Joshua Robinson

Stature and robusticity during the agricultural transition: Evidence from the bioarchaeological record

The population explosion that followed the Neolithic revolution was initially explained by improved health experiences for agriculturalists. However, empirical studies of societies shifting subsistence from foraging to primary food production have found evidence for deteriorating health from an increase in infectious and dental disease and a rise in nutritional deficiencies. In Paleopathology at the Origins of Agriculture (Cohen and Armelagos, 1984), this trend towards declining health was observed for 19 of 21 societies undergoing the agricultural transformation. The counterintuitive increase in nutritional diseases resulted from seasonal hunger, reliance on single crops deficient in essential nutrients, crop blights, social inequalities, and trade. In this study, we examined the evidence of stature reduction in studies since 1984 to evaluate if the trend towards decreased health after agricultural transitions remains. The trend towards a decrease in adult height and a general reduction of overall health during times of subsistence change remains valid, with the majority of studies finding stature to decline as the reliance on agriculture increased. The impact of agriculture, accompanied by increasing population density and a rise in infectious disease, was observed to decrease stature in populations from across the entire globe and regardless of the temporal period during which agriculture was adopted, including Europe, Africa, the Middle East, Asia, South America, and North America.

Multimodal Imaging Of West Nile Virus Chorioretinitis

Purpose: To report the results of multimodal imaging of West Nile virus chorioretinitis. Methods: Three patients with West Nile virus chorioretinitis were evaluated by color fundus photography, fluorescein angiography, enhanced depth optical coherence tomography, indocyanine green angiography, and fundus autofluorescence. Results: Imaging results demonstrate outer retinal and retinal pigment epithelial involvement with inner retinal sparing. Conclusion: Multiple fundus imaging modalities used during the diagnosis of West Nile chorioretinitis are consistent with outer retinal and pigment epithelial changes, suggesting outer retina and retinal pigment epithelium as the primary sites of ocular involvement.

Longitudinal optical density analysis of subretinal fluid after surgical repair of rhegmatogenous retinal detachment.

Purpose: To investigate optical coherence tomography–derived reflectivity and optical density (OD) characteristics of persistent subretinal fluid (SRF) in eyes after surgical repair of macula-off rhegmatogenous retinal detachment. Methods: Retrospective case series of nine eyes with macula-off rhegmatogenous retinal detachment that underwent surgical repair with either scleral buckling or vitrectomy with or without scleral buckling. Major inclusion criteria included 1) availability of high-quality optical coherence tomography scans at 2 or more time points, and 2) sufficient SRF for optical coherence tomography sampling without including tissue edges. Demographic, clinical, and optical coherence tomography imaging data were collected on all eyes. Optical density and SRF height measurements were obtained using a manual image segmentation method with ImageJ. Optical density measurements were standardized by conversion to optical density ratios to facilitate comparison between different visits and eyes. Correlations were assessed for significance through both univariate and multivariate regression analyses. Results: Optical density ratio measurements increased with time after surgery, and this was statistically significant (P = 0.001, R2 = 0.331). Subretinal fluid height measurements decreased in all eyes. There was a significant correlation between optical density ratios and log of SRF height (P ⩽ 0.001, R2 = 0.485). In multivariate analysis, neither optical density ratios nor SRF height was a statistically significant predictor of visual acuity. Conclusion: Changes in optical density ratios of the residual SRF after retinal detachment repair may be representative of changes in the SRF composition over time. This is in agreement with previous biochemical studies and may serve as a noninvasive method of assessing SRF content in vivo.

Long-term outcomes on lens clarity after lens-sparing vitrectomy for retinopathy of prematurity.

OBJECTIVE To describe the long-term effect of lens-sparing vitrectomy surgery for advanced retinopathy of prematurity (ROP) on lens clarity. DESIGN Retrospective case series at a single tertiary referral pediatric vitreoretinal practice. PARTICIPANTS Four hundred ninety-six eyes from 351 patients were included. METHODS A retrospective chart review was conducted of patients with diagnosis of ROP stage 4A, 4B, and 5 who underwent lens-sparing vitrectomy (LSV) between 1992 and 2013. Data were collected from patient charts, including gender, date of birth, gestational age at birth, birthweight, stage of ROP at presentation, initial treatment (laser or cryotherapy), date of LSV, date of lensectomy (if performed), lens status at time of lensectomy, date of last visit, lens status at last visit, subsequent retinal surgeries, and retinal attachment status at last visit. Patients were excluded if any surgery had been performed at an outside institution before referral, or if a scleral buckle had been placed. Eyes with a concurrent anatomic abnormality, such as coloboma or microcornea, or a known family history of familial exudative vitreoretinopathy (FEVR), were also excluded. MAIN OUTCOME MEASURES Retinal reattachment after LSV, lensectomy after LSV, lens opacity at the time of lensectomy, and lens clarity at last follow-up. RESULTS Four hundred ninety-six eyes from 351 patients met inclusion criteria for this study. The reattachment rate after a single LSV surgery was 82.1% for stage 4A, 69.5% for stage 4B, and 42.6% for stage 5. Subsequent retinal surgeries were required in 19.8% of eyes, with 88.7% of them including a lensectomy. Among eyes requiring lensectomy, 75% occurred within the first year after LSV surgery. Lens opacities were present in 26.6% of eyes at the time of lensectomy. Of all eyes in this series, 5.9% required lensectomy because of lens opacity. CONCLUSIONS This study demonstrates that lens clarity is observed in most eyes after LSV surgery for advanced ROP for the patients childhood. Within the first decade of life, if necessary, lensectomy after LSV occurred mostly within 1 year following LSV.

Vitrectomy After ocriplasmin for VitreOmacular adhesion Or Macular hole (VAVOOM) study

Background/aims To describe the results of pars plana vitrectomy (PPV) for persistent symptomatic vitreomacular traction (VMT) with or without macular hole (MH) after intravitreal ocriplasmin injection. Methods Multicentre retrospective study of eyes that received intravitreal ocriplasmin between January 2013 and January 2014 for symptomatic VMT with or without MH, and then went on to PPV (ocriplasmin-treated group) for persistent pathology, compared with a control group of patients with symptomatic VMT with or without MH who were offered ocriplasmin injection but proceeded directly to PPV (PPV-only group). Intraoperative characteristics, visual acuity (VA) outcomes and spectral-domain optical coherence tomography images were reviewed for the two groups. Primary outcome measure was VA after PPV. Results 51 eyes of 51 patients underwent PPV after receiving ocriplasmin, and 22 eyes of 22 patients proceeded directly to PPV. Although VA was significantly better at all time points in the PPV-only compared with the ocriplasmin-treated group, at 3 and 6 months after PPV both groups had similar amount of visual improvement. Both groups had similar rates of pathology resolution; 50/51 (98%) eyes in the ocriplasmin group and 22/22 (100%) eyes in the PPV-only group had release of VMT and/or MH closure after PPV. The two groups had similar PPV-related complication rates. Conclusions Eyes with persistent symptomatic VMT and/or MH have similarly high rates of pathology resolution as well as similar VA gains regardless of whether they received ocriplasmin prior to PPV.

WIDE-FIELD IMAGING OF NONEXUDATIVE AND EXUDATIVE CONGENITAL X-LINKED RETINOSCHISIS.

Purpose: To describe wide-field imaging features of patients with congenital X-linked retinoschisis. Methods: This is a retrospective nonconsecutive series of 36 eyes from 18 patients with congenital X-linked retinoschisis from 2008 to 2014. Wide-field color fundus photographs, optical coherence tomography images, and wide-field fluorescein angiography images were reviewed. Patients were classified to have either exudative or nonexudative retinoschisis based on the presence or absence of lipid exudates. Results: Eleven eyes exhibited exudative retinoschisis (30%), whereas the remaining were nonexudative. Exudative disease occurred more commonly in older patients (14.4 vs. 4.0 years; P < 0.001). The most frequent location of exudation was the macula. Subretinal hemorrhage was present in 4 eyes (11%). Macular findings included an atypical foveal avascular zone in 7 eyes (19%) and submacular fibrosis or retinal folds in 6 eyes (17%). Peripheral characteristics included fibrosis or folds (11%), bridging vessels (8%), and vascular sheathing (8%). Thirteen of the 22 eyes (59%) demonstrated leakage on fluorescein angiography. Conclusion: Exudation may be more common in congenital X-linked retinoschisis than previously recognized. The presence of exudates with concurrent angiographic leakage suggests that exudation may be due to chronic vascular permeability and not solely caused by intraschisis hemorrhage, which has been classically described.

Peripheral Retinal Ischemia, Neovascularization, and Choroidal Infarction in Wyburn-Mason Syndrome

Peripheral Retinal Ischemia, Neovascularization, and Choroidal Infarction in Wyburn-Mason Syndrome Wyburn-Mason syndrome is a unilateral, sporadic disorder characterized by arteriovenous malformations (AVMs) of the retina, face, and central nervous system. Clinically, these lesions often manifest as dilated, tortuous retinal vessels.1 We report a complication of Wyburn-Mason syndrome, peripheral retinal neovascularization, that has not yet been described to our knowledge. Additionally, we present an iatrogenic consequence consisting of extensive retinal and choroidal ischemia after intra-arterial embolization therapy for posterior intracranial AVM extension. Report of a Case | A boy was referred for vascular abnormalities in the right eye. On examination, visual acuity was counting fingers OD and 20/20 OS. Adnexal examination findings were notable for facial telangiectasias in the right V2 distribution. Intraocular pressure and anterior segment examination findings were unremarkable. Examination revealed dilated, tortuous arteriovenous vessels emanating from the right optic nerve, consistent with Wyburn-Mason syndrome, and a normal left eye. During the next 2 years, visual acuity of the right eye progressed to no light perception. Computed tomography demonstrated posterior extension of the AVM into the right optic nerve, chiasm, and tract. The ocular examination findings were unchanged and the patient was referred to pediat-

Review of the latest treatments for retinopathy of prematurity: laser photo-ablation versus intravitreal anti-VEGF agents in the management of high-risk pre-threshold (type 1) disease

From a global perspective, retinopathy of prematurity (ROP) remains a major cause of visual impairment and blindness. For the past several decades, peripheral retinal laser photo-ablation has been, and currently remains the gold standard for the treatment of high-risk ROP. More recently, suppression of VEGF by way of intravitreal injection of bevacizumab has emerged as a promising approach to manage high-risk ROP. Currently, however, there remain many unanswered questions regarding its dosing, safety and long-term efficacy that preclude the universal adoption of intravitreal bevacizumab as the primary treatment modality for high-risk ROP.

Macular Development in Aggressive Posterior Retinopathy of Prematurity

Purpose. To report anatomic outcomes after early and confluent laser photocoagulation of the entire avascular retina, including areas in close proximity to the fovea, in patients with APROP. We aspire to demonstrate fundoscopic evidence of transverse growth and macular development following laser treatment in APROP. Methods. Retrospective review of 6 eyes with APROP that underwent confluent laser photocoagulation of the entire avascular retina. Photographic fundoscopic imaging was performed using the RetCam to compare outcomes after treatment. Results. Mean birth weight and gestational age were 704.8 g and 24.33 weeks, respectively. There were 2 females and 1 male. The average time to laser was 9.3 weeks after birth, with the mean postmenstrual age of 34 weeks. Two eyes had zone 1 and 4 eyes had posterior zone 2 disease. Three eyes developed 4A detachments, which were successfully treated. All 6 eyes experienced transverse growth, with expansion of the posterior pole and anterior displacement of the laser treatment. Conclusion. Confluent photocoagulation of the entire avascular retina, regardless of foveal proximity, should be the mainstay for treating APROP. Examination should be conducted within 5–10 days to examine areas previously hidden by neovascularization to ensure prudent therapy. Macular development involves both transverse and anterior-posterior growth.