Publications by authors named "Aakriti Garg Shukla"

11 Publications

  • Page 1 of 1

iStent versus iStent inject implantation combined with phacoemulsification in open angle glaucoma.

Indian J Ophthalmol 2021 Sep;69(9):2488-2495

Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Purpose: To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification.

Methods: This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure.

Results: One hundred ninety-seven eyes of 148 patients were included (122 iStent, 75 iStent inject). Both groups achieved significant IOP and medication reduction at months 6/12 (P < 0.05). At month 6, IOP was significantly lower in iStent inject vs. iStent eyes (P = 0.003), but the difference was insignificant by month 12 (P = 0.172). Medication number was comparable in both groups at months 6/12 (P > 0.05). More iStent inject eyes achieved IOP ≤15 mmHg at month 6 (P = 0.003) and 12 (P = 0.047). Surgical success was comparable in both groups at months 6/12 (P > 0.05). Kaplan-Meier survival analysis showed similar cumulative rate of surgical failure at year-1 in both groups (P = 0.644). The multivariate model identified older age (P = 0.017) and lower baseline IOP (P = 0.002) as the strongest predictors of surgical failure.

Conclusion: Compared to iStent, iStent inject achieved lower IOP at month 6 and higher proportion of eyes achieved IOP ≤15 mmHg at month 6/12. However, surgical success was similar in both groups. Predictors of surgical failure were older age and lower baseline IOP rather than the stent type.
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http://dx.doi.org/10.4103/ijo.IJO_308_21DOI Listing
September 2021

Female Editorial Authorship Trends in High-Impact Ophthalmology Journals.

JAMA Ophthalmol 2021 Aug 12. Epub 2021 Aug 12.

Wills Eye Hospital, Philadelphia, Pennsylvania.

Importance: Individuals with perceived experience and expertise are invited by editorial boards to provide commentary through editorials. Female representation among editorialists is not yet defined.

Objective: To determine female representation as editorial authors in 3 high-impact general ophthalmology journals.

Design, Setting, And Participants: This cross-sectional study investigates the proportion of female authorship in editorials published between 2005 to 2009 and 2015 to 2019 in 3 journals: Ophthalmology, JAMA Ophthalmology, and American Journal of Ophthalmology. Data were collected from April to June 2020.

Main Outcomes And Measures: Proportions of female first and senior (last or solo) authors between 2005 to 2009 compared with 2015 to 2019. Secondary outcome measures include representation by sex across degree types and subspecialties. Comparisons were made for all editorialists and ophthalmologist editorialists.

Results: Of 814 editorial articles, there were 1179 (first and senior) authors identified. Women held 301 (25.5%) of these authorships, including 116 of 365 first authorships (32.9%) and 185 of 814 senior authorships (23.9%). Overall, female first and senior authorships grew by 68.0% between 2005 to 2009 and 2015 to 2019 (85 of 469 [18.1%] vs 216 of 710 [30.4%]; difference, 12.3%; 95% CI, 7.4-317.2; P < .001). Between 2005 to 2009 and 2015 to 2019, first and senior authorships by women increased (first: 33 of 133 [24.8%] vs 83 of 232 [35.8%]; difference, 11.0%; 95% CI, 1.4-320.6; P = .03; senior: 52 of 336 [15.5%] vs 133 of 478 [27.8%]; difference, 12.3%; 95% CI, 6.8-317.9; P < .001). JAMA Ophthalmology most substantially contributed to the increase in female first and senior authorships (13.8% and 16%), although the test for homogeneity among the 3 journals was not significant. The proportion of female ophthalmologist first authors was greater than the proportion of American Board of Ophthalmology-certified female ophthalmologists (81 of 281 [28.9%] vs 123 of 672 [18.3%]; difference, 10.6%; 95% CI, 5.3-315.9; P < .001).

Conclusions And Relevance: The proportion of female senior authors increased by 68.0% between 2005 to 2009 and 2015 to 2019, but female authors represented only 25.5% of editorialists. Compared with male ophthalmologists, female ophthalmologists were more commonly first than senior authors. Additionally, female authors were more likely to be nonophthalmologists or to hold nonmedical, non-PhD degrees. While the swelling rank of female editorialists has paralleled the rising proportion of female ophthalmologists over time, parity by sex has yet to be attained. Greater awareness of disparities and strategies to mitigate them may help equalize representation.
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http://dx.doi.org/10.1001/jamaophthalmol.2021.3027DOI Listing
August 2021

Urgent and emergent glaucoma care during the COVID-19 pandemic: An analysis at a tertiary care hospital in South India.

Indian J Ophthalmol 2021 Aug;69(8):2215-2221

Wilmer Eye Institute, Baltimore, MD, USA.

Purpose: To describe the demographic profiles, clinical characteristics, and clinical outcomes of patients presenting with glaucoma emergencies during the COVID-19 lockdown in India.

Methods: This retrospective, cross-sectional, observational case series involved review of medical records of all patients presenting to the glaucoma service during the COVID-19 lockdown period and comparison with the previous year (March 23 to June 23, 2020 Vs 2019) in a tertiary center in India.

Results: We found a 78.9% reduction in overall outpatient visits (54,345 vs. 257,339; P < 0.001) and 80.9% reduction in the number of glaucoma outpatient visits (4,788 vs. 25,083; P < 0.001). Additionally, the proportion of true glaucoma emergency visits significantly increased by 62.4% in 2020 Vs 2019 (1,408/4,788 (29.4%) vs. 4,542/25,083 (18.1%); P < 0.001). Lens-induced glaucomas were the most common glaucoma surgical emergency (13.4%) in 2020. Moreover, comparison of procedures demonstrated a proportionate decrease in incisional glaucoma surgeries (70/115 (60.86%) vs. 806/939 (85.83%); P < 0.001) and an increase in the proportion of emergency cataract surgeries (129/475 (27.15%) vs. 170/2715 (6.26%); P < 0.001) and transscleral cyclophotocoagulation (45/115 (39.13%) vs. 133/939 (14.16%); P = 0.0001) during 2020 vs. 2019.

Conclusion: Our study demonstrated a 62% increase in the proportion of visits that were true glaucoma emergencies. Additionally, the proportions of emergency cataract surgeries increased by 4.3 times and the proportion of transscleral cyclophotocoagulation increased by 2.8 times during the pandemic. More nonincisional procedures and less diagnostic testing were performed to minimize postoperative visits and virus transmission. Further understanding of the profile of emergencies may help in developing novel strategies to anticipate future challenges in managing glaucoma care during subsequent waves of the pandemic.
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http://dx.doi.org/10.4103/ijo.IJO_635_21DOI Listing
August 2021

The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment.

Am J Ophthalmol 2021 07 27;227:53-65. Epub 2021 Mar 27.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA. Electronic address:

Purpose: TO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight.

Design: Prospective cross-sectional comparative study.

Methods: Setting: institutional.

Patients: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma.

Procedure: telephone questionnaires.

Main Outcome Measures: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure.

Results: Surveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age (P = .008) and lower education level (P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P = .045), were concerned about access to health care (P <.001), obtained news through word of mouth (P <.001), and less commonly wore masks (P = .003). Controls more commonly performed frequent handwashing (P = .001), were aware of telemedicine (P = .029), and had fewer concerns about social interactions (P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began.

Conclusions: The pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.
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http://dx.doi.org/10.1016/j.ajo.2021.03.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997933PMC
July 2021

Reoperation for complications within 90 days of minimally invasive glaucoma surgery.

J Cataract Refract Surg 2021 Jul;47(7):886-891

From the Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania (Shalaby, Myers, Lee, Razeghinejad, Kolomeyer, Katz, Shukla); Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt (Shalaby); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Bechay).

Objective: To describe reoperations that occurred within 90 days of minimally invasive glaucoma surgery (MIGS) at a single institution over a 30-month period.

Setting: Tertiary care hospital.

Design: Retrospective case series.

Methods: Charts of adult patients who underwent trabecular microbypass stents, gel microstents, and goniotomy procedures (including gonioscopy-assisted transluminal trabeculotomy) from October 1, 2017, to March 15, 2020, at Wills Eye Hospital were examined. Outcome measures were unanticipated reoperations within the first 90 days after MIGS procedures and the complications that led to these reoperations.

Results: A total of 448 MIGS procedures were performed on 436 eyes of 348 patients over a 30-month period by 6 glaucoma surgeons. Of these, 206 (46.0%) were trabecular microbypass stents (198 iStent/iStent inject and 8 Hydrus), 152 (33.9%) were gel microstents, and 90 (20.1%) were goniotomy procedures. Combined phacoemulsification took place in 256 eyes (58.7%). Reoperation within 90 days took place in 23 (5.3%) of 436 eyes, including 16 (10.5%) of 152 eyes in the gel microstent group, 4 (2.0%) of 198 eyes in iStent/iStent inject group, and 3 (3.3%) of 90 eyes in the goniotomy group. Indications for reoperation were elevated intraocular pressure (IOP) in 16 (69.6%) of 23 eyes, gel microstent tip exposure with wound leakage in 3 (13.0%) of 23 eyes, and early gel microstent encapsulation without elevated IOP in 1 (4.3%) of 23 eyes. Two (8.7%) of 23 eyes required reoperation for intraocular lens complications, whereas 1 (4.3%) of 23 eyes had elevated IOP and aphakia requiring reoperation.

Conclusions: The rate of reoperation within the first 90 days after MIGS was low. Elevated IOP and complications associated with gel microstents were the main indications for reoperation.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000545DOI Listing
July 2021

Gender Compensation Gap for Ophthalmologists in the First Year of Clinical Practice.

Ophthalmology 2021 Jul 26;128(7):971-980. Epub 2020 Nov 26.

NYU Grossman School of Medicine, NYU Langone Health, New York, New York. Electronic address:

Purpose: To identify the role of gender and other factors in influencing ophthalmologists' compensation.

Design: Cross-sectional study.

Participants: U.S. practicing ophthalmologists.

Methods: Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables.

Main Outcome Measures: Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus.

Results: Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P = 0.00). The PSM analysis showed an SWB difference of -$27 273.89 (10.3% gap, P = 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (-$27 793.67 [10.5% gap, P = 0.0013]) and clinic days (-$23 597.57 [8.90% gap, P = 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22 261.49, $-18 604.65, and $-16 191.26, respectively; P = 0.017, P = 0.015, P = 0.002, respectively). Gender independently predicted income in all 3 analyses (P < 0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P = 0.03).

Conclusions: Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.
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http://dx.doi.org/10.1016/j.ophtha.2020.11.022DOI Listing
July 2021

Early Experience with Netarsudil in Pediatric Patients: A Retrospective Case Series.

Ophthalmol Glaucoma 2021 Mar-Apr;4(2):232-234. Epub 2020 Oct 14.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania. Electronic address:

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http://dx.doi.org/10.1016/j.ogla.2020.10.005DOI Listing
October 2020

Outcomes of Valved and Nonvalved Tube Shunts in Neovascular Glaucoma.

Ophthalmol Glaucoma 2021 Mar-Apr;4(2):182-192. Epub 2020 Sep 18.

Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania. Electronic address:

Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV; New World Medical Inc) and Baerveldt glaucoma implant (BGI; Advanced Medical Optics) surgery in the setting of neovascular glaucoma (NVG).

Design: Single-center, retrospective study.

Participants: Consecutive patients who underwent AGV or BGI surgery for the treatment of NVG and had ≥6 months of follow-up.

Methods: Chart review of AGV and BGI surgical outcomes in patients with NVG.

Main Outcome Measures: Progression to no light perception (NLP) vision and 6-month surgical failure, which was defined as intraocular pressure (IOP) >21 mmHg with medications or <5 mmHg at 2 consecutive visits, or glaucoma reoperation.

Results: A total of 152 eyes (91 AGV, 61 BGI) were included with an average follow-up of 29.6 ± 25.8 months. Baseline demographics and clinical characteristics were comparable between groups. At month 6, failure was similar between AGV and BGI eyes (21.6% vs. 25.9%; P = 0.552), but glaucoma medication use was lower in BGI eyes (P < 0.001). At the final visit, 18.7% of AGV and 14.8% of BGI eyes progressed to NLP vision (P = 0.530), and medication use was lower in BGI eyes (P < 0.0001). Multivariate analysis identified lower preoperative visual acuity (VA) (P = 0.001), failure to receive panretinal photocoagulation within 2 weeks of surgery (P = 0.003), and bilaterality of the underlying ischemic retinal pathology (P = 0.026) as the strongest predictors of NLP outcome. Age, sex, race, NVG etiology, tube type, preoperative IOP, extent of synechial angle closure preoperatively, preoperative hyphema, IOP at the first NLP visit, and final IOP were not significant predictors of NLP vision.

Conclusions: Eyes with AGV and BGI had comparable outcomes in NVG, although fewer medications were required in BGI eyes to control IOP. Progression to NLP vision was associated with poor baseline VA, delayed retinal treatment, and bilaterality of the underlying ischemic retinal pathology.
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http://dx.doi.org/10.1016/j.ogla.2020.09.010DOI Listing
September 2020

Transscleral Cyclophotocoagulation for Glaucoma in the Setting of Uveal Melanoma.

Ophthalmol Glaucoma 2020 Sep 19. Epub 2020 Sep 19.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.ogla.2020.09.011DOI Listing
September 2020
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