Farzin Forooghian

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (70)231.66 Total impact

  • Chris Or, Andrew W Kirker, Farzin Forooghian
    12/2015; 5(1). DOI:10.1186/s12348-015-0037-0
  • Mei Young, Nader Fallah, Farzin Forooghian
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    ABSTRACT: The purpose of the study was to determine if progressive choroidal changes occur in birdshot chorioretinopathy (BSCR). Retrospective chart review of all patients with BSCR who were seen over a 3-year period. Controls consisted of healthy age-matched and gender-matched patients. Choroidal thickness at baseline and final follow-up visit was measured with the use of optical coherence tomography. Results were analyzed using univariate and multivariable statistical models. A total of 11 patients (22 eyes) with BSCR were identified. The majority of BSCR eyes (86%) had clinically inactive disease. Follow-up ranged from 2 months to 27 months. Mean age was 55 years. Patients with BSCR had significantly thinner choroid compared with controls (P < 0.001). Furthermore, the rate of choroid thinning for patients diagnosed with BSCR (2.68 μm per month) was significantly higher than that of controls (0.27 μm per month) (P = 0.003). There was no statistically significant difference in the rate of choroidal thinning between the two eyes of patients with BSCR (P = 0.859), indicating that the choroidal thinning was symmetrical. Despite having clinically inactive uveitis, eyes with BSCR can develop progressive choroidal thinning. The clinical relevance of this choroidal thinning, or degeneration, remains to be fully elucidated.
    Retina 04/2015; 35(4). DOI:10.1097/IAE.0000000000000489 · 3.18 Impact Factor
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    ABSTRACT: This report describes a novel, non-invasive and label-free optical imaging technique, speckle variance optical coherence tomography (svOCT), for visualising blood flow within human retinal capillary networks. This imaging system uses a custom-built swept source OCT system operating at a line rate of 100 kHz. Real-time processing and visualisation is implemented on a consumer grade graphics processing unit. To investigate the quality of microvascular detail acquired with this device we compared images of human capillary networks acquired with svOCT and fluorescein angiography. We found that the density of capillary microvasculature acquired with this svOCT device was visibly greater than fluorescein angiography. We also found that this svOCT device had the capacity to generate en face images of distinct capillary networks that are morphologically comparable with previously published histological studies. Finally, we found that this svOCT device has the ability to non-invasively illustrate the common manifestations of diabetic retinopathy and retinal vascular occlusion. The results of this study suggest that graphics processing unit accelerated svOCT has the potential to non-invasively provide useful quantitative information about human retinal capillary networks. Therefore svOCT may have clinical and research applications for the management of retinal microvascular diseases, which are a major cause of visual morbidity worldwide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
  • Farzin Forooghian, Sijia Cao, Jing Cui, Joanne A Matsubara
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    ABSTRACT: To compare intravitreal bevacizumab versus ranibizumab as adjuvant treatment prior to pars plana vitrectomy (PPV) in proliferative diabetic retinopathy (PDR) with respect to parameters of surgical complexity. Prospective, randomized, double-masked pilot study of patients requiring PPV for nonclearing vitreous hemorrhage or tractional retinal detachment (TRD) secondary to PDR. Patients were randomized to receive either intravitreal bevacizumab or ranibizumab at standard doses 1 week preoperatively. Measured parameters included total surgical time, presence of TRD, intraoperative bleeding, iatrogenic retinal breaks, and use of endolaser and endodiathermy or silicone oil. A total of 29 patients were recruited. For surgical parameters, there were no statistically significant differences between the groups in the univariate analyses. Multivariable analysis showed no statistically significant difference for total surgical time. This pilot study suggests that intravitreal bevacizumab and ranibizumab are equivalent as surgical adjuvants when used as pre-treatment in patients with PDR undergoing PPV. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:521-524.]. Copyright 2014, SLACK Incorporated.
    11/2014; 45(6):521-4. DOI:10.3928/23258160-20141118-06
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    ABSTRACT: PurposeTo describe the fundus autofluorescence (FAF) features of the inflammatory maculopathies and develop a quantification method for FAF analysis.MethodsThis is a retrospective, consecutive case series of patients with inflammatory maculopathies from two tertiary centers. The clinical findings, demographics, and FAF imaging characteristics were reviewed. Foveal autofluorescence (AF) was analyzed. Median and standard deviation (SD) of foveal AF intensity were measured.ResultsThirty eyes of 15 patients were evaluated with both qualitative and quantitative FAF analysis. In acute macular neuroretinopathy, the active phase showed foveal hypoautofluorescence, which became hypoautofluorescent with resolution. In acute posterior multifocal placoid pigment epitheliopathy, multiple lesions with hypoautofluorescent centers with hyperautofluorescent borders were observed in active disease and became hypoautofluorescent with disease convalescence. In multifocal choroiditis and punctate inner choroiditis, the active hyperautofluorescent lesions progressed to inactive, hypoautofluorescent scars. Active serpiginous choroiditis showed hyperautofluorescent borders adjacent to a helicoid-shaped, hypoautofluorescent scar. Active unilateral acute idiopathic maculopathy (UAIM) showed a complex pattern of hypo- and hyperautoflourescence in the macula. The median foveal AF was the greatest in acute macular neuroretinopathy and UAIM among the maculopathies, while the greatest SD of foveal AF intensity was observed in UAIM.ConclusionThe active phase of the majority of inflammatory maculopathies was characterized by hyperautofluorescent lesions. Increased SD of foveal AF correlated with a mixture of hypo-and hyperautoflourescence. Median and SD may be useful metrics in foveal AF and quantifiable values that may be assessed over time as a disease process evolves. Improvements in quantification methods of FAF imaging may allow us to objectively evaluate posterior uveitis.
    Clinical ophthalmology (Auckland, N.Z.) 09/2014; 8:2001-12. DOI:10.2147/OPTH.S68446
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    ABSTRACT: PURPOSE: To determine whether baseline drusen load, as measured using spectral-domain optical coherence tomography (SD OCT), is a useful predictor of development of advanced age-related macular degeneration (AMD). DESIGN: Retrospective cohort study. METHODS: SETTING: Academic clinical practice. STUDY POPULATION: All patients with non-neovascular AMD and no retinal pigment epithelial (RPE) atrophy at baseline who were seen between 2007 and 2012 in a single academic retina practice. A minimum of 1 year of follow-up was required. OBSERVATION: Drusen load (area and volume) was assessed using automated SD OCT software algorithms. MAIN OUTCOME MEASURE: RPE atrophy area, assessed using an automated SD OCT software algorithm, and the development of neovascular AMD. RESULTS: Eighty-three patients met the inclusion criteria with a mean age of 80 years and a mean follow-up time of 2.8 years. Repeated-measures analysis of variance showed an association between drusen area (P = .005) and drusen volume (P = .001) and the development of RPE atrophy. We also found an association between drusen area (P = .001) and drusen volume (P = .001) and the development of neovascular AMD. CONCLUSIONS: Drusen load, as measured using SD OCT, is associated with the development of RPE atrophy and neovascular AMD. SD OCT assessments of drusen load are simple and practical measurements that may be useful in stratifying the risk of developing advanced AMD. These measurements have potential applications in both routine clinical care and clinical trials.
    American Journal of Ophthalmology 06/2014; 158(4). DOI:10.1016/j.ajo.2014.06.021 · 4.02 Impact Factor
  • Canadian Journal of Ophthalmology 06/2014; 49(3):e73-6. DOI:10.1016/j.jcjo.2014.03.012 · 1.30 Impact Factor
  • Steven Yeh, Farzin Forooghian, Eric B Suhler
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    ABSTRACT: IMPORTANCE Uveitis is responsible for a significant proportion of legal blindness in the United States. Currently, there are few population-based reports characterizing the epidemiology of uveitis. OBJECTIVE To ascertain the incidence and prevalence of uveitis in a Hawaiian population and compare these estimates with those from prior population-based studies. DESIGN Retrospective, population-based cohort study conducted from January 1, 2006, to December 31, 2007. SETTING Kaiser Permanente Hawaii, a multispecialty managed care organization serving approximately 15% of the general Hawaiian population with locations throughout the Hawaiian islands. PARTICIPANTS All patients enrolled in the Kaiser Permanente Hawaii health plan during the study (N = 217 061). MAIN OUTCOMES AND MEASURES Clinical diagnosis of uveitis, either incident or prevalent, during the study determined by an initial search of the electronic medical record database of Kaiser Permanente Hawaii for uveitis-associated International Classification of Diseases, Ninth Revision diagnosis codes and subsequently confirmed through individual record review by a uveitis specialist. RESULTS Of 217 061 eligible patients, 872 were identified using International Classification of Diseases, Ninth Revision codes and 224 cases of uveitis were confirmed. The overall uveitis incidence ratewas 24.9 cases per 100 000 person-years. The annual prevalence rates for 2006 and 2007 were 57.5 and 58.0per 100 000 persons, respectively. No difference in incidence rate was found by sex (P = .63), but female patients had a higher prevalence (P = .008). Incidence and prevalence increased with older age (P < .001 for incidence and prevalence). Pacific Islanders had a lower prevalence rate than non-Pacific Islanders (2006: P = .09,2007: P = .04), while white individuals had a higher prevalence rate than nonwhite individuals (2006: P = .07, 2007: P = .01). CONCLUSIONS AND RELEVANCE The incidence and prevalence of uveitis in this population were much lower than in the Northern California Epidemiology ofUveitis Study, but similar to the Northwest Veterans Affairs Study. The results of this study highlight incidence and prevalence estimates in a new population and provide novel comparisons by race. These differences by race raise questions regarding the effects of genetic and environmental influences on the pathophysiology of uveitis.
    JAMA The Journal of the American Medical Association 05/2014; 311(18):1912-3. DOI:10.1001/jama.2014.2294 · 30.39 Impact Factor
  • Kathryn L Pepple, Russell Van Gelder, Farzin Forooghian
    American Journal of Ophthalmology 04/2014; 157(4):752-3. DOI:10.1016/j.ajo.2013.12.021 · 4.02 Impact Factor
  • Kaivon Pakzad-Vaezi, Chris Or, Steven Yeh, Farzin Forooghian
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    ABSTRACT: Optical coherence tomography (OCT) has become an integral tool in the imaging of numerous diseases of the posterior segment. The diagnostic investigation of infectious and noninfectious uveitic conditions often requires multiple imaging modalities in the appropriate clinical context. Modern OCT technology has proved useful not only in the diagnostic investigation of these conditions, but also in monitoring of their clinical course and therapeutic response. Inflammation-induced changes at the level of the retina, retinal pigment epithelium, and choroid can now easily be identified in these conditions using OCT. Prognostic information on visual acuity outcome can also be estimated based on OCT findings. Numerous OCT findings have been described in the setting of the various uveitides. Although none of these findings appear to be pathognomonic for diagnosis of specific uveitic syndromes, in the appropriate clinical context they can add a great deal of information in the diagnosis and management of uveitis.
    Canadian Journal of Ophthalmology 02/2014; 49(1):18-29. DOI:10.1016/j.jcjo.2013.10.005 · 1.30 Impact Factor
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    ABSTRACT: To study the progression of retinal pigment epithelium (RPE) and choroidal atrophy in patients with neovascular age-related macular degeneration (AMD) and to assess for a possible association with the number and type of anti-vascular endothelial growth factor treatments. Patients with neovascular AMD and a minimum of 1-year follow-up were reviewed. Fellow eyes with nonneovascular AMD were used as control eyes. Retinal pigment epithelial atrophy area and choroidal thickness were determined using spectral-domain optical coherence tomography. Multivariable regression models were used for statistical analyses. A total of 415 eyes were included in the study, with a mean follow-up of 2.2 years. Eyes with neovascular AMD had greater progression of RPE atrophy and choroidal atrophy compared with those with nonneovascular AMD (P < 0.001). Progression of RPE atrophy and choroidal atrophy was independently associated with the total number of injections of bevacizumab and ranibizumab (all P values ≤ 0.001). In the subgroup of 84 eyes with neovascular AMD and without RPE atrophy at baseline, only bevacizumab was associated with the progression of RPE atrophy (P = 0.003). This study likely lacked statistical power to detect an association with ranibizumab in this subgroup. Retinal pigment epithelial atrophy and choroidal atrophy in neovascular AMD seem to be exacerbated by anti-vascular endothelial growth factor treatment. Possible differences between bevacizumab and ranibizumab require further investigation.
    Retina (Philadelphia, Pa.) 01/2014; DOI:10.1097/IAE.0000000000000081 · 3.18 Impact Factor
  • Chris Or, Farzin Forooghian
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    ABSTRACT: Focal choroidal excavations (FCE) are characterized by foveal or perifoveal choroid excavations seen on optical coherence tomography (OCT). The authors report a case of FCE associated with a vitelliform lesion within the excavation. A case of FCE associated with a small vitelliform lesion has been described previously, but the larger extent of the vitelliform lesion observed in the current case has not been previously reported. This may represent a novel category of FCE, vitelliform focal choroidal excavation, in which deposition of vitelliform material is associated with its development. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:e26-e28.
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    ABSTRACT: Vitreoretinal lymphoma is a diffuse large B cell non-Hodgkin lymphoma. Targeting malignant cells with rituximab is being used increasingly as local chemotherapy, but information on this treatment is scant. We aimed to describe current therapeutic approaches, as well as responses to and complications of, intravitreal rituximab in patients with vitreoretinal lymphoma. Clinical data were collected in a standardised manner retrospectively on patients with vitreoretinal lymphoma treated with intravitreal rituximab. 48 eyes (34 patients) with vitreoretinal lymphoma were treated with a median of 3.5 intravitreal injections of rituximab (1 mg/0.1 mL) for new diagnosis (68.8%), progressive disease (29.9%) and maintenance therapy (2.1%). Intravitreal rituximab±methotrexate was the sole treatment in 19 eyes (39.6%). 31 eyes (64.6%) eyes achieved complete remission, after a median of 3 injections; 7 of these eyes developed recurrent disease. 11 eyes (22.9%) achieved partial remission. Although rituximab may have contributed to complications reported in 12 eyes (25.0%), a 2-line loss of Snellen visual acuity occurred in only 2 of those eyes (4.2%). Approaches in rituximab-based intravitreal chemotherapy vary widely, but our findings suggest that this treatment may be safe and effective in inducing remission in a majority of eyes with vitreoretinal lymphoma.
    The British journal of ophthalmology 10/2013; 98(1). DOI:10.1136/bjophthalmol-2013-304043 · 2.81 Impact Factor
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    ABSTRACT: To investigate the relationship between systemic cytokines, the complement factor H (CFH) Y402H polymorphism, drusen load, and subfoveal choroidal thickness in patients with dry age-related macular degeneration (AMD). Cross-sectional study. Forty-four dry AMD patients under care of the Retina Service at the University of British Columbia were enrolled. Drusen load was measured with an automated software algorithm in spectral-domain optical coherence tomography; subfoveal choroidal thickness was measured manually using enhanced depth imaging. Bio-Plex suspension assays (Bio-Rad Laboratories) were used to analyze cytokines in plasma and CFH Y402H was genotyped. Statistical analyses included analysis of covariance and Pearson correlation, corrected for multiple comparisons. The levels of 3 of 4 studied cytokines were significantly different among patients with CC, CT, or TT variants of the CFH Y402H polymorphism (P < .01). Patients with the at-risk CC variant had higher systemic levels of interleukin-6, interleukin-18, and tumor necrosis factor α than those with the CT variants, the TT variant, or both (P < .01). Interleukin-1β did not reach significance (P = .02), but did demonstrate a consistent trend. No correlation was found between plasma cytokines and drusen load or choroidal thickness (all P > .15). The elevated systemic levels of selected proinflammatory cytokines, including those representing products of inflammasome activation, were associated with the CC at-risk variant of the Y402H polymorphism and suggest that genetic factors regulate the inflammatory status in dry AMD patients. Our data support the central role of inflammation in the pathogenesis of AMD and provide further evidence of a systemic involvement in AMD etiology.
    American Journal of Ophthalmology 09/2013; DOI:10.1016/j.ajo.2013.08.003 · 4.02 Impact Factor
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    ABSTRACT: Abstract Objective: To determine the risk of uveitis associated with the use of oral fluoroquinolones. Methods: Nested case-control study of all patients who visited an ophthalmologist in British Columbia, Canada, between 2000 and 2007, as captured in the British Columbia Health Linked Database. Results: A total 3383 incident cases of uveitis and 33,830 corresponding controls were identified. Among patients who had used oral fluoroquinolones within the past 30 days, the adjusted relative risk of uveitis was 3.53 (95% CI, 2.84-4.39). However, the relative risk of uveitis among patients taking oral macrolides and beta-lactams was also significantly elevated. Conclusions: Our data do not provide convincing evidence of an association between fluoroquinolones and uveitis, as this study found an association between several classes of antibiotics and uveitis. It is possible that the systemic processes for which these antibiotics are being prescribed are in fact the inciting factors for the uveitis.
    Ocular immunology and inflammation 07/2013; 21(5). DOI:10.3109/09273948.2013.808351 · 1.44 Impact Factor
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    ABSTRACT: Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Subretinal fluid (SRF) and sub-retinal pigment epithelium (sub-RPE) fluid are signs of AMD and can be detected in optical coherence tomography images. However, manual detection and segmentation of SRFs and sub-RPE fluids are laborious and time consuming. In this paper, a novel pipeline is proposed for automatic detection of SRFs and sub-RPE fluids. First, top and bottom layers of retina are segmented using a graph cut method. Then, a Split Bregman-based segmentation method is used to segment dark regions between layers. These segmented regions are considered as potential fluid candidates, on which a set of features are generated. After that, a random forest classifier is trained to distinguish between the true fluid regions from the falsely detected fluid regions. This method shows reasonable performance in a leave-one-out evaluation using a dataset from 21 patients.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 07/2013; 2013:7388-7391. DOI:10.1109/EMBC.2013.6611265
  • Chris Or, Jing Cui, Joanne Matsubara, Farzin Forooghian
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    ABSTRACT: AIM: Bisphosphonates have been shown to induce ocular inflammatory diseases such as uveitis and scleritis, while being protective against angiogenic diseases like neovascular age-related macular degeneration (AMD). Therefore, we studied the effects of bisphosphonates on primary culture of human fetal retinal pigment epithelium (hRPE), a cell type known to secrete both inflammatory and angiogenic factors. Alendronate and etidronate were selected for this experiment as they are members of the two structurally different classes of bisphosphonates. METHODS: Primary cultures of hRPE were serum-starved for 24 h and then treated for 24 h with alendronate (0.0001, 0.1, 100 µM) or etidronate (0.01, 1 µM). Cell viability was measured using the MTT assay. Investigation of secreted cytokines induced by bisphosphonates was performed using a human cytokine 29-Plex Panel (Bio-Plex) array and the results were analysed with an analysis of variance (ANOVA). RESULTS: Etidronate, at the lower concentration, significantly increased the expression of interleukin (IL)-6 (p=0.03) and IL-8 (p=0.04). At the higher concentration, etidronate significantly decreased the expression of granulocyte macrophage colony-stimulating factor (p=0.02) and basic fibroblast growth factor (bFGF) (p=0.02). Alendronate, at the highest concentration, significantly increased the expression of IL-8 (p=0.02) and decreased the expression of eotaxin (p=0.02). Alendronate also significantly decreased the expression of bFGF at all concentrations (p<0.05) and demonstrated a trend towards decreasing vascular endothelial growth factor expression at low concentration. CONCLUSIONS: Alendronate and etidronate display dose dependent effects in hRPE cells. Alendronate and etidronate administration resulted in concentration dependent elevations in inflammatory cytokines. Furthermore, alendronate and etidronate administration resulted in reduced expression of a number of angiogenic factors. These findings may explain the increased incidence of ocular inflammation as well as the therapeutic effect on neovascular AMD which have been described with bisphosphonates.
    The British journal of ophthalmology 06/2013; 97(8). DOI:10.1136/bjophthalmol-2013-303355 · 2.81 Impact Factor
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    ABSTRACT: PURPOSE: To investigate the safety and effects of subconjunctival sirolimus, a mTOR inhibitor and immunosuppressive agent, for the treatment of geographic atrophy (GA). METHODS: The study was a single-center, open-label phase II trial, enrolling 11 participants with bilateral GA; 8 participants completed 24 months of follow-up. Sirolimus (440µg) was administered every 3 months as a subconjunctival injection in only one randomly-assigned eye in each participant for 24 months. Fellow eyes served as untreated controls. The primary efficacy outcome measure was the change in the total GA area at 24 months. Secondary outcomes included changes in visual acuity, macular sensitivity, central retinal thickness, and total drusen area. RESULTS: Study drug was well-tolerated with few symptoms and related adverse events. Study treatment in study eyes was not associated with structural or functional benefits relative to the control fellow eyes. At Month 24, mean GA area increased by 54.5% and 39.7% in study and fellow eyes respectively (p = 0.41), while mean visual acuity decreased by 21.0 letters and 3.0 letters in study and fellow eyes respectively (p = 0.03). Substantial differences in mean changes in drusen area, central retinal thickness, and macular sensitivity were not detected for all analysis time-points up to 24 months. CONCLUSIONS: Repeated subconjunctival sirolimus was well-tolerated in patients with GA, however no positive anatomical or functional effects were identified. Subconjunctival sirolimus may not be beneficial in the prevention of GA progression, and may potentially be associated with effects detrimental to visual acuity.
    Investigative ophthalmology & visual science 04/2013; 54(4). DOI:10.1167/iovs.13-11650 · 3.66 Impact Factor
  • Chris Or, Natasha Press, Farzin Forooghian
    Canadian Journal of Ophthalmology 04/2013; 48(2):e18-20. DOI:10.1016/j.jcjo.2012.09.016 · 1.30 Impact Factor

Publication Stats

722 Citations
231.66 Total Impact Points

Institutions

  • 2001–2014
    • University of British Columbia - Vancouver
      • • Department of Ophthalmology and Visual Sciences
      • • Brain Research Centre
      Vancouver, British Columbia, Canada
  • 2008–2013
    • NEI Corporation
      Сомерсет, New Jersey, United States
  • 2012
    • Emory University
      • Emory Eye Center
      Atlanta, GA, United States
  • 2010–2011
    • Icahn School of Medicine at Mount Sinai
      Borough of Manhattan, New York, United States
  • 2008–2011
    • National Institutes of Health
      • • Laboratory of Immunology
      • • Division of Clinical and Epidimiological Research
      Maryland, United States
  • 2009
    • National Eye Institute
      Maryland, United States
  • 2004–2007
    • University of Toronto
      • • Hospital for Sick Children
      • • Department of Ophthalmology and Vision Sciences
      Toronto, Ontario, Canada