Los Angeles, VA, United States
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Kuehlewein L.,Doheny Eye Institute | Kuehlewein L.,Stein Eye Institute | Sadda S.R.,Doheny Eye Institute | Sadda S.R.,Stein Eye Institute | And 3 more authors.
Eye (Basingstoke) | Year: 2015

PurposeTo study the precise structural aspects of a type 2 neovascular membrane in a patient with age-related macular degeneration (AMD) using optical coherence tomography (OCT) angiography and perform sequential quantitative analysis of the membrane after ranibizumab therapy.Patients and methodsSplit-spectrum amplitude-decorrelation (SSADA) OCT angiography macular cubes (3 × 3 mm) were acquired with a light source centered at 840 nm, a bandwidth of 45 nm, and an A-scan-rate of 70 000 scans per second. Visible pathologic vessels were outlined manually on average intensity projection en face images, and the area of the lesion and the vessel density were measured at baseline and follow-up.ResultsAt baseline, the neovascular lesion measured 4.12 mm 2 and the vessel density was 19.83 mm -1. Four weeks after the first, and 2 and 4 weeks after the second ranibizumab injection, OCT angiography revealed a progressively smaller vascular lesion (2.32, 1.77 and 1.64 mm 2), and vessel density (10.24, 8.52 and 7.57 mm -1), although the large central trunks of the lesion were unchanged.ConclusionsIn this study, an obvious reduction in size and vessel density of the neovascular lesion was noted after treatment with ranibizumab using SSADA OCT angiography technology. Microvascular components can be delineated with precision, suggesting that this technique may be useful for the management of patients with neovascular AMD in a clinical setting as well as for future clinical trials. © 2015 Macmillan Publishers Limited.


Mrejen S.,Vitreous Retina Macula Consultants of New York | Mrejen S.,Ear and Throat Hospital | Sarraf D.,University of California at Los Angeles | Sarraf D.,Greater Los Angeles Healthcare Center | And 4 more authors.
Retina | Year: 2013

PURPOSE:: To describe the spectrum of pigment epithelial detachments (PEDs) occurring mainly in age-related macular degeneration and central serous chorioretinopathy and also in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders. METHODS:: Pigment epithelial detachments are divided into drusenoid, serous, vascularized, or mixed categories. RESULTS:: The clinical presentation, classification, and natural history of PEDs are reviewed as illustrated with multimodal imaging combining traditional and novel imaging techniques, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and spectral domain optical coherence tomography. Most PEDs occur because of pathophysiologic mechanisms taking place below the retinal pigment epithelium that are difficult to identify with conventional imaging modalities. Enhanced depth imaging optical coherence tomography and indocyanine green angiography allow a better analysis of the subretinal pigment epithelium compartment. CONCLUSION:: The differentiation between various kinds of PEDs is essential because each PED type is a distinct entity that has a specific pathogenesis, natural history, prognosis, and optimal treatment strategy. © by Ophthalmic Communication Society Inc.


Mendez M.F.,University of California at Los Angeles | Mendez M.F.,Greater Los Angeles Healthcare Center | Joshi A.,University of California at Los Angeles | Tassniyom K.,Khon Kaen University | And 3 more authors.
Neurology | Year: 2013

Objective: To characterize the presenting symptoms and signs of patients clinically diagnosed with behavioral variant frontotemporal dementia (bvFTD) and who had different neuropathologic findings on autopsy. Methods: This study reviewed all patients entered as clinical bvFTD in the National Alzheimer's Coordinating Center's database and who had both clinical and neuropathologic data from 2005 to 2011. Among the 107 patients identified, 95 had unambiguous pathologic findings, including 74 with frontotemporal lobar degeneration (bvFTD-FTLD) and 21with Alzheimer disease (bvFTD-AD). The patients with bvFTD-FTLD were further subdivided into t-positive (n = 23) or t-negative (n = 51) histopathology subgroups. Presenting clinical signs and symptoms were compared between these neuropathologic groups. Results: The patients with bvFTD-FTLD were significantly more likely than patients with bvFTD-AD to have initially predominant personality changes and poor judgment/decision-making. In contrast, patients with bvFTD-AD were more likely than patients with bvFTD-FTLD to have memory difficulty and delusions/hallucinations and agitation. Within the bvFTD-FTLD group, the t-positive subgroup had more patients with initial behavioral problems and personality change than the t-negative subgroup, who, in turn, had more patients with initial cognitive impairment and speech problems. Conclusion: During life, patients with AD pathology may be misdiagnosed with bvFTD if they have an early age at onset and prominent neuropsychiatric features despite having greater memory difficulties and more intact personality and executive functions than patients with bvFTD-FTLD. Among those with FTLD pathology, patients with t-positive bvFTD were likely to present with behavior/personality changes. These findings offer clues for antemortem recognition of neuropathologic subtypes of bvFTD. © 2013 American Academy of Neurology.


Schneider B.,Greater Los Angeles Healthcare Center | Ercoli L.,University of California at Los Angeles | Siddarth P.,University of California at Los Angeles | Lavretsky H.,University of California at Los Angeles
American Journal of Geriatric Psychiatry | Year: 2012

BACKGROUND: Vascular burden is known to contribute to geriatric depression and cognitive impairment. The objective of our study was to evaluate the relationship between vascular burden and pattern of cognitive impairment in older adults with depression. METHODS: Ninety-four community-dwelling older adults (mean age = 70.8 years; SD = 7.63) diagnosed with major depression were recruited to participate in the tai chi complementary use study aimed to improve antidepressant response to an antidepressant medication. All participants received comprehensive evaluations of depression, apathy, and vascular risk factors, and completed a battery of cognitive measures of memory, cognitive control, verbal fluency, and attention. RESULTS: The severity of vascular burden was significantly correlated with depression severity and impaired performance on measures of cognitive control (i.e., inhibition/mental flexibility), and attention, but not memory or verbal fluency. Neither the severity of comorbid apathy nor medical illness burden was related to cognitive impairment. CONCLUSIONS: Vascular burden in older depressed adults contributes to cognitive impairment, particularly in domains of attention and cognitive control. Our findings suggest that aggressive treatment of vascular risk factors may reduce risk for further cognitive decline in depressed older adults. © 2012 American Association for Geriatric Psychiatry.


Rahimy E.,University of California at Los Angeles | Sarraf D.,University of California at Los Angeles | Sarraf D.,Greater Los Angeles Healthcare Center
Ophthalmic Surgery Lasers and Imaging Retina | Year: 2013

The authors report a case of nanoparticle albumin-bound paclitaxel-induced cystoid macular edema (CME) without fluorescein angiographic leakage in a patient being treated for metastatic breast cancer. The CME briskly improved 3 weeks after the chemotherapeutic agent was discontinued and was completely resolved after 6 weeks. Patients receiving taxane therapy must be counseled to report any vision problems during their treatment period because early recognition of this rare but severe adverse event can facilitate appropriate intervention to reverse visual compromise and minimize any potential long-term ophthalmologic sequelae.


Pang C.E.,Vitreous | Pang C.E.,Ear and Throat Hospital | Shah V.P.,Vitreous | Shah V.P.,New York University | And 5 more authors.
American Journal of Ophthalmology | Year: 2014

Purpose To describe the spectrum of ultra-widefield autofluorescence (AF) and indocyanine green (ICG) angiographic findings in central serous chorioretinopathy (CSC). Design Retrospective observational case series. Methods In 37 patients, 65 eyes with CSC from 2 vitreoretinal clinical practices were imaged using ultra-widefield AF and 24 of these eyes with ultra-widefield ICG angiography. Images were correlated with clinical findings and spectral-domain optical coherence tomography (OCT). Results In 37 (57%) eyes, a variety of altered AF patterns, including gravitational tracts, extended beyond the posterior 50 degrees of retina. Hyper-AF corresponded to areas of subretinal fluid (SRF) on spectral-domain OCT and was found to persist in 44 (70%) eyes for up to 8 years despite resolution of SRF. These areas corresponded to outer retinal atrophy with viable retinal pigment epithelium (RPE) on spectral-domain OCT and may be explained by the unmasking of normal background RPE AF. Ultra-widefield ICG angiography revealed dilated choroidal vessels and choroidal hyperpermeability in areas corresponding to altered AF on ultra-widefield AF in all 24 eyes. In 20 (83.3%) eyes, dilated vessels were observed in association with 1 or more congested vortex veins ampullas, suggesting that outflow congestion may be a contributing factor to the pathogenesis of CSC. Conclusions Ultra-widefield AF and ICG angiography in CSC revealed more widespread disease in a single image than with standard field imaging and may be useful for identifying peripheral areas of previous or ongoing SRF and choroidal hyperpermeability that can assist in the diagnosis of CSC, surveillance of recurrent disease and treatment of active disease. © 2014 by Elsevier Inc. All rights reserved.


Sarraf D.,University of California at Los Angeles | Sarraf D.,Greater Los Angeles Healthcare Center | Chan C.,Medical Group | Chan C.,Loma Linda University | And 2 more authors.
Retina | Year: 2013

PURPOSE:: To prospectively determine the incidence and risk factors for retinal pigment epithelial (RPE) tears in eyes with vascularized pigment epithelial detachments (PED) and exudative age-related macular degeneration receiving antivascular endothelial growth factor therapy. METHODS:: Eyes were prospectively randomized into 1 of 4 arms: 1) 0.5 mg of ranibizumab monthly for 12 months; 2) 0.5 mg of ranibizumab monthly for 3 months and then pro re nata on the basis of clinical and optical coherence tomography-guided indications; 3) high-dose 2.0 mg of ranibizumab monthly for 12 months; or 4) 2.0 mg of ranibizumab monthly for 3 months and then pro re nata thereafter. All PEDs were measured for height, greatest linear diameter, and surface area at baseline. The incidence of RPE tears in the entire 4-arm cohort was determined at the end of 12 months. Eyes were divided into two groups (tear vs. nontear) and statistically compared to determine risk factors for the development of RPE tear. RESULTS:: Of 37 eyes, a total of 5 developed postranibizumab RPE tears during the course of the study (incidence 14%). Four of the 5 tears occurred in the high-dose 2.0-mg groups. Baseline PED height, surface area, and greatest linear diameter were significantly greater in the group that developed RPE tears versus the nontear group (P = 0.018, 0.031, and 0.048, respectively). There were significantly more eyes with PED height >550 microns in the RPE tear group (4 of 5, 80%) compared with the nontear group (9 of 32, 18%) (P = 0.042). The presence of PED height >550 microns was associated with an increased tear rate from 14% to 31%. Furthermore, retrospective identification of a ring sign or Grade 1 tear at baseline, in addition to PED height >550 microns, was associated with a further increase in the tear rate to 67%. CONCLUSION:: In this study, the prospective incidence of RPE tears was ∼14%. A baseline PED height >550 microns and presence of a Grade 1 tear, or positive ring sign, were identified as high-risk factors for the subsequent development of an RPE tear. © by Ophthalmic Communications Society, Inc.


Goldman D.,Jules Stein Eye Institute | Freund K.,New York University | McCannel C.,Jules Stein Eye Institute | Sarraf D.,Jules Stein Eye Institute | Sarraf D.,Greater Los Angeles Healthcare Center
Retina | Year: 2013

PURPOSE:: Polypoidal choroidal vasculopathy (PCV) is characterized by polyp-like sub-retinal pigment epithelium vascular abnormalities predominantly found in the macula and peripapillary region. Less commonly, PCV can be found peripherally and be a cause of peripheral exudative hemorrhagic chorioretinopathy (PEHCR). We sought to further describe the clinical spectrum of this ill-defined subgroup of PEHCR. METHODS:: A retrospective observational case series, of 10 eyes of 8 patients diagnosed with PEHCR caused by peripheral PCV, was conducted. In all cases, the presence of PCV was confirmed with indocyanine green angiography and/or fluorescein angiography and optical coherence tomography. The clinical presentation, natural history, and clinical outcomes with or without intervention were studied. RESULTS:: Patients with PEHCR caused by peripheral PCV were most commonly men, white, asymptomatic, and had a concomitant diagnosis of age-related macular degeneration. The mean age was 70 years (range, 59-82 years) with a mean follow-up of 32.5 months (range, 4-91 months). Four patients had unilateral involvement with minimal subretinal hemorrhage that resolved spontaneously, one patient had unilateral involvement outside the macula that responded to anti-vascular endothelial growth factor therapy, one patient had unilateral involvement with subretinal hemorrhage threatening the macula that responded to anti-vascular endothelial growth factor therapy, and two patients had extensive bilateral subretinal hemorrhage requiring surgical intervention. Both patients with multiple lesions in one eye had bilateral lesions (two of eight patients). Lesions were most commonly located in the temporal periphery (8 of 10 eyes). CONCLUSION:: A new subclassification is proposed that includes both eyes with polyps and those without polyps within the spectrum of disease described previously as PEHCR. Within the spectrum of disease described previously as PEHCR exists a subgroup of lesions caused by peripheral PCV, which has not been well defined before this report. The largest case series to date of eyes with PEHCR due to peripheral PCV, a unique form of type 1 neovascularization, is further classified and described. These eyes have a spectrum of disease, including small, medium-sized, and large lesions. Although most eyes with PEHCR from peripheral PCV experience a benign course with spontaneous resolution, a subset of eyes may experience macula-threatening hemorrhage, requiring treatment with laser-based therapies, anti-vascular endothelial growth factor injections, or surgical intervention.


Schneider B.C.,Greater Los Angeles Healthcare Center | Lichtenberg P.A.,Wayne State University
Archives of Clinical Neuropsychology | Year: 2011

Use of normative data stratified by education may result in misclassification of African American older adults because reading ability, an estimate of educational attainment, is lower than reported years of education for some African American elders. This study examined the contribution of reading ability versus education to neuropsychological test performance in 86 community-dwelling African American elders ages 56-91 with 8-18 years of education. Hierarchical multiple regression analyses revealed that reading ability, but not education, was significantly associated with performances on the Trail Making Test, Controlled Oral Word Association Test, Animal Naming, Digit Span, and the Stroop test. Reading ability was not significantly related to performances on measures of memory. Medium to large effect sizes (Cohen's d 1=4 0.58-1.41) were found when comparing mean performances on neuropsychological measures in groups with low versus high reading scores. Results indicate that reading ability contributes beyond educational attainment to performances on some neuropsychological measures among African American elders. These findings have implications for reducing misclassification among minority populations through the use of appropriate normative data. © The Author 2011. Published by Oxford University Press. All rights reserved.


Pang C.E.,Vitreous Retina Macula Consultants of New York | Pang C.E.,Ear and Throat Hospital | Sarraf D.,University of California at Los Angeles | Sarraf D.,Greater Los Angeles Healthcare Center | And 3 more authors.
Retina | Year: 2015

Purpose: To describe the spectral domain optical coherence tomography characteristics of extreme choroidal thinning in high myopia and demonstrate its compatibility with good visual acuity. Methods: This was a retrospective observational case review of nonconsecutive myopic patients with extreme choroidal thinning, defined as a subfoveal choroidal thickness of 20 m or less as measured with spectral domain optical coherence tomography. Clinical features, such as visual acuity, axial length, and spectral domain optical coherence tomography characteristics including choroidal and retinal thicknesses in four quadrants were analyzed. Results: Thirty-six eyes of 20 patients with extreme choroidal thinning were included. Mean subfoveal choroidal thickness was 13.9 ± 6.0 m, mean age was 71 years (range, 32-85 years), mean axial length was 30.7 ± 2.2 mm, and mean follow-up duration was 44.7 ± 15.4 months. Of these, 25 eyes (70%) had visual acuity of 20/40 or better (mean visual acuity was 20/30), whereas the remaining eyes had mean visual acuity of 20/193. All eyes with extreme choroidal thinning had prominent choroidal vessels seen under the macula documented on color fundus photography and near-infrared reflectance imaging. All eyes with visual acuity poorer than 20/40 had fovea-involving choroidal neovascularization and/or atrophy. In the 25 eyes with good visual acuity, the mean choroidal thickness was thinnest at the nasal zone, followed by inferior, superior, and temporal zones (P 0.01); and there was no detectable decrease in choroidal thickness over time. The mean retinal thickness was thinner in the fovea and parafoveal zones when compared with highly myopic eyes without extreme choroidal thinning. Conclusion: Extreme choroidal thinning in myopic eyes is compatible with good visual acuity of 20/40 or better, may be present in a wide age range, and may not demonstrate any progressive decline over up to 70 months of follow-up; suggesting that choroidal thickness alone is not a reliable indicator of visual function.

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