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Article ; Online: Cornea Classic: Stern, Beuerman, Fox, Gao, Mircheff, and Pflugfelder, "The Pathology of Dry Eye: The Interaction Between the Ocular Surface and Lacrimal Glands" (1998).

Shtein, Roni M

2023 Volume 43, Issue 4, Page(s) 403

Abstract: Abstract: In one of the most frequently cited articles from Cornea , Stern et al's "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands" (1998) revolutionized our current understanding of the pathophysiology of dry ... ...

Abstract	Abstract: In one of the most frequently cited articles from Cornea , Stern et al's "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands" (1998) revolutionized our current understanding of the pathophysiology of dry eye disease.
MeSH term(s)	Humans ; Lacrimal Apparatus/pathology ; Dry Eye Syndromes ; Cornea/pathology ; Tears/physiology
Language	English
Publishing date	2023-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	604826-2
ISSN	1536-4798 ; 0277-3740
ISSN (online)	1536-4798
ISSN	0277-3740
DOI	10.1097/ICO.0000000000003227
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Article ; Online: Update on pharmacotherapy for dry eye.

Manohar, Divya / Shtein, Roni M

Current opinion in ophthalmology

2023 Volume 34, Issue 6, Page(s) 550–554

Abstract: Purpose of review: This review provides an overview of pharmacologic treatments for dry eye disease (DED), with a focus on newer developments.: Recent findings: Along with the existing treatments, there are several new pharmacologic treatments ... ...

Abstract	Purpose of review: This review provides an overview of pharmacologic treatments for dry eye disease (DED), with a focus on newer developments. Recent findings: Along with the existing treatments, there are several new pharmacologic treatments available and being developed for DED. Summary: There are many currently available options for treatment of DED, and ongoing research and development to expand potential treatments for patients with DED.
MeSH term(s)	Humans ; Dry Eye Syndromes/drug therapy
Language	English
Publishing date	2023-04-27
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1049383-9
ISSN	1531-7021 ; 1040-8738
ISSN (online)	1531-7021
ISSN	1040-8738
DOI	10.1097/ICU.0000000000000968
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Zs.A 3047: Show issues

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Article ; Online: Small Payments, Large Consequences.

Shtein, Roni M / Lichter, Paul R / Lee, Paul P

JAMA ophthalmology

2022 Volume 140, Issue 9, Page(s) 862–863

MeSH term(s)	Drug Industry ; Humans ; United States
Language	English
Publishing date	2022-07-28
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701705-9
ISSN	2168-6173 ; 2168-6165
ISSN (online)	2168-6173
ISSN	2168-6165
DOI	10.1001/jamaophthalmol.2022.2763
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Article ; Online: Dry Eye Subtypes in the Dry Eye Assessment and Management (DREAM) Study: A Latent Profile Analysis.

Yu, Kimberley / Asbell, Penny A / Shtein, Roni M / Ying, Gui-Shuang

Translational vision science & technology

2022 Volume 11, Issue 11, Page(s) 13

Abstract: Purpose: Dry eye disease (DED) is a heterogeneous condition with poorly characterized subtypes. The DREAM study was a large multicenter randomized clinical trial that did not find omega-3 to be more effective than placebo in treating symptomatic DED. We ...

Abstract	Purpose: Dry eye disease (DED) is a heterogeneous condition with poorly characterized subtypes. The DREAM study was a large multicenter randomized clinical trial that did not find omega-3 to be more effective than placebo in treating symptomatic DED. We performed secondary analysis of DREAM data to characterize DED subtypes and their omega-3 response. Methods: A total of 535 patients with moderate-to-severe DED were randomized to omega-3 or placebo treatment for one year. We used latent profile analysis to identify subtypes based on baseline Ocular Surface Disease Index, tear break-up time (TBUT), anesthetized Schirmer's test, corneal and conjunctival staining, and meibomian gland dysfunction (MGD). We evaluated omega-3's effect for each subtype using generalized linear regression. Results: Five clinically meaningful DED subtypes were identified. They differed significantly in sex (P < 0.001) and race (P = 0.02). Subtype 1 had the most severe DED signs yet milder symptoms and was associated with more Sjögren's syndrome (21%, P < 0.001). Subtype 2 had the mildest DED signs except MGD. Subtype 3 had the most severe symptoms, out of proportion to DED signs. Subtype 4 had relatively milder symptoms and MGD. Subtype 5 had severe MGD and TBUT and was associated with rosacea (29%, P = 0.04). Omega-3 was not significantly more beneficial than placebo for any subtype. Conclusions: Five clinically meaningful DED subtypes differed significantly in demographics, symptoms, signs, and systemic disease associations. Omega-3 was not significantly more effective than placebo for any subtype. Translational relevance: T3 translational research identifying subtypes in the DREAM study can improve DED clinical classification and targeted management.
MeSH term(s)	Humans ; Dry Eye Syndromes/diagnosis ; Dry Eye Syndromes/drug therapy ; Tears ; Meibomian Gland Dysfunction ; Cornea ; Fatty Acids, Omega-3/therapeutic use
Chemical Substances	Fatty Acids, Omega-3
Language	English
Publishing date	2022-11-17
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2674602-5
ISSN	2164-2591 ; 2164-2591
ISSN (online)	2164-2591
ISSN	2164-2591
DOI	10.1167/tvst.11.11.13
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Article: Post-LASIK dry eye.

Shtein, Roni M

Expert review of ophthalmology

2011 Volume 6, Issue 5, Page(s) 575–582

Abstract: Laser-assisted in situ keratomileusis (LASIK) is a frequently performed corneal refractive surgery with excellent refractive outcomes. The most common complication of LASIK is dry eyes, with virtually all patients developing some degree of dryness in the ...

Abstract	Laser-assisted in situ keratomileusis (LASIK) is a frequently performed corneal refractive surgery with excellent refractive outcomes. The most common complication of LASIK is dry eyes, with virtually all patients developing some degree of dryness in the immediate postoperative period. Identifying preoperative dry eyes, and conscientious attention and treatment in the perioperative time period, can lead to enhanced patient satisfaction and more accurate visual outcomes. Improved understanding of the development of dry eyes after LASIK will advance our understanding of the complex pathophysiology of dry eye disease.
Language	English
Publishing date	2011-11-15
Publishing country	England
Document type	Journal Article
ISSN	1746-9899
ISSN	1746-9899
DOI	10.1586/eop.11.56
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Article ; Online: Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology.

Kuo, Anthony N / Cortina, Maria S / Greiner, Mark A / Li, Jennifer Y / Miller, Darby D / Shtein, Roni M / Veldman, Peter B / Yin, Jia / Kim, Stephen J / Shen, Joanne F

Ophthalmology

2023 Volume 131, Issue 1, Page(s) 107–121

Abstract: Purpose: To review the published literature on the diagnostic capabilities of the newest generation of corneal imaging devices for the identification of keratoconus.: Methods: Corneal imaging devices studied included tomographic platforms ( ... ...

Abstract	Purpose: To review the published literature on the diagnostic capabilities of the newest generation of corneal imaging devices for the identification of keratoconus. Methods: Corneal imaging devices studied included tomographic platforms (Scheimpflug photography, OCT) and functional biomechanical devices (imaging an air impulse on the cornea). A literature search in the PubMed database for English language studies was last conducted in February 2023. The search yielded 469 citations, which were reviewed in abstract form. Of these, 147 were relevant to the assessment objectives and underwent full-text review. Forty-five articles met the criteria for inclusion and were assigned a level of evidence rating by the panel methodologist. Twenty-six articles were rated level II, and 19 articles were rated level III. There were no level I evidence studies of corneal imaging for the diagnosis of keratoconus found in the literature. To provide a common cross-study outcome measure, diagnostic sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were extracted. (A perfect diagnostic test that identifies all cases properly has an AUC of 1.0.) RESULTS: For the detection of keratoconus, sensitivities for all devices and parameters (e.g., anterior or posterior corneal curvature, corneal thickness) ranged from 65% to 100%. The majority of studies and parameters had sensitivities greater than 90%. The AUCs ranged from 0.82 to 1.00, with the majority greater than 0.90. Combined indices that integrated multiple parameters had an AUC in the mid-0.90 range. Keratoconus suspect detection performance was lower with AUCs ranging from 0.66 to 0.99, but most devices and parameters had sensitivities less than 90%. Conclusions: Modern corneal imaging devices provide improved characterization of the cornea and are accurate in detecting keratoconus with high AUCs ranging from 0.82 to 1.00. The detection of keratoconus suspects is less accurate with AUCs ranging from 0.66 to 0.99. Parameters based on single anatomic locations had a wide range of AUCs. Studies with combined indices using more data and parameters consistently reported high AUCs. Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
MeSH term(s)	Humans ; Cornea/diagnostic imaging ; Corneal Pachymetry/methods ; Corneal Topography/methods ; Keratoconus/diagnostic imaging ; Ophthalmology ; ROC Curve ; Tomography
Language	English
Publishing date	2023-10-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	392083-5
ISSN	1549-4713 ; 0161-6420
ISSN (online)	1549-4713
ISSN	0161-6420
DOI	10.1016/j.ophtha.2023.07.030
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Ul II Zs.83: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 533: Show issues

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Article ; Online: Qualitative analysis of Web-based refractive surgery information sessions.

Shtein, Roni M / Lee, Paul P

Journal of cataract and refractive surgery

2014 Volume 40, Issue 1, Page(s) 159–161

MeSH term(s)	Health Services Research ; Humans ; Information Dissemination/methods ; Internet ; Ophthalmology/methods ; Patient Education as Topic ; Patient-Centered Care/methods ; Refractive Surgical Procedures ; Surveys and Questionnaires
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Letter
ZDB-ID	632744-8
ISSN	1873-4502 ; 0886-3350
ISSN (online)	1873-4502
ISSN	0886-3350
DOI	10.1016/j.jcrs.2013.11.007
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Zs.A 1806: Show issues

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Article ; Online: Cost-Benefit and Cost-Utility Analysis of Amphotericin B Supplementation of Corneal Storage Media With Endothelial Keratoplasty-Prepared Tissue.

Chiang, Trent Tsun-Kang / Shtein, Roni M / McCoy, Kristen / Hurlbert, Susan / Grossman, Gregory H

Cornea

2020 Volume 39, Issue 4, Page(s) 422–430

Abstract: Purpose: To determine the cost-effectiveness of amphotericin B supplementation, we analyzed both current costs to treat postendothelial keratoplasty (EK) fungal infections and potential costs associated with amphotericin B supplementation.: Methods: ... ...

Abstract	Purpose: To determine the cost-effectiveness of amphotericin B supplementation, we analyzed both current costs to treat postendothelial keratoplasty (EK) fungal infections and potential costs associated with amphotericin B supplementation. Methods: We collected 19 US cases of post-EK fungal eye infections from the published literature and assessed the associated costs from the literature. A survey of surgeons was also conducted with questions regarding their experiences in managing these infections. Results: We estimated that the costs to diagnose, manage, and treat post-EK fungal keratitis and post-EK fungal endophthalmitis are USD $21,113 and $34,850, respectively. The largest portion of the costs can be attributed to the need for additional surgical management, which is required in 79% of the cases. We estimated the total cost of amphotericin B supplementation to be $44.39 per graft with use of conventional amphotericin B and conservative assumptions regarding supplementation processes. Cost-effectiveness analysis demonstrated that amphotericin B supplementation is cost-effective at $100,000 per quality-adjusted life-year level only if amphotericin B supplementation can prevent more than 69.62% of post-EK fungal infections, assuming the incidence of post-EK fungal infection remains at the level it was between 2012 and 2017. Conclusions: We found that amphotericin B supplementation can be cost-effective under conservative assumptions if it is moderately effective in preventing post-EK fungal infections.
MeSH term(s)	Administration, Oral ; Amphotericin B/administration & dosage ; Antifungal Agents/administration & dosage ; Corneal Transplantation/methods ; Cost-Benefit Analysis ; Endothelium, Corneal/cytology ; Endothelium, Corneal/transplantation ; Eye Infections, Fungal/drug therapy ; Eye Infections, Fungal/economics ; Humans ; Mycoses/drug therapy ; Mycoses/economics ; Organ Preservation/methods
Chemical Substances	Antifungal Agents ; Amphotericin B (7XU7A7DROE)
Language	English
Publishing date	2020-01-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604826-2
ISSN	1536-4798 ; 0277-3740
ISSN (online)	1536-4798
ISSN	0277-3740
DOI	10.1097/ICO.0000000000002242
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Zs.A 1790: Show issues

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Article ; Online: Corneal confocal microscopy as a measure of diabetic neuropathy.

Shtein, Roni M / Callaghan, Brian C

Diabetes

2012 Volume 62, Issue 1, Page(s) 25–26

MeSH term(s)	Cornea/innervation ; Diabetes Mellitus, Type 1/complications ; Diabetic Neuropathies/physiopathology ; Female ; Humans ; Kidney Transplantation ; Male ; Nerve Regeneration ; Pancreas Transplantation
Language	English
Publishing date	2012-12-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	80085-5
ISSN	1939-327X ; 0012-1797
ISSN (online)	1939-327X
ISSN	0012-1797
DOI	10.2337/db12-1114
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Article ; Online: The Dry Eye Assessment and Management (DREAM) extension study - A randomized clinical trial of withdrawal of supplementation with omega-3 fatty acid in patients with dry eye disease.

Hussain, Munira / Shtein, Roni M / Pistilli, Maxwell / Maguire, Maureen G / Oydanich, Marko / Asbell, Penny A

The ocular surface

2019 Volume 18, Issue 1, Page(s) 47–55

Abstract: Purpose: To determine effects of continued or discontinued use of omega-3 (ω3) fatty acid supplements through a randomized withdrawal trial among patients assigned to ω3 supplements in the first year of the DREAM study.: Methods: Patients who were ... ...

Abstract	Purpose: To determine effects of continued or discontinued use of omega-3 (ω3) fatty acid supplements through a randomized withdrawal trial among patients assigned to ω3 supplements in the first year of the DREAM study. Methods: Patients who were initially assigned to ω3 (3000 mg) for 12 months in the primary trial were randomized 1:1 to ω3 active supplements or placebos (refined olive oil) for 12 more months. The primary outcome was change in the Ocular Surface Disease Index (OSDI) score. Secondary outcomes included change in conjunctival staining, corneal staining, tear break-up time, Schirmer test, and adverse events. Results: Among 22 patients assigned to ω3 and 21 to placebo supplements, the mean change in OSDI score between month 12 and 24 was similar between treatment groups (mean difference in change -0.6 points, 95% confidence interval [CI], (-10.7, 9.5), p = 0.91). There were no significant differences between groups in mean change in conjunctival staining (difference in mean change -0.5 points; 95% CI (-1.2, 0.3)), corneal staining (-0.3 points; 95% CI (-1.2, 0.3)), tear break-up time (-0.8 s; 95% CI (-2.6, 0.9)) and Schirmer test (0.6 mm, 95% CI (-2.0, 3.2)). Rates of adverse events were similar in both groups. Conclusion: Among patients who received ω3 supplements for 12 months in the primary trial, those discontinuing use of ω3 for an additional 12 months did not have significantly worse outcomes compared to those who continued use of ω3. ClinicalTrials.gov number NCT02128763.
MeSH term(s)	Adult ; Aged ; Conjunctiva ; Dietary Supplements ; Double-Blind Method ; Dry Eye Syndromes/diagnosis ; Dry Eye Syndromes/drug therapy ; Fatty Acids, Omega-3 ; Female ; Humans ; Male ; Middle Aged ; Tears
Chemical Substances	Fatty Acids, Omega-3
Language	English
Publishing date	2019-08-16
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2208578-6
ISSN	1937-5913 ; 1542-0124
ISSN (online)	1937-5913
ISSN	1542-0124
DOI	10.1016/j.jtos.2019.08.002
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