Publications by authors named "Sasha Hubschman"

7 Publications

  • Page 1 of 1

Evaluation of Available Online Information Regarding Treatment for Vitreous Floaters.

Semin Ophthalmol 2021 Feb 18;36(1-2):58-63. Epub 2021 Feb 18.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.

Objective: To assess the quality, content, and readability of information available online on vitreous floater information.

Design: Cross-sectional study.

Participants: Not applicable.

Methods: Websites were generated using a Google search of "vitreous floaters treatment" and "[State]" and were analyzed using a standardized checklist of 22 questions. Readability was assessed using the Flesch Reading Ease score. Websites met qualification criteria if they represented U.S.-based institutions, if they provided clinical care and addressed vitreous floater treatment on their website.

Results: Of the 1,065 websites screened, 456 were included. Of these, 406 (89%) were private institutions, 24 (5.3%) were academic, and 26 (5.7%) were a combination of private and academic. The average readability score correlated to a 10th-12th grade reading level. Vitreous floater treatment was discussed on 283 (62.1%) websites and 63 (21.8%) websites discussed potential side effects. Google rank was inversely correlated with the depth of explanation (r = -0.114, = .016). Observation was the main treatment recommended (55.8%, n = 158), followed by laser treatment (27.6%, n = 78), no specific treatment recommendation (11.3%, n = 32), and vitrectomy (5.3%, n = 15). Centers with vitreoretinal surgeons were 16.43 times more likely to recommend vitrectomy than those without vitreoretinal surgeons ( < .001).

Conclusions: Online information about vitreous floater treatment is variable, and the material is at a higher than recommended reading level for health information. While treatment was discussed by nearly two thirds of websites, less than a quarter mentioned possible complications, and treatment recommendations varied significantly depending on physician training.
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February 2021

Effect of Funding Source on "Spin" in Studies of Ocriplasmin Therapy for Vitreomacular Traction and Macular Hole.

Clin Ophthalmol 2020 13;14:81-88. Epub 2020 Jan 13.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.

Purpose: To examine the relationship between industry funding and "spin" in randomized controlled trials (RCTs) and meta-analyses investigating use of ocriplasmin for patients with vitreomacular traction (VMT) and macular hole (MH).

Methods: In this study, we examined all PubMed and Ovid MEDLINE RCTs and meta-analyses published in journals with impact factor ≥2 investigating effectiveness of ocriplasmin use for VMT and MH. The main outcome measure was correspondence between the studies' main statistical outcome and their abstract conclusion wording. Each article was reviewed by three independent observers and was evaluated for source of funding, industry co-authorship, study methodology, statistical significance of main outcome measure, correspondence between results of main outcome measure and abstract conclusion, and journal impact factor. Funding was determined by public disclosure. Discrepancies were resolved by consensus.

Results: Twelve studies met inclusion criteria, of which 11 were industry funded and 1 was non-industry funded; 11 (91.67%) showed correspondence between outcome and abstract conclusion, without difference between industry-funded and non-industry funded publications or between publications in journals with high impact factor (≥3) versus low impact factor (≥2 and <3).

Conclusion: In RCTs and meta-analyses of ocriplasmin for VMT and MH, our results suggest that neither industry funding nor journal impact factor affected the rate of "spin" in study conclusions. This study helps physicians understand what challenges they face when learning about a newer, less-established drug.
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January 2020

Association Between Early Sjögren Markers and Symptoms and Signs of Dry Eye.

Cornea 2020 Mar;39(3):311-315

Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL; and.

Purpose: Animal models suggest that early markers of Sjögren syndrome (EMS)-antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)-are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS.

Methods: In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ test, Fisher exact test, independent sample t test, and Spearman correlation.

Results: Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures.

Conclusions: Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE.
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March 2020

Perceptions of Vitreoretinal Surgical Fellowship Training in the United States.

Ophthalmol Retina 2019 09 10;3(9):802-804. Epub 2019 May 10.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. Electronic address:

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September 2019

Resorbable Implants for Orbital Fractures: A Systematic Review.

Ann Plast Surg 2018 09;81(3):372-379

University of Miami Miller School of Medicine, Miami, FL.

Background: Orbital fractures are one of the most common sequelae of facial trauma.

Objective: The objective of this study was to summarize published data for resorbable implants in orbital reconstruction, including polymer composition, degradation characteristics, osteoconductivity, and complications such as enophthalmos, diplopia, and peri-implant inflammation. A literature search of the National Library of Medicine was performed via PubMed using the keyword resorbable orbital implant. A total of 27 studies were reviewed. Strength of data was assessed according to the Oxford Centre criteria.

Results: Most commercially available implants provide adequate tensile strength for up to 6 months (with the exception of polydioxanone, which loses strength within 1 month, and poly(D,L-lactide) within 3 months). This is sufficient for the isolated orbital floor or medial wall (tensile strength, ~300 MPa) but insufficient for reconstruction of load-bearing areas (eg, the inferior orbital rim with tensile strength of ~1.2 GPa). Thicker products (>1 mm) have increased risk for delayed inflammation than thinner products. Postoperative complications including delayed inflammation (0%-9%), eyelid malposition (0%-5%), enophthalmos (5%-16%), diplopia (0%-16%), infection (0%-2%), and infraorbital nerve hypesthesia (2%-18%) are variably distributed across implants with several notable exceptions: poly(L-lactide) has an increased risk of delayed inflammation, and polydioxanone has a risk of delayed enophthalmos and hematoma.

Conclusions: Resorbable implants are suitable for isolated medial wall or floor fractures with intact bony buttresses and function as a barrier rather than a load-bearing support.
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September 2018

Reactivation of retinopathy of prematurity after ranibizumab treatment.

Retina 2015 Apr;35(4):675-80

Retina Division, Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.

Introduction: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the developing retina and a significant cause of childhood blindness around the world. Vascular endothelial growth factor (VEGF) plays an important role in the neovascular phase of ROP, and treatment with an anti-VEGF agent is justified in select cases. Bevacizumab is the most commonly used anti-VEGF agent in ROP, but ranibizumab has a shorter half-life with the potential for decreased systemic toxicity. The purpose of this study is to report our experience with anti-VEGF agents for the treatment of ROP.

Methods: A retrospective chart review was performed on consecutive infants screened for ROP. Infants treated with peripheral retinal ablation, bevacizumab 0.625 mg/0.025 mL, or ranibizumab 0.25 mg/0.025 mL were specifically identified for review of their clinical outcomes. All treated infants had at least 6 months of follow-up with the treating team and were examined until total regression of ROP.

Results: One hundred and forty-two infants were screened over a two-year period. Six infants received anti-VEGF agents, with a mean gestational age of 23.48 weeks and mean birth weight of 620 g. Ten eyes from the six infants received anti-VEGF treatment. All ten eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5/6 (83%) eyes treated with ranibizumab, on average 5.9 weeks after treatment; whereas none of the 4 eyes treated with bevacizumab experienced reactivation (P < 0.05). One infant who received a unilateral injection of ranibizumab demonstrated bilateral regression of ROP.

Conclusion: The role of anti-VEGF treatment for ROP is still being evaluated. Although the shorter half-life of ranibizumab makes it an attractive option, reactivation of ROP is possible. Physicians and families should be aware of this to follow infants closely for an extended period of time.
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April 2015

Ischemic index and neovascularization in central retinal vein occlusion.

Retina 2011 Jan;31(1):105-10

Department of Ophthalmology, University of California, Los Angeles, CA, USA.

Purpose: To explore the association of angiographic nonperfusion with anterior segment and posterior segment neovascularization in central retinal vein occlusion (CRVO).

Methods: An imaging database at one institution was searched for the diagnosis of central retinal vein occlusion. Ultra wide field fluorescein angiograms were graded for image quality, the presence of retinal neovascularization, and the quantity of nonperfusion; an ischemic index (ISI) was calculated. Charts were reviewed to exclude eyes with previous treatment and to determine which eyes had anterior segment or posterior segment neovascularization on the day of the angiogram. Time from onset to presentation could not accurately be ascertained.

Results: In a 39-month period, there were 69 eyes that met inclusion criteria. The mean ISI was 25% (SD, 26%; range, 0-100%), and 15 eyes (21%) with neovascularization had a mean ISI of 75% (range, 47-100%) compared with eyes without neovascularization that had an ISI of 6% (range, 0-43%). Ischemic index significantly correlated to neovascularization, and eyes that had evidence of neovascularization had an ISI >45% (P < 0.0001).

Conclusion: Ultra wide field fluorescein angiography provides visualization of nonperfusion in eyes with central retinal vein occlusion. Eyes with neovascularization on the day of the angiogram were found to have significantly larger areas of retinal nonperfusion compared with eyes without neovascularization. A prospective study is indicated to know if early treatment of peripheral retinal nonperfusion in CRVO improves outcomes.
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January 2011