorescein leakage, retinal capillary dilatation, capillary obliteration, and broken capillary foveal arcade (P < 0.0001) in I-CRVO than NI-CRVO. Resolution time of CRVO was longer for I-CRVO than NI-CRVO (P < 0.0001). Conclusion: Characteristics and natural history of fundus findings in the two types of CRVO are different.
    Retina (Philadelphia, Pa.) 07/2014; 35(1). DOI:10.1097/IAE.0000000000000256 · 3.18 Impact Factor
  • Sohan Singh Hayreh
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    ABSTRACT: Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye.
    Progress in Retinal and Eye Research 04/2014; 41(1). DOI:10.1016/j.preteyeres.2014.04.001 · 9.90 Impact Factor
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    Sohan Singh Hayreh
    Expert Review of Ophthalmology 01/2014; 2(6). DOI:10.1586/17469899.2.6.889
  • Sohan Singh Hayreh · M. Bridget Zimmerman
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    ABSTRACT: Branch retinal vein occlusion (BRVO) is a common, visually disabling disease. It was first described by Leber in 1877 [1]. Since then, an enormous amount of literature on its various aspects has been accumulated. A review of that is often confusing, unfortunately, because of one major problem: the majority of the studies have combined all types of retinal vein occlusions into one group, rather than separately describing the findings on BRVO specifically. I will discuss BRVO to provide the latest information on this important disease where available.
    01/2014; 132(1):13. DOI:10.1001/jamaophthalmol.2013.5515
  • Sohan Singh Hayreh · M Bridget Zimmerman
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    ABSTRACT: In patients with bilateral sequential nonarteritic anterior ischemic optic neuropathy (NA-AION), previous studies have reported conflicting results on whether or not the visual outcome is similar in the 2 eyes. The authors investigated this issue in 174 consecutive patients with bilateral NA-AION. At the first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation. Visual evaluation was performed by recording Snellen visual acuity and visual fields with kinetic perimetry. The same ophthalmic evaluation was performed at each follow-up visit. The data on the difference in visual acuity, which was converted to logarithm of the minimum angle of resolution (logMAR) form, and visual field defects between the first eye and the second eye of each patient at the initial visit and at the final follow-up were analyzed. A similar subgroup analysis was performed on patients treated with systemic corticosteroids. At presentation, both initial visual acuity and visual field defects were significantly better in the second eye than in the first eye (P < 0.0001). As a predictor of initial visual acuity in the second eye, the initial logMAR of the first eye only explained 7.0% (R) of the total variation in the initial logMAR of the second eye. Intraclass correlation (ICC) between the paired eyes was 0.19 (95% confidence interval [CI], 0.04-0.33), indicating poor agreement. The absolute difference in initial visual field grade between the 2 eyes was 0.5 or greater in 78%. The weighted kappa statistic for agreement between visual field defects of the 2 eyes was 0.27 (95% CI, 0.19-0.36), indicating poor agreement. At the final follow-up, a difference in logMAR of at least 0.3 between the paired eyes was found in 38% of the steroid-treated group and 45% of the untreated group. For visual field grade, there was a difference of at least 0.5 in 70% of those who were treated with steroid and in 76% of those not treated. The ICC for logMAR and weighted kappa for visual field grade for the paired eyes was below 0.60 for both the groups. The findings indicated poor agreement between the 2 eyes. The results show that in patients with bilateral sequential NA-AION, there are large differences between the visual acuity and visual field findings of paired eyes at initial and final visit, whether or not treated with steroids. It is not possible to predict the visual acuity and visual field grade in the second eye based solely on the first eye.
    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 07/2013; 33(4). DOI:10.1097/WNO.0b013e31829b5d03 · 1.81 Impact Factor
  • Sohan Singh Hayreh
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    ABSTRACT: Ischemic optic neuropathy is of two types: anterior and posterior. Non-arteritic anterior ischemic optic neuropathy (NA-AION) is the most common type of ischemic optic neuropathy. There are three major misconceptions about NA-AION: (1) that its pathogenesis is not known, (2) that NA-AION and ischemic cerebral stroke are similar in nature, pathogenetically and in management, and (3) that there is no treatment. All these misconceptions are based on lack of in-depth knowledge of the subject. They are discussed in the light of our current scientific knowledge. The pathogenesis of NA-AION is known but is highly complex. NA-AION and ischemic cerebral stroke are very different clinical entities, pathogenetically and in management. Aspirin has no beneficial effect. Corticosteroid therapy during the initial stages can be beneficial. To reduce the risk of development of NA-AION in the other eye or of further visual loss in the same eye, it is essential to reduce as many risk factors as possible. Management of arteritic anterior ischemic optic neuropathy and of posterior ischemic optic neuropathy is discussed.
    Albrecht von Graæes Archiv für Ophthalmologie 07/2013; 251(8). DOI:10.1007/s00417-013-2399-z · 2.33 Impact Factor
  • Sohan S Hayreh · M Bridget Zimmerman
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    ABSTRACT: PURPOSE:: To investigate systematically the prevalence of amaurosis fugax (AF) in various ocular vascular occlusive disorders individually and to discuss the pathogeneses of each. METHODS:: The study comprised patients with central retinal artery occlusion (271 eyes), branch retinal artery occlusion (169 eyes), ocular ischemic syndrome (39 eyes), central retinal vein occlusion (864 eyes), hemi-central retinal vein occlusion (67 eyes), branch retinal vein occlusion (285 eyes), nonarteritic anterior ischemic optic neuropathy (946 eyes), and giant cell arteritis with visual loss (147 eyes). At first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation and systemic evaluation. RESULTS:: Prevalence of AF was 12.18% in central retinal artery occlusion, 14.20% in branch retinal artery occlusion, 15.38% in ocular ischemic syndrome, 4.86% in central retinal vein occlusion, 37.84% in central retinal vein occlusion with cilioretinal artery occlusion, 13.43% in hemi-central retinal vein occlusion, 0.35% in branch retinal vein occlusion, and 2.54% in nonarteritic anterior ischemic optic neuropathy. In giant cell arteritis, 32.4% of patients with ocular involvement had a history of AF or 26.5% of the involved eyes. Amaurosis fugax in central retinal artery occlusion, branch retinal artery occlusion, and nonarteritic anterior ischemic optic neuropathy is mostly because of transient embolism. The pathogenesis of AF in each ocular vascular occlusive disorder is discussed. CONCLUSION:: Prevalence and pathogenesis of AF in various ocular vascular occlusive disorders varies widely. Amaurosis fugax may be the presenting symptom in these disorders and that always requires urgent evaluation.
    Retina (Philadelphia, Pa.) 04/2013; 34. DOI:10.1097/IAE.0b013e31829234b5 · 3.18 Impact Factor
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    Jost B Jonas · Sohan S Hayreh · Yong Tao
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    ABSTRACT: Objective: To investigate the clinicopathological correlation of parapapillary atrophy. Materials and Methods: The study included 16 eyes of rhesus monkeys (Macaca mulatta) – 4 eyes with experimental glaucoma, 11 eyes after experimental temporary occlusion of the central retinal artery, and 1 normal eye. On histological sections, we measured zones with different histological characteristics. On fundus photographs, alpha zone and beta zone of parapapillary atrophy were measured and correlated with the histological data. Results: The size of the clinical alpha zone of parapapillary atrophy was significantly correlated with the size of the histological region with irregularities of the retinal pigment epithelium (P = 0.05; correlation coefficient r = 0.49) and with the size of the histological region with a decreased density of retinal photoreceptors (P = 0.01; r = 0.60). The size of clinical beta zone of parapapillary atrophy significantly correlated with the size of the histological region with complete loss of the retinal pigment epithelium (P <0.001; r = 0.91), with the size of the histological zone with a complete loss of photoreceptors (P <0.001; r = 0.81), and with the size of the histological zone with a closed choriocapillaris (P <0.001; r = 0.89). Conclusions: The clinically seen alpha zone of parapapillary atrophy correlates with histological parapapillary irregularities of the retinal pigment epithelium and decreased density of retinal photoreceptors. The clinically seen beta zone of parapapillary atrophy correlates with histological complete loss of the retinal pigment epithelium and of the photoreceptors, and a closure of the choriocapillaris.
    Indian Journal of Ophthalmology 04/2013; 62(2). DOI:10.4103/0301-4738.111216 · 0.93 Impact Factor
  • Sohan Singh Hayreh · Valérie Biousse
    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 09/2012; 32(3):278-87. DOI:10.1097/WNO.0b013e3182688218 · 1.81 Impact Factor
  • Sohan Singh Hayreh · M Bridget Zimmerman · Patricia A Podhajsky
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    ABSTRACT: : To investigate the effect of cup to disk (C/D) ratio in various types of retinal vein occlusion (RVO) on the severity of retinopathy, visual outcome, and resolution of retinopathy and validity of the concept of the "compartment syndrome" in RVO. : The study comprised 1,222 consecutive eyes (768 central retinal vein occlusion [CRVO], 183 hemi-CRVO, and 271 branch retinal vein occlusion). Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. : Compared to sex-matched and age-matched normal eyes, C/D ratio ≥0.5 was significantly more common in all CRVOs and hemi-CRVO eyes but not in branch retinal vein occlusion. Retinal hemorrhages were significantly more severe in nonischemic CRVO with C/D ratio ≥0.5 compared to those with no or small cup, but no difference was found in hemi-CRVO and branch RVO. In ischemic CRVO, moderate hemorrhages were more with C/D ≥0.5 but severe hemorrhages were more with no cup. In various types of RVO, there was no significant association of C/D ratio with macular edema, retinopathy resolution, visual acuity, and visual field defect. : The findings of our study contradict the concept that the "compartment syndrome" plays any role in the prevalence of various types of RVO or in their severity, the resolution of retinopathy, or the visual outcome. This indicates that the advocated procedure of radial optic neurotomy, based on the compartment syndrome, is not a logical treatment for CRVO.
    Retina (Philadelphia, Pa.) 08/2012; 32(10):2108-18. DOI:10.1097/IAE.0b013e31825620f2 · 3.18 Impact Factor
  • Sohan Singh Hayreh
    Albrecht von Graæes Archiv für Ophthalmologie 05/2012; 251(3). DOI:10.1007/s00417-012-2062-0 · 2.33 Impact Factor
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    ABSTRACT: To evaluate changes in cup/disc (C/D) diameter ratios and parapapillary atrophy in patients with non-arteritic anterior ischemic optic neuropathy (NA-AION), using morphometric methods. The clinical non-interventional study included 157 patients with unilateral or bilateral NA-AION. Optic disc photographs taken from both eyes at the end of follow-up were morphometrically examined. Follow-up was 86.3±70.3 months. Horizontal and vertical disc diameters (P = 0.30;P = 0.61, respectively), horizontal and vertical C/D ratios (P = 0.47;P = 0.19,resp.), and size of alpha zone and beta zone of parapapillary atrophy (P = 0.27;P = 0.32,resp.) did not differ significantly between affected eyes and contralateral normal eyes in patients with unilateral NA-AION. Similarly, horizontal and vertical disc diameters, horizontal and vertical C/D ratios, and size of alpha zone and beta zone did not vary significantly (all P>0.05) between the unaffected eyes of patients with unilateral NA-AION and the eyes of patients with bilateral NA-AION. Optic disc diameters, C/D ratios, size of alpha zone or beta zone of parapapillary atrophy were not significantly associated with final visual outcome in the eyes affected with NA-AION (all P>0.20) nor with the difference in final visual acuity between affected eyes and unaffected eyes in patients with unilateral NA-AION (all P>0.25). NA-AION did not affect C/D ratios nor alpha zone and beta zone of parapapillary atrophy. Optic disc size was not related to the final visual acuity outcome in NA-AION.
    PLoS ONE 05/2012; 7(5):e37499. DOI:10.1371/journal.pone.0037499 · 3.23 Impact Factor
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    Sohan Singh Hayreh
    Albrecht von Graæes Archiv für Ophthalmologie 04/2012; 250(9):1255-60. DOI:10.1007/s00417-012-2026-4 · 2.33 Impact Factor
  • Sohan Singh Hayreh · M Bridget Zimmerman
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    ABSTRACT: To investigate the incidence of ocular neovascularization (NV) in central and hemicentral retinal vein occlusion. The study comprised consecutive 912 (673 nonischemic and 239 ischemic) central retinal vein occlusion and 190 (147 nonischemic, 43 ischemic) hemicentral retinal vein occlusion eyes. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. In ischemic central retinal vein occlusion, within 6 months from time of onset, the cumulative probability of development of iris NV was 49%, angle NV 37%, NV glaucoma 29%, retinal NV 9%, and disk NV 6%. More severe peripheral retinal hemorrhages were significantly associated with iris NV (P = 0.005), angle NV (P = 0.0004), and NV glaucoma (P = 0.012). Eyes that developed disk NV had more cotton wool spots (P = 0.058) than those without. In ischemic hemicentral retinal vein occlusion, within 12 months of onset, the cumulative probability of development of retinal NV was 29%, disk NV 12%, and iris NV 12%; within 6 months of onset, angle NV was found in 10% and NV glaucoma in 5%. Anterior chamber flare was associated with anterior segment NV and may precede the development of NV. Patients who developed NV were significantly younger, and there was a greater prevalence of NV glaucoma in patients with primary open angle glaucoma. In ischemic central retinal vein occlusion, anterior segment NV is much more common than posterior segment NV, and the cumulative chance of developing anterior segment NV is maximum during the first 6 months. In ischemic hemicentral retinal vein occlusion, posterior segment NV is much more common than anterior segment NV.
    Retina (Philadelphia, Pa.) 04/2012; 32(8):1553-65. DOI:10.1097/IAE.0b013e318246912c · 3.18 Impact Factor
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    Sohan Singh Hayreh
    The British journal of ophthalmology 09/2011; 95(11):1617-8. DOI:10.1136/bjophthalmol-2011-300799 · 2.81 Impact Factor
  • Sohan Singh Hayreh · M Bridget Zimmerman
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    ABSTRACT: To investigate the natural history of visual outcome in hemicentral retinal vein occlusion (HCRVO). The study comprised 65 consecutive HCRVO patients (67 eyes) seen within 3 months of onset. At first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Hemicentral retinal vein occlusion was classified into nonischemic (57 eyes) and ischemic (10 eyes) at initial visit. Nonischemic HCRVO involved superior and inferior half of the retina in 39% and 56%, respectively, and in ischemic HCRVO in 50% and 40%, respectively. In nonischemic HCRVO, initial visual acuity was 20/60 or better in 73.7% and minimal to mild visual field loss in 96% and in ischemic HCRVO in 40% and 55.5%, respectively. After resolution of macular edema, in nonischemic HCRVO eyes, cumulative chance of improvement was 50% with 20/70 or worse initial visual acuity, and deterioration in only 6% with 20/60 or better initial visual acuity, and in 5% with minimal to mild visual initial field loss. This study suggests a good prognosis in the natural history of visual outcome in nonischemic HCRVO.
    Retina (Philadelphia, Pa.) 08/2011; 32(1):68-76. DOI:10.1097/IAE.0b013e31821801f5 · 3.18 Impact Factor

Publication Stats

10k Citations
898.12 Total Impact Points

Institutions

  • 1982–2015
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
    • University of Nebraska Medical Center
      Omaha, Nebraska, United States
  • 1974–2015
    • University of Iowa
      • • Department of Ophthalmology and Visual Sciences
      • • Department of Pharmacology
      Iowa City, Iowa, United States
  • 2000
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Ophthalmology
      Erlangen, Bavaria, Germany
  • 1999
    • University of Lausanne
      Lausanne, Vaud, Switzerland
  • 1989
    • University of Illinois at Chicago
      • Department of Ophthalmology and Visual Sciences (Chicago)
      Chicago, Illinois, United States
  • 1987
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 1979
    • Bascom Palmer Eye Institute
      Miami, Florida, United States
  • 1972
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom