Felipe A Medeiros

University of California, San Diego, San Diego, California, United States

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Publications (211)741.79 Total impact

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    ABSTRACT: Schizophrenia is a complex mental disorder associated with not only cognitive dysfunctions, such as memory and attention deficits, but also changes in basic sensory processing. Although most studies on schizophrenia have focused on disturbances in higher-order brain functions associated with the prefrontal cortex or frontal cortex, recent investigations have also reported abnormalities in low-level sensory processes, such as the visual system. At very early stages of the disease, schizophrenia patients frequently describe in detail symptoms of a disturbance in various aspects of visual perception that may lead to worse clinical symptoms and decrease in quality of life. Therefore, the aim of this review is to describe the various studies that have explored the visual issues in schizophrenia.
    Current Psychiatry Reports 05/2015; 17(5):569. DOI:10.1007/s11920-015-0569-x · 3.05 Impact Factor
  • Journal of glaucoma 04/2015; 24(4):334. DOI:10.1097/IJG.0b013e3181c29bae · 1.74 Impact Factor
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    ABSTRACT: To evaluate racial differences in the development of visual field (VF) damage in glaucoma suspects. Prospective, observational cohort study. Six hundred thirty six eyes from 357 glaucoma suspects with normal VF at baseline were included from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES). Racial differences in the development of VF damage were examined using multivariable Cox Proportional Hazard models. Thirty one (25.4%) of 122 African descent participants and 47 (20.0%) of 235 European descent participants developed VF damage (p=0.078). In multivariable analysis, worse baseline VF mean deviation, higher mean arterial pressure during follow up, and a race *mean intraocular pressure (IOP) interaction term were significantly associated with the development of VF damage suggesting that racial differences in the risk of VF damage varied by IOP. At higher mean IOP levels, race was predictive of the development of VF damage even after adjusting for potentially confounding factors. At mean IOPs during follow-up of 22, 24 and 26 mmHg, multivariable hazard ratios (95%CI) for the development of VF damage in African descent compared to European descent subjects were 2.03 (1.15-3.57), 2.71 (1.39-5.29), and 3.61 (1.61-8.08), respectively. However, at lower mean IOP levels (below 22 mmHg) during follow-up, African descent was not predictive of the development of VF damage. In this cohort of glaucoma suspects with similar access to treatment, multivariate analysis revealed that at higher mean IOP during follow-up, individuals of African descent were more likely to develop VF damage than individuals of European descent. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 01/2015; 159(4). DOI:10.1016/j.ajo.2015.01.011 · 4.02 Impact Factor
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    ABSTRACT: Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life. To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma. Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables. Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores. Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors. Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.
    Jama Ophthalmology 01/2015; DOI:10.1001/jamaophthalmol.2014.5319 · 3.83 Impact Factor
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    ABSTRACT: Glaucoma is neurodegenerative disease characterized by distinctive changes in the optic nerve head and visual field. Without treatment, glaucoma can lead to permanent blindness. Therefore, monitoring glaucoma progression is important to detect uncontrolled disease and the possible need for therapy advancement. In this context, three-dimensional (3-D) spectral domain optical coherence tomography (SD-OCT) has been commonly used in the diagnosis and management of glaucoma patients. We present a new framework for detection of glaucoma progression using 3-D SD-OCT images. In contrast to previous works that use the retinal nerve fiber layer thickness measurement provided by commercially available instruments, we consider the whole 3-D volume for change detection. To account for the spatial voxel dependency, we propose the use of the Markov random field (MRF) model as a prior for the change detection map. In order to improve the robustness of the proposed approach, a nonlocal strategy was adopted to define the MRF energy function. To accommodate the presence of false-positive detection, we used a fuzzy logic approach to classify a 3-D SD-OCT image into a "non-progressing" or "progressing" glaucoma class. We compared the diagnostic performance of the proposed framework to the existing methods of progression detection.
    12/2014; 1(3):034504-1-9. DOI:10.1117/1.JMI.1.3.034504
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    ABSTRACT: Purpose To evaluate the diagnostic accuracies of swept source optical coherence tomography (SS-OCT) wide-angle and peripapillary retinal nerve fiber layer (RNFL) thickness measurements for glaucoma detection. Design Cross-sectional case-control study. Methods 144 glaucomatous eyes of 106 subjects and 66 eyes of 42 healthy subjects from the Diagnostic Innovations in Glaucoma Study were enrolled in this study. Glaucoma was defined by the presence of repeatable abnormal standard automated perimetry results and/or progressive glaucomatous optic disc change on masked grading of stereophotographs. Wide-angle and peripapillary RNFL thicknesses were assessed using SS-OCT. Peripapillary RNFL thickness was also evaluated using spectral-domain OCT (SD-OCT). Areas under the receiver operating characteristic (ROC) curves were calculated to evaluate the ability of the different SS-OCT and SD-OCT parameters to discriminate glaucomatous from healthy eyes. Results Mean (± standard deviation) average SS-OCT wide-angle RNFL thickness were 50.5 ± 5.8 μm and 35.0 ± 9.6 μm in healthy and glaucomatous eyes, respectively (P<0.001). Corresponding values for SS-OCT peripapillary RNFL thickness were 103.5 ± 12.3 μm and 72.9 ± 16.5 μm, respectively (P<0.001). Areas under the ROC curves of SS-OCT wide-angle and peripapillary RNFL thickness were 0.88 and 0.89, respectively. SS-OCT performed similarly to average peripapillary RNFL thickness obtained with SD-OCT (area under the ROC curve of 0.90). Conclusion SS-OCT wide-angle and peripapillary RNFL thickness measurements performed well for detecting glaucomatous damage. Diagnostic accuracies of the SS-OCT and SD-OCT RNFL imaging protocols evaluated in this study were similar.
    American Journal of Ophthalmology 10/2014; 159(1). DOI:10.1016/j.ajo.2014.10.019 · 4.02 Impact Factor
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    ABSTRACT: Purpose To evaluate the association between longitudinal changes in quality of life (QoL) and rates of progressive visual field loss in glaucoma. Design Prospective observational cohort study. Participants We recruited 322 eyes of 161 patients with glaucomatous visual field loss from the Diagnostic Innovations Glaucoma Study followed for an average of 3.5±0.7 years. Methods All subjects had National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 performed annually and standard automated perimetry (SAP) at 6-month intervals. Subjects were included if they had a minimum of 2 NEI VFQ-25 and ≥5 SAP during follow-up. Evaluation of rates of visual field change was performed using the mean sensitivity (MS) of the integrated binocular visual field (BVF). Rasch analysis was performed to obtain final scores of disability as measured by the NEI VFQ-25. A joint longitudinal multivariate mixed model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in BVF sensitivity. Potentially confounding socioeconomic and clinical variables also were analyzed. Main Outcome Measures The relationship between change in NEI VFQ-25 Rasch-calibrated scores and change in binocular SAP MS. Results There was a significant correlation between change in the NEI VFQ-25 Rasch scores during follow-up and change in binocular SAP sensitivity. Each 1-dB change in binocular SAP MS per year was associated with a change of 2.9 units per year in the NEI VFQ-25 Rasch scores during the follow-up period (R2 = 26%; P<0.001). Eyes with more severe disease at baseline were also more likely to have a decrease in NEI VFQ-25 scores during follow-up (P<0.001). For subjects with the same amount of change in SAP sensitivity, those with shorter follow-up times had larger changes in NEI VFQ-25 scores (P = 0.005). A multivariable model containing baseline and rate of change in binocular MS had an adjusted R2 of 50% in predicting change in NEI VFQ-25 scores. Conclusions Baseline severity, magnitude, and rates of change in BVF sensitivity were associated with longitudinal changes in QoL of glaucoma patients. Assessment of longitudinal visual field changes may help to identify patients at greater risk for developing disability from the disease.
    Ophthalmology 10/2014; 122(2). DOI:10.1016/j.ophtha.2014.08.014 · 6.17 Impact Factor
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    ABSTRACT: To evaluate choroidal thickness (CT) in healthy and glaucomatous eyes using Swept Source Optical Coherence Tomography (SS-OCT).
    PLoS ONE 10/2014; 9(10):e109683. DOI:10.1371/journal.pone.0109683 · 3.53 Impact Factor
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    ABSTRACT: To evaluate whether optic disc hemorrhages are associated with faster rates of estimated retinal ganglion cell (RGC) loss in glaucoma.
    PLoS ONE 08/2014; 9(8):e105611. DOI:10.1371/journal.pone.0105611 · 3.53 Impact Factor
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    ABSTRACT: To investigate the relationship between macular ganglion cell-inner plexiform layer (mGCIPL) thickness and estimated macular retinal ganglion cell (RGC) counts in glaucoma.
    Ophthalmology 08/2014; 121(12). DOI:10.1016/j.ophtha.2014.06.047 · 6.17 Impact Factor
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    ABSTRACT: Purpose To examine the relationship between glaucomatous structural damage and ability to divide attention during simulated driving. Design Cross-sectional observational study. Methods Setting: Hamilton Glaucoma Center, University of California San Diego. Patient Population 158 subjects from the Diagnostic Innovations in Glaucoma Study, including 82 with glaucoma and 76 similarly aged controls. Observation Procedure Ability to divide attention was investigated by measuring reaction times to peripheral stimuli (at low, medium or high contrast) while concomitantly performing a central driving task (car following or curve negotiation). All subjects had standard automated perimetry (SAP) and optical coherence tomography was used to measured retinal nerve fiber (RNFL) thickness. Cognitive ability was assessed using the Montreal Cognitive Assessment and subjects completed a driving history questionnaire. Main outcome measures Reaction times to the driving simulator divided attention task. Results The mean reaction times to the low contrast stimulus were 1.05 s and 0.64 s in glaucoma and controls respectively during curve negotiation (P <0.001), and 1.19 s and 0.77 s (P = 0.025) respectively during car following. There was a non-linear relationship between reaction times and RNFL thickness in the better eye. RNFL thickness remained significantly associated with reaction times even after adjusting for age, SAP mean deviation in the better eye, cognitive ability and central driving task performance. Conclusions Although worse SAP sensitivity was associated with worse ability to divide attention, RNFL thickness measurements provided additional information. Information from structural tests may improve our ability to determine which patients are likely to have problems performing daily activities, such as driving.
    American Journal of Ophthalmology 07/2014; DOI:10.1016/j.ajo.2014.07.028 · 4.02 Impact Factor
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    ABSTRACT: Purpose To identify the most commonly used statistical analyses in the ophthalmic literature and to determine the likely gain in comprehension of the literature that readers could expect if they were to add knowledge of more advanced techniques sequentially to their statistical repertoire. Design Cross-sectional study. Methods All articles published from January 2012 through December 2012 in Ophthalmology, the American Journal of Ophthalmology, and Archives of Ophthalmology were reviewed. A total of 780 peer-reviewed articles were included. Two reviewers examined each article and assigned categories to each one depending on the type of statistical analyses used. Discrepancies between reviewers were resolved by consensus. Main Outcome Measures Total number and percentage of articles containing each category of statistical analysis were obtained. Additionally, we estimated the accumulated number and percentage of articles that a reader would be expected to be able to interpret depending on their statistical repertoire. Results Readers with little or no statistical knowledge would be expected to be able to interpret the statistical methods presented in only 20.8% of articles. To understand more than half (51.4%) of the articles published, readers would be expected to be familiar with at least 15 different statistical methods. Knowledge of 21 categories of statistical methods was necessary to comprehend 70.9% of articles, whereas knowledge of more than 29 categories was necessary to comprehend more than 90% of articles. Articles related to retina and glaucoma subspecialties showed a tendency for using more complex analysis when compared with articles from the cornea subspecialty. Conclusions Readers of clinical journals in ophthalmology need to have substantial knowledge of statistical methodology to understand the results of studies published in the literature. The frequency of the use of complex statistical analyses also indicates that those involved in the editorial peer-review process must have sound statistical knowledge to appraise critically the articles submitted for publication. The results of this study could provide guidance to direct the statistical learning of clinical ophthalmologists, researchers, and educators involved in the design of courses for residents and medical students.
    Ophthalmology 07/2014; 121(7). DOI:10.1016/j.ophtha.2014.01.015 · 5.56 Impact Factor
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    ABSTRACT: Purpose To compare the rates of retinal nerve fiber layer (RNFL) loss in patients suspected of having glaucoma who developed visual field damage (VFD) with those who did not develop VFD and to determine whether the rate of RNFL loss can be used to predict the development of VFD. Design Prospective, observational cohort study. Participants Glaucoma suspects, defined as having glaucomatous optic neuropathy or ocular hypertension (intraocular pressure, >21 mmHg) without repeatable VFD at baseline, from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Methods Global and quadrant RNFL thickness (RNFLT) were measured with the Spectralis spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA+OCT [Heidelberg Engineering, Heidelberg, Germany]). Visual field damage was defined as having 3 consecutive abnormal visual fields. The rate of RNFL loss in eyes developing VFD was compared to eyes not developing VFD using multivariate linear mixed-effects models. A joint longitudinal survival model used the estimated RNFLT slope to predict the risk of developing VFD, while adjusting for potential confounding variables. Main Outcome Measures The rate of RNFL thinning and the probability of developing VFD. Results Four hundred fifty-four eyes of 294 glaucoma suspects were included. The average number of SD-OCT examinations was 4.6 (range, 2–9), with median follow-up of 2.2 years (0.4–4.1 years). Forty eyes (8.8%) developed VFD. The estimated mean rate of global RNFL loss was significantly faster in eyes that developed VFD compared with eyes that did not develop VFD (−2.02 μm/year vs. −0.82 μm/year; P < 0.001). The joint longitudinal survival model showed that each 1-μm/year faster rate of global RNFL loss corresponded to a 2.05-times higher risk of developing VFD (hazard ratio, 2.05; 95% confidence interval, 1.14–3.71; P = 0.017). Conclusions The rate of global RNFL loss was more than twice as fast in eyes that developed VFD compared with eyes that did not develop VFD. A joint longitudinal survival model showed that a 1-μm/year faster rate of RNFLT loss corresponded to a 2.05-times higher risk of developing VFD. These results suggest that measuring the rate of SD-OCT RNFL loss may be a useful tool to help identify patients who are at a high risk of developing visual field loss.
    Ophthalmology 07/2014; DOI:10.1016/j.ophtha.2014.01.017 · 5.56 Impact Factor
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    ABSTRACT: Objective To evaluate the ability of a binocular automated pupillograph to discriminate healthy subjects from those with glaucoma. Design Cross-sectional observational study. Participants Both eyes of 116 subjects, including 66 patients with glaucoma in at least 1 eye and 50 healthy subjects from the Diagnostic Innovations in Glaucoma Study. Eyes were classified as glaucomatous by repeatable abnormal standard automated perimetry (SAP) or progressive glaucomatous changes on stereophotographs. Methods All subjects underwent automated pupillography using the RAPDx pupillograph (Konan Medical USA, Inc., Irvine, CA). Main Outcome Measures Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic ability of pupil response parameters to white, red, green, yellow, and blue full-field and regional stimuli. A ROC regression model was used to investigate the influence of disease severity and asymmetry on diagnostic ability. Results The largest area under the ROC curve (AUC) for any single parameter was 0.75. Disease asymmetry (P < 0.001), but not disease severity (P = 0.058), had a significant effect on diagnostic ability. At the sample mean age (60.9 years), AUCs for arbitrary values of intereye difference in SAP mean deviation (MD) of 0, 5, 10, and 15 dB were 0.58, 0.71, 0.82, and 0.90, respectively. The mean intereye difference in MD was 2.2±3.1 dB. The best combination of parameters had an AUC of 0.85; however, the cross-validated bias-corrected AUC for these parameters was only 0.74. Conclusions Although the pupillograph had a good ability to detect glaucoma in the presence of asymmetric disease, it performed poorly in those with symmetric disease.
    Ophthalmology 06/2014; DOI:10.1016/j.ophtha.2013.12.015 · 5.56 Impact Factor
  • Renato Lisboa, Felipe A Medeiros
    Jama Ophthalmology 06/2014; 132(6):785-786. DOI:10.1001/jamaophthalmol.2014.2005 · 3.83 Impact Factor
  • Robert N Weinreb, Tin Aung, Felipe A Medeiros
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    ABSTRACT: Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
    JAMA The Journal of the American Medical Association 05/2014; 311(18):1901-11. DOI:10.1001/jama.2014.3192 · 29.98 Impact Factor
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    ABSTRACT: Machine learning classifiers were employed to detect glaucomatous progression using longitudinal series of structural data extracted from retinal nerve fiber layer thickness measurements and visual functional data recorded from standard automated perimetry tests. Using the collected data, a longitudinal feature vector was created for each patient's eye by computing the norm 1 difference vector of the data at the baseline and at each follow-up visit. The longitudinal features from each patient's eye were then fed to the machine learning classifier to classify each eye as stable or progressed over time. This study was performed using several machine learning classifiers including Bayesian, Lazy, Meta, and Tree, composing different families. Combinations of structural and functional features were selected and ranked to determine the relative effectiveness of each feature. Finally, the outcomes of the classifiers were assessed by several performance metrics and the effectiveness of structural and functional features were analyzed.
    IEEE Transactions on Biomedical Engineering 04/2014; 61(4):1143-1154. DOI:10.1109/TBME.2013.2295605 · 2.23 Impact Factor
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    ABSTRACT: A hierarchical approach to learn from visual field data was adopted to identify glaucomatous visual field defect patterns and to detect glaucomatous progression. The analysis pipeline included three stages, namely, clustering, glaucoma boundary limit detection, and glaucoma progression detection testing. First, cross-sectional visual field tests collected from each subject were clustered using a mixture of Gaussians and model parameters were estimated using expectation maximization. The visual field clusters were further estimated to recognize glaucomatous visual field defect patterns by decomposing each cluster into several axes. The glaucoma visual field defect patterns along each axis then were identified. To derive a definition of progression, the longitudinal visual fields of stable glaucoma eyes on the abnormal cluster axes were projected and the slope was approximated using linear regression to determine the confidence limit of each axis. For glaucoma progression detection, the longitudinal visual fields of each eye on the abnormal cluster axes were projected and the slope was approximated by linear regression. Progression was assigned if the progression rate was greater than the boundary limit of the stable eyes; otherwise, stability was assumed. The proposed method was compared to a recently developed progression detection method and to clinically available glaucoma progression detection software. The clinical accuracy of the proposed pipeline was as good as or better than the currently available methods.
    IEEE transactions on bio-medical engineering 04/2014; 61(7). DOI:10.1109/TBME.2014.2314714 · 2.15 Impact Factor
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    Andrew J Tatham, Robert N Weinreb, Felipe A Medeiros
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    ABSTRACT: The early detection of glaucoma is important in order to enable appropriate monitoring and treatment, and to minimize the risk of irreversible visual field loss. Although advances in ocular imaging offer the potential for earlier diagnosis, the best method is likely to involve a combination of information from structural and functional tests. Recent studies have shown it is possible to estimate the number of retinal ganglion cells from optical coherence tomography and standard automated perimetry, and to then pool the results to produce a combined structure-function index (CSFI). The CSFI represents the estimated percentage of retinal ganglion cells lost compared to an age-matched healthy eye. Previous studies have suggested that the CSFI is better able to detect glaucoma than isolated measures of structure and function, and that it performs well even in preperimetric glaucoma. The purpose of this review is to describe new strategies, such as the CSFI, that have the potential to improve the early detection of glaucoma. We also describe how our ability to detect early glaucoma may be further enhanced by incorporating demographic risk factors, clinical examination findings, and imaging and functional test results into intuitive models that provide estimates of disease probability.
    Clinical ophthalmology (Auckland, N.Z.) 03/2014; 8:611-621. DOI:10.2147/OPTH.S44586
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    ABSTRACT: Optic nerve head drusen (ONHD) are calcific deposits buried or at the surface of the optic disc. Although ONHD may be associated with progressive visual field defects, the mechanism of drusen-related field loss is poorly understood. Methods for detecting and imaging disc drusen include B-scan ultrasonography, fundus autofluorescence, and optical coherence tomography (OCT). These modalities are useful for drusen detection but are limited by low resolution or poor penetration of deep structures. This review was designed to assess the potential role of new OCT technologies in imaging ONHD. Critical appraisal of published literature and comparison of new imaging devices to established technology. The new imaging modalities of enhanced depth imaging optical coherence tomography (EDI-OCT) and swept source optical coherence tomography (SS-OCT) are able to provide unprecedented in vivo detail of ONHD. Using these devices it is now possible to quantify optic disc drusen dimensions and assess integrity of neighboring retinal structures, including the retinal nerve fiber layer. EDI-OCT and SS-OCT have the potential to allow better detection of longitudinal changes in drusen and neural retina and improve our understanding of drusen-related visual field loss.
    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 03/2014; DOI:10.1097/WNO.0000000000000115 · 1.09 Impact Factor

Publication Stats

5k Citations
741.79 Total Impact Points

Institutions

  • 2003–2015
    • University of California, San Diego
      • Department of Ophthalmology
      San Diego, California, United States
  • 2002–2013
    • National University (California)
      San Diego, California, United States
  • 2005–2012
    • La Jolla Pharmaceutical
      San Diego, California, United States
    • CSU Mentor
      Long Beach, California, United States
  • 2010–2011
    • Universidade Federal de São Paulo
      San Paulo, São Paulo, Brazil
    • University of Alabama at Birmingham
      • Department of Ophthalmology
      Birmingham, AL, United States
  • 2008
    • University of California, Irvine
      • Department of Ophthalmology
      Irvine, CA, United States
  • 2001–2008
    • University of São Paulo
      • Departamento de Oftalmologia (FM) (São Paulo)
      San Paulo, São Paulo, Brazil
  • 2007
    • University of Melbourne
      Melbourne, Victoria, Australia