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Kane M.A.C.,Manhattan Eye | Cox S.E.,University of North Carolina at Chapel Hill | Jones D.,University of California at Los Angeles | Lei X.,Allergan, Inc. | Gallagher C.J.,Allergan, Inc.
Dermatologic Surgery | Year: 2015

BACKGROUND Patterns of crow's feet lines (CFLs) vary among individuals. OBJECTIVE To characterize distribution and predictors of CFL patterns. METHODS Patterns of CFLs (full fan, lower fan, central fan, and upper fan) were evaluated at maximum smile and at rest from photographs of subjects with moderate-to-severe CFLs. Relationships between CFL pattern and severity, age, gender, and subject-reported outcomes were explored. RESULTS Evaluations of 2,699 photographs from 1,392 subjects were conducted; 1,389 and 1,310 had evaluable CFL patterns at maximum smile and at rest, respectively. Lower-fan, central-fan, and full-fan patterns were identified in 28.4% to 34.7% at maximum smile and 27.7% to 33.9% at rest; upper fan was found in 5%. The pattern distribution of CFLs demonstrated a relationship to baseline CFL severity, age, and gender; full-fan and lower-fan patterns were more common in severe versus moderate CFL at maximum smile; full fan increased with age. Lower fan was more common in males. Subjects with full fan at maximum smile were most dissatisfied with their appearance and perceived themselves to look older versus other patterns. CONCLUSION Baseline CFL severity, age, and gender may predict fan pattern. Patterns may progress with age from central to lower fan or full fan. Pattern heterogeneity of CFLs suggests that tailored treatment may be warranted. © 2015 by the American Society for Dermatologic Surgery, Inc. Source


Su D.,Einhorn Clinical Research Center | Greenberg A.,Einhorn Clinical Research Center | Simonson J.L.,Einhorn Clinical Research Center | Teng C.C.,Yale University | And 3 more authors.
Ophthalmology | Year: 2016

Purpose To investigate the efficacy of the Amsler grid test in detecting central visual field (VF) defects in glaucoma. Design Prospective, cross-sectional study. Participants Patients with glaucoma with reliable Humphrey 10-2 Swedish Interactive Threshold Algorithm standard VF on the date of enrollment or within the previous 3 months. Methods Amsler grid tests were performed for each eye and were considered "abnormal" if there was any perceived scotoma with missing or blurry grid lines within the central 10 degrees ("Amsler grid scotoma"). An abnormal 10-2 VF was defined as ≥3 adjacent points at P < 0.01 with at least 1 point at P < 0.005 in the same hemifield on the pattern deviation plot. Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area were calculated with the 10-2 VF as the clinical reference standard. Among eyes with an abnormal 10-2 VF, regression analyses were performed between the Amsler grid scotoma area and the 10-2 VF parameters (mean deviation [MD], scotoma extent [number of test points with P < 0.01 in total deviation map] and scotoma mean depth [mean sensitivity of test points with P < 0.01 in total deviation map]). Main Outcome Measures Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area. Results A total of 106 eyes (53 patients) were included (mean ± standard deviation age, 24-2 MD and 10-2 MD = 66±12 years, -9.61±8.64 decibels [dB] and -9.75±9.00 dB, respectively). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid test were 68%, 92%, 97%, and 46%, respectively. Sensitivity was 40% in eyes with 10-2 MD better than -6 dB, 58% in eyes with 10-2 MD between -12 and -6 dB, and 92% in eyes with 10-2 MD worse than -12 dB. The area under the receiver operating characteristic curve of the Amsler grid scotoma area was 0.810 (95% confidence interval, 0.723-0.880, P < 0.001). The Amsler grid scotoma area had the strongest relationship with 10-2 MD (quadratic R2=0.681), followed by 10-2 scotoma extent (quadratic R2=0.611) and 10-2 scotoma mean depth (quadratic R2=0.299) (all P < 0.001). Conclusions The Amsler grid can be used to screen for moderate to severe central vision loss from glaucoma. © 2016 by the American Academy of Ophthalmology Published by Elsevier Inc. Source


Zhang X.,Capital Medical University | Zhang X.,University of Sydney | Wang N.,Capital Medical University | Barile G.R.,Manhattan Eye | And 2 more authors.
International Journal of Biochemistry and Cell Biology | Year: 2013

Diabetic retinopathy (DR) has mainly been regarded as a microvascular disease that is caused by hyperglycaemia and characterized by retinal vascular leakage, macular oedema and preretinal neovascularisation. Increasing clinical evidence from electroretinographic, contrast sensitivity, perimetric, and colour vision studies suggest that neuronal changes may occur prior to clinically detectable microvasculopathy. Thus, there may be a primary neurodegenerative process which contributes to loss of vision in DR. Neuronal apoptosis in DR has been reported both in vivo and in vitro. Consequently, neuroprotection in DR may be a valuable therapeutic target. This review outlines the recent new concepts of neurodegeneration in the pathogenesis of DR, particularly emphasising its potential for new therapeutic approaches. © 2013 Elsevier Ltd. Source


Kane M.A.C.,Manhattan Eye
Plastic and Reconstructive Surgery | Year: 2015

Background: There is a high patient demand for periorbital rejuvenation because the periorbita are often the first facial areas to show visible signs of aging. In addition to rhytides and skin laxity, aging appearance of the periorbital area is caused by changes in tissue volume resulting from soft-tissue atrophy and bone loss in the aging face. These changes are among the easiest areas to correct using several noninvasive techniques. The author uses three different techniques in his practice. Methods: The author shares his experience using three different techniques for nonsurgical periorbital rejuvenation. Results: Patients develop unique crow's feet lines, and treatment with toxins should be adapted to each particular pattern. Low doses generally produce a more natural appearance than high doses. Using hyaluronic acid fillers, three tissue layers within the periorbita can be injected to produce maximally beneficial results and minimize the risk of adverse events. Filling tear troughs depends on whether they occurred early in life or are age-related. The key to avoiding complications is a careful patient analysis and a slow technique. Conclusions: One deformity should not be singled out when rejuvenating the periorbita. The best results are obtained when the entire periorbital area is treated at the same time. Copyright © 2014 by the American Society of Plastic Surgeons. Source


Background: Currently available technologies for performing aesthetic body sculpting are either noninvasive but require multiple treatments to achieve relatively superficial effects or very effective but also invasive and sometimes associated with serious complications. A new, noninvasive alternative is to ablate adipose tissue using high-intensity focused ultrasound (HIFU). When focused within subcutaneous adipose tissue, HIFU quickly raises the local temperature, resulting in instantaneous cell death via coagulative necrosis within the targeted area but no damage to the surrounding tissue. Methods: A new HIFU device, the LipoSonix system (Medicis Technologies Corporation, Bothell, WA, USA), was used by our clinic staff to reduce waist circumference via removal of excess adipose tissue from the anterior abdomen and flank areas. This report describes the results of a retrospective chart review of patients at one clinic who underwent HIFU treatment of the anterior abdomen and flank areas. Results: A total of 85 men and women with a mean age of 43.8 years underwent a single HIFU treatment session. The time required to complete treatment was approximately 1 to 1.5 h. Using a mean energy level of 134.8 J/cm2 and a focal depth of 1.1 to 1.6 cm, the waist circumference was decreased by an average of 4.6 cm after 3 months. Of the 85 patients, 10 (11.8%) reported adverse events including prolonged tenderness (n = 3), ecchymosis (n = 3), hard lumps (n = 2), edema (n = 1), and pain (n = 1), which resolved spontaneously. Conclusions: The authors conclude from their experience that HIFU represents a safe and effective means for performing noninvasive body sculpting. © 2010 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery. Source

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