Stephen G Schwartz

Bascom Palmer Eye Institute, Miami, Florida, United States

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Publications (84)193.15 Total impact

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    ABSTRACT: To assess the incidence and outcomes of infectious endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents. Patient records at the Bascom Palmer Eye Institute (BPEI) from January 1, 2005, through December 31, 2014, were reviewed. The largest commercial claims and encounters database in the U.S. (MarketScan) was utilized to calculate the population-based endophthalmitis rate for 2011 to 2013. The population-based rate of endophthalmitis after anti-VEGF injections for 2011 to 2013 was 391/740,757 (0.053%). BPEI's rate was 20/121,285 (0.016%) during the study period: eight after bevacizumab (0.012%), six after ranibizumab (0.018%), and six after aflibercept (0.031%) injection. Nine BPEI cases (45%) were culture-positive: Streptococcus species (5), coagulase-negative Staphylococcus (3), and non-anthracis Bacillus (1). Final visual acuity varied from 20/25 to no light perception. Endophthalmitis after anti-VEGF injection was uncommon in our institution and in the population-based database. Treatment outcomes were variable but generally fared better in the culture-negative cases. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:643-648.]. Copyright 2015, SLACK Incorporated.
    06/2015; 46(6):643-648. DOI:10.3928/23258160-20150610-08
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    ABSTRACT: To determine the association of strabismus surgery reoperation rates with adjustable or conventional sutures. Retrospective cross-sectional study. Setting. Review of a large national private insurance database. Adults age 18 to 89 having strabismus surgery between 2007 and 2011. Adjustable versus conventional suture strabismus surgery. Reoperation rate in the first postoperative year. Overall, 526 of 6178 surgical patients had a reoperation (8.5%). Reoperations were performed after 8.1% of adjustable suture surgeries and after 8.6% of conventional suture surgeries (p=0.57). Of the 4357 horizontal muscle surgeries, reoperations were performed after 5.8% of adjustable suture surgeries, and after 7.8% of conventional suture surgeries (p=0.02). Of the 1072 vertical muscle surgeries, reoperations were performed after 15.2% of adjustable suture surgeries, and after 10.4% of conventional suture surgeries (p=0.05). Younger age (18 to 39 years) was associated with a lower reoperation rate (p ≤ 0.02). The significant multivariable predictors of reoperation for horizontal surgery were adjustable sutures (odds ratio, OR 0.69, 95% confidence interval 0.52 to 0.91), monocular deviation (OR 0.64), complex surgery (OR 1.63), and unilateral surgery on two horizontal muscles (OR 0.70, all p ≤ 0.01). Adjustable sutures were not significantly associated with reoperation rates after vertical muscle surgery (multivariable OR 1.45, p=0.07). Adjustable sutures were associated with significantly fewer reoperations for horizontal muscle surgery. Adjustable sutures tended to be associated with more reoperations for vertical muscle surgery, but this observation was not statistically significant in the primary analysis after controlling for age. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 05/2015; DOI:10.1016/j.ajo.2015.05.014 · 4.02 Impact Factor
  • Stephen G Schwartz, J William Harbour
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    ABSTRACT: The retinal tumor provisionally referred to as presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) is a rare, benign lesion of unknown pathogenesis and histopathology. The authors present a case of PSCRAP that was analyzed with spectral-domain optical coherence tomography (OCT), which demonstrated a demarcation between the mass and the retinal nerve fiber layer. This finding stands in contrast to previous descriptions using time-domain OCT, suggesting that this tumor may originate from mid-retinal layers rather than the nerve fiber layer. In addition, the OCT of PSCRAP is distinct from that of astrocytic hamartoma associated with tuberous sclerosis complex. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:586-588.]. Copyright 2015, SLACK Incorporated.
    05/2015; 46(5):586-588. DOI:10.3928/23258160-20150521-13
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    ABSTRACT: The pathophysiology of ocular hypertension (OH) leading to primary open angle glaucoma shares many features with a secondary form of OH caused by treatment with glucocorticoids, but also exhibits distinct differences. In this study, a pharmacogenomics approach was taken to discover candidate genes for this disorder. A genome-wide association study was performed, followed by an independent candidate gene study, using a cohort enrolled from patients treated with off-label intravitreal triamcinolone, and handling change in intraocular pressure as a quantitative trait. An intergenic quantitative trait locus (QTL) was identified at chromosome 6p21.33 near the 5' end of HCG22 that attained the accepted statistical threshold for genome-level significance. The HCG22 transcript, encoding a novel mucin protein, was expressed in trabecular meshwork cells and expression was stimulated by IL-1 and inhibited by triamcinolone acetate and TGF-beta. Bioinformatic analysis defined the QTL as an ~4 kilobase linkage disequilibrium block containing ten common single nucleotide polymorphisms (SNPs). Four of these SNPs were identified in NCBI's GTEx eQTL browser as modifiers of HCG22 expression. Most are predicted to disrupt or improve motifs for transcription factor binding, the most relevant being disruption of the glucocorticoid receptor binding motif. A second QTL was identified within the predicted signal peptide of the HCG22 encoded protein that could affect its secretion. Translation, O-glycosylation and secretion of the predicted HCG22 protein was verified in cultured trabecular meshwork cells. Identification of two independent QTLs that could affect expression of the HCG22 mucin gene product via two different mechanisms (transcription or secretion) is highly suggestive of a role in steroid-induced OH. Copyright © 2015 by Association for Research in Vision and Ophthalmology.
    Investigative ophthalmology & visual science 03/2015; 56(4). DOI:10.1167/iovs.14-14803 · 3.66 Impact Factor
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    ABSTRACT: Endophthalmitis is an uncommon diagnosis but can have devastating visual outcomes. Endophthalmitis may be endogenous or exogenous. Exogenous endophthalmitis is caused by introduction of pathogens through mechanisms such as ocular surgery, open-globe trauma, and intravitreal injections. Endogenous endophthalmitis occurs as a result of hematogenous spread of bacteria or fungi into the eye. These categories of endophthalmitis have different risk factors and causative pathogens, and thus require different diagnostic, prevention, and treatment strategies. Novel diagnostic techniques such as real-time polymerase chain reaction (RT-PCR) have been reported to provide improved diagnostic results over traditional culture techniques and may have a more expanded role in the future. While the role of povidone-iodine in prophylaxis of postoperative endophthalmitis is established, there remains controversy with regard to the effectiveness of other measures, including prophylactic antibiotics. The Endophthalmitis Vitrectomy Study (EVS) has provided us with valuable treatment guidelines. However, these guidelines cannot be directly applied to all categories of endophthalmitis, highlighting the need for continued research into attaining improved treatment outcomes.
    Clinical ophthalmology (Auckland, N.Z.) 01/2015; 9:95-108. DOI:10.2147/OPTH.S76406
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    ABSTRACT: To the ancient Greeks, glaukos occasionally described diseased eyes, but more typically described healthy irides, which were glaucous (light blue, gray, or green). During the Hippocratic period, a pathologic glaukos pupil indicated a media opacity that was not dark. Although not emphasized by present-day ophthalmologists, the pupil in acute angle closure may appear somewhat green, as the mid-dilated pupil exposes the cataractous lens. The ancient Greeks would probably have described a (normal) green iris or (diseased) green pupil as glaukos. During the early Common Era, eye pain, a glaucous hue, pupil irregularities, and absence of light perception indicated a poor prognosis with couching. Galen associated the glaucous hue with a large, anterior, or hard crystalline lens. Medieval Arabic authors translated glaukos as zarqaa, which also commonly described light irides. Ibn Sina (otherwise known as Avicenna) wrote that the zarqaa hue could occur due to anterior prominence of the lens and could occur in an acquired manner. The disease defined by the glaucous pupil in antiquity is ultimately indeterminate, as the complete syndrome of acute angle closure was not described. Nonetheless, it is intriguing that the glaucous pupil connoted a poor prognosis, and came to be associated with a large, anterior, or hard crystalline lens.
    Clinical ophthalmology (Auckland, N.Z.) 01/2015; 9:207-15. DOI:10.2147/OPTH.S77471
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    ABSTRACT: To evaluate the 5-year incidence rate of blebitis and bleb-associated endophthalmitis in the United States. In this retrospective cross-sectional study, we utilized a large commercial health insurance claim-based database during 2007-2011 and identified all patients who had a record of trabeculectomy in 2007. These patients were followed until the end of 2011. During the follow-up period, all incidences of blebitis, confirmed bleb-associated endophthalmitis, and presumed bleb-associated endophthalmitis were recorded. Kaplan-Meier survival analysis was utilized to calculate 5-year cumulative incidence rates of blebitis and bleb-associated endophthalmitis following trabeculectomy procedures. Among the 1,461 trabeculectomies included in our analysis, eight cases of blebitis, five cases of confirmed bleb-associated endophthalmitis, and eight cases of presumed bleb-associated endophthalmitis were identified. We found that the 5-year cumulative incidence of blebitis was 0.55%±0.19%. The 5-year cumulative incidence of bleb-associated endophthalmitis was 0.45%±0.2% when only confirmed cases were included and 1.3%±0.34% when presumed cases were also added to the analysis. The mean time from procedure to diagnosis was 45 months for blebitis and 33 months for bleb-associated endophthalmitis. Blebitis and bleb-related endophthalmitis are uncommon in the United States. The 5-year cumulative incidence was 0.55% for blebitis and 0.45%-1.3% for bleb-associated endophthalmitis.
    Clinical ophthalmology (Auckland, N.Z.) 01/2015; 9:317-22. DOI:10.2147/OPTH.S75286
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    ABSTRACT: The “Chevalier” John Taylor was perhaps the most important itinerant oculist of 18th century Europe. His professional legacy is controversial, and he was accused by many contemporaries and subsequent historians of being a quack. Nevertheless, his writings demonstrate an understanding of ocular anatomy and disease better than that of most of his contemporaries, including the first published illustration of the semidecussation of the optic nerves. Taylor’s personal legacy is more favorable. His son, John Taylor, Jr., and his grandsons John and Jeremiah Taylor, were respected oculists. Their lives give perspective on ophthalmic practice in 18th and 19th century Europe.
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    ABSTRACT: To report the 3-month incidence rates of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries and to examine the subsequent surgical treatments in these eyes. This is a retrospective study using the nationally pooled, insurance claim-based MarketScan databases from the years 2007-2011. Patients with records of trabeculectomy and/or tube shunt procedures were identified, and all cases of "definite" (ie, properly coded) and "suspected" (possibly miscoded) postoperative suprachoroidal hemorrhage occurring within 3 months of their glaucoma filtration procedures were captured along with the surgical interventions used for this condition. Kaplan-Meier survival analysis was used to evaluate the 3-month incidence rates of suprachoroidal hemorrhage, and regression analysis was applied to calculate the odds ratios, confidence intervals, and P-values. There were 17,843 trabeculectomies and 9,597 tube shunt surgeries identified. Among these, there were 107 cases (247 including "suspected" cases) of postoperative suprachoroidal hemorrhage within 3 months of trabeculectomy and 113 cases (255 including "suspected" cases) within 3 months of tube shunt procedures. The 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage ranged from 0.6%±0.06% to 1.4%±0.09% after trabeculectomy and 1.2%±0.11% to 2.7%±0.16% after tube shunt surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries than after trabeculectomies for both "definite" and "definite" plus "suspected" cases (odds ratio, 1.98; 95% confidence interval, 1.51-2.58; P<0.001; and odds ratio, 1.95; 95% confidence interval, 1.63-2.32; P<0.001, respectively). Among the 502 "definite" and "suspected" cases of postoperative suprachoroidal hemorrhage, 32.9% (165 cases) had a treatment record of choroidal tap and 8.8% (44 cases) had a treatment record of pars plana vitrectomy. In this sample, the 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage was 0.6%-1.4% after trabeculectomy and 1.2%-2.7% after tube shunt procedures, and the majority of the cases appeared to be managed without further surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries as after trabeculectomies.
    Clinical Ophthalmology 01/2015; 9:579. DOI:10.2147/OPTH.S78359 · 0.76 Impact Factor
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    Blake M Hampton, Jaclyn L Kovach, Stephen G Schwartz
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    ABSTRACT: The Age-Related Eye Disease Study (AREDS) recommended treatment with antioxidants plus zinc in patients with intermediate or advanced age-related macular degeneration in order to reduce progression risks. Recent pharmacogenetic studies have reported differences in treatment outcomes with respect to variants in genes for CFH and ARMS2, although the treatment recommendations based on these differences are controversial. Different retrospective analyses of subsets of patients from the same AREDS trial have drawn different conclusions. The practicing clinician, who is not an expert on genetics, clinical trial design, or statistical analysis, may be uncertain how to interpret these results. Based on the balance of the available literature, we suggest not changing established practice recommendations until additional evidence from clinical trials becomes available.
    Clinical ophthalmology (Auckland, N.Z.) 01/2015; 9:873-6. DOI:10.2147/OPTH.S84155
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    Stephen G. Schwartz, Christopher T. Leffler
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    ABSTRACT: We compiled uses of the word “macula” in written English by searching multiple databases, including the Early English Books Online Text Creation Partnership, America’s Historical Newspapers, the Gale Cengage Collections, and others. “Macula” has been used: as a non-medical “spot” or “stain”, literal or figurative, including in astronomy and in Shakespeare; as a medical skin lesion, occasionally with a following descriptive adjective, such as a color (macula alba); as a corneal lesion, including the earliest identified use in English, circa 1400; and to describe the center of the retina. Francesco Buzzi described a yellow color in the posterior pole (“retina tinta di un color giallo”) in 1782, but did not use the word “macula”. “Macula lutea” was published by Samuel Thomas von Sömmering by 1799, and subsequently used in 1818 by James Wardrop, which appears to be the first known use in English. The Google n-gram database shows a marked increase in the frequencies of both “macula” and “macula lutea” following the introduction of the ophthalmoscope in 1850. “Macula” has been used in multiple contexts in written English. Modern databases provide powerful tools to explore historical uses of this word, which may be underappreciated by contemporary ophthalmologists.
    Survey of Ophthalmology 11/2014; 59(6). DOI:10.1016/j.survophthal.2014.03.001 · 3.51 Impact Factor
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    ABSTRACT: Endophthalmitis following pars plana vitrectomy is a very uncommon cause of endophthalmitis. Cases reported over the last decade show a decrease in incidence over time. To optimize visual outcome, early diagnosis and treatment are essential. In this review we report a summary of the incidence of endophthalmitis following vitrectomy, various risk factors for their occurrence, the microbiological profile and the visual outcomes post treatment.
    Clinical ophthalmology (Auckland, N.Z.) 10/2014; 8:2183-8. DOI:10.2147/OPTH.S71293
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    Christopher R Henry, Stephen G Schwartz, Harry W Flynn
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    ABSTRACT: A case of Staphylococcus caprae endophthalmitis in a young patient following pars plana vitrectomy for symptomatic vitreous floaters is reported here. Recent literature suggests that there is an increasing trend of performing pars plana vitrectomy for symptomatic floaters. Although rare, the potential risk of endophthalmitis should be explicitly discussed with patients considering surgical intervention for vitreous floaters.
    Clinical ophthalmology (Auckland, N.Z.) 08/2014; 8:1649-53. DOI:10.2147/OPTH.S67855
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    Stephen G Schwartz, Harry W Flynn Jr
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    ABSTRACT: Endophthalmitis remains a rare but serious cause of visual loss. Over time, changes have been noted in endophthalmitis in terms of predominant causes, infecting organisms and antibiotic susceptibilities. There is controversy regarding the use of intracameral prophylactic antimicrobials during cataract surgery. Alternatively, there appears to be increasing evidence against using routine topical antibiotics for intravitreal injections. There are also increasing reports of multidrug-resistant organisms causing endophthalmitis, but the combination of vancomycin and ceftazidime appears effective for the vast majority of cases. Future trends may involve increasing utilization of polymerase chain reaction for diagnosis, and possibly office-based pars plana vitrectomy for treatment of endophthalmitis.
    Expert Review of Ophthalmology 08/2014; DOI:10.1586/17469899.2014.951331
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    Stephen G Schwartz, Harry W Flynn Jr, Ingrid U Scott
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    ABSTRACT: Introduction: Diabetic macular edema (DME) is the most common cause of visual impairment due to diabetic retinopathy. The treatment of DME has recently undergone a paradigm shift. Traditionally, photocoagulation was standard treatment, but pharmacologic therapies are becoming increasingly used for this purpose. All currently available drug therapies for DME are either anti-VEGF agents or corticosteroids.Areas covered: The pathogenesis of DME involves angiogenesis, inflammation and oxidative stress. The scientific rationale to treat DME through the pharmacologic blockade of VEGF and other pro-angiogenic factors is discussed. The fluocinolone insert is approved for the treatment of DME in several European countries, but not in the US at this time. Some medications that are already approved for other retinal diseases, most prominently aflibercept and the dexamethasone delivery system, have recently obtained approval for DME in the US. Other compounds are being studied in earlier-phase clinical trials.Expert opinion: Pharmacologic treatment of DME will likely become increasingly used, especially for patients with edema involving the fovea. At this time, the two main classes of medication for treatment of DME are anti-VEGF agents and corticosteroids. As we continue to collect clinical trials data, the precise role of individual agents, and the continuing role for photocoagulation, will become more clear.
    Expert Opinion on Emerging Drugs 08/2014; 19(3). DOI:10.1517/14728214.2014.938048 · 3.28 Impact Factor
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    ABSTRACT: We tried to identify the earliest cataract surgeons in the English-speaking areas of America. In 1751, couching was performed on the Caribbean island of Montserrat by John Morphy. William Stork of England, who couched cataracts, practiced in Jamaica in 1760 and then in cities from Annapolis to Boston between 1761 and 1764. Frederick William Jericho of Germany, upon completion of his training at Utrecht, published his 1767 treatise on his preferred surgical technique of extracapsular cataract extraction. Jericho had practiced in the Leeward Islands by 1776 and then in cities from Charleston to Boston between 1783 and 1785. The French surgeon Lewis Leprilete was the first to advertise cataract extraction in the United States in 1782 and probably passed on the skill to his protégé, Nathaniel Miller of Massachusetts. Leprilete was also the first to publicize Benjamin Franklin’s invention of bifocals.. These pioneers exposed American doctors and the public to cataract surgery. Shortly after their arrival, evidence emerges of other surgeons performing these procedures in America.
    Survey of Ophthalmology 08/2014; 60(1). DOI:10.1016/j.survophthal.2014.08.002 · 3.51 Impact Factor
  • Stephen G. Schwartz
    Ophthalmology 08/2014; 121(8). DOI:10.1016/j.ophtha.2013.12.046 · 6.17 Impact Factor
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    ABSTRACT: Purpose:Age-Related Macular Degeneration (AMD) is the leading cause of irreversible visual loss in developed countries. Its etiology includes genetic and environmental factors. Although VEGFA variants are associated with AMD, the joint action of variants within the VEGF pathway and their interaction with non-genetic factors has not been investigated. Methods:Affymetrix 6.0 chipsets were used to genotype 668,238 SNPs in 1,207 AMD cases and 686 controls. Environmental exposures were collected by questionnaire. A set-based test was conducted using the chi-square statistic at each SNP derived from Kraft's 2df joint test. Pathway and gene-based test statistics were calculated as the mean of all independent SNP statistics. Phenotype labels were permuted 10,000 times to generate an empirical p-value. Results: While a main effect of the VEGF pathway was not identified, the pathway was associated with neovascular AMD in women when accounting for birth control pill (BCP) use (P= 0.017). Analysis of VEGF's subpathways found that SNPs in the Proliferation subpathway were associated with neovascular AMD (P=0.029) when accounting for BCP use. Nominally significant genes within this subpathway were also observed. Stratification by BCP use revealed novel significant genetic effects in women who had taken BCPs. Conclusions: These results illustrate that some AMD genetic risk factors may only be revealed when considering complex relationships among risk factors. This shows the utility of exploring pathways of previously associated genes to find novel effects. It also demonstrates the importance of incorporating environmental exposures in tests of genetic association at the SNP, gene, or pathway level.
    Investigative Ophthalmology &amp Visual Science 07/2014; 55(8). DOI:10.1167/iovs.14-14494 · 3.66 Impact Factor
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    ABSTRACT: Three English ophthalmic texts of the 1580s were frequently republished: 1) Walter Bailey's A Briefe Treatise Touching the Preseruation of the Eie Sight, 2) The Method of Phisicke, an adaptation of the medieval treatise of Benevenutus Grassus, and 3) A Worthy Treatise of the Eyes, a translation of Jacques Guillemeau's treatise. Their history is intertwined through composite publications, some of which lacked clear attribution. At least 21 editions incorporated these texts. Although not previously realized, major elements of all 3 works are found in Two Treatises Concerning the Preseruation of Eie-sight, first published in 1616. To preserve eyesight, Bailey recommended eyebright (Euphrasia officinalis), fennel (Fæniculum vulgare), and a moderate lifestyle incorporating wine. In the works of Grassus and Guillemeau, cataracts were believed to lie anterior to the 'crystalline humor,' and were treated by the 'art of the needle,' or couching. Links are found between Grassus, Guillemeau, and eighteenth century glaucoma concepts. Although one of his students has traditionally received credit, it was English oculist John Thomas Woolhouse who first combined the early concepts and used the term glaucoma to describe the palpably hard eye in the early eighteenth century. The three primary ophthalmic texts of 1580s England influenced ophthalmic thought for over a century.
    The Open Ophthalmology Journal 05/2014; 8(1):12-8. DOI:10.2174/1874364101408010012
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    Christopher T Leffler, Stephen G Schwartz, Byrd Davenport
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    ABSTRACT: From antiquity through the Renaissance, congenital blindness was generally regarded as incurable, as noted in both medical and lay publications. The earliest reference to congenital cataract surgery that we identified, reported in 1663, referred to an 18-year-old female treated by English oculist John Stepkins (d. 1652). An examination of the literature related to the Stepkins family reveals the presence of male and female oculists during that period, including his daughter, Lady Theodosia Ivy. Eye waters attributed to Stepkins contained tutty (an oxide of zinc), roses, sugar candy, and other ingredients. Interestingly, John Thomas Woolhouse, the author of the next identified report of congenital cataract surgery in 1706, stated that he was related to Stepkins. Woolhouse reported by 1721 that he had performed 36 congenital cataract surgeries, with the youngest patient being 18 months of age.
    Jama Ophthalmology 05/2014; 132(7). DOI:10.1001/jamaophthalmol.2014.519 · 3.83 Impact Factor

Publication Stats

938 Citations
193.15 Total Impact Points

Institutions

  • 2006–2015
    • Bascom Palmer Eye Institute
      Miami, Florida, United States
  • 2009–2014
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
  • 2013
    • Penn State Hershey Medical Center and Penn State College of Medicine
      Hershey, Pennsylvania, United States
  • 2007–2010
    • University of Miami Miller School of Medicine
      Miami, Florida, United States
  • 2002–2003
    • Virginia Commonwealth University
      • Department of Ophthalmology
      Richmond, VA, United States
    • Baylor College of Medicine
      • Department of Ophthalmology
      Houston, TX, United States