Bio

Bio


Dr. Pershing is on the ophthalmology faculty at Stanford University School of Medicine and serves as Chief of Ophthalmology for the VA Palo Alto Health Care System, with an academic career blending clinical practice, teaching, research, and administration.

Her research interests focus on improved utilization of evidence-based medicine to determine cost-effectiveness and relative outcomes of ophthalmic treatments. Through this, she aims to provide additional information to policymakers and clinicians in order to optimize treatment choices. She is also interested in health care innovation – technology as well as quality and delivery systems. Dr. Pershing is active in big data initiatives and analysis, including collaborative projects at Stanford and serving on the American Academy of Ophthalmology (AAO) IRIS registry working group and as the AAO representative to the International Consortium for Health Outcomes Measurement (ICHOM).

She graduated from university summa cum laude in 2002, and with high honors from medical school in 2006. During medical school, she was elected to the Alpha Omega Alpha national medical honor society, served as chapter president in her final year, and was honored with the President’s Clinical Science Award, Merck Award for Academic Excellence, and American Medical Women’s Association Commendation. She subsequently completed ophthalmology residency at Stanford University, followed by an AHRQ fellowship in Health Care Research and Health Policy through the Center for Health Policy/Primary Care and Outcomes Research. She presently sees patients at the Byers Eye Institute at Stanford and oversees eye care services at the Palo Alto VA Medical Center.

Dr. Pershing also serves on the national board of directors of the Alpha Omega Alpha medical honor society, with focus on resident initiatives, and mentors both medical students and undergraduate students (through the Stanford Immersion in Medicine series and VA clinical internships in ophthalmology). Dr. Pershing has had an interest in teaching since tutoring fellow students in college and medical school. She is currently co-director for the medical student ophthalmology clerkship, Ophth 300A, and co-instructor for a multidisciplinary student policy lab addressing key health care system issues identified by the congressional Medicare Payment Advisory Commission (MedPAC).

Clinical Focus


  • Ophthalmology

Academic Appointments


Administrative Appointments


  • Chief, Ophthalmology Section, VA Palo Alto Health Care System (2013 - 2014)

Honors & Awards


  • President’s Clinical Science Award, Medical University of South Carolina (2006)
  • American Medical Women’s Association Glasgow-Rubin Certificate of Commendation, Medical University of South Carolina (2006)
  • Merck Award for Academic Excellence, Medical University of South Carolina (2006)
  • Elected Member, Alpha Omega Alpha Medical Honor Society (2004)
  • Stanford Faculty Teaching Award, Stanford Department of Ophthalmology (2014)

Boards, Advisory Committees, Professional Organizations


  • Board Member, Alpha Omega Alpha National Medical Honor Society (2009 - Present)
  • Working Group Task Force Member, American Academy of Ophthalmology IRIS Clinical Data Registry (2012 - Present)
  • Working Group Member, Cataract Surgery, International Consortium for Health Outcomes Measurement (2013 - Present)

Professional Education


  • Fellowship:Stanford University - Ophthalmology DepartmentCA
  • Residency:Stanford University - Ophthalmology Department (2010) CA
  • Internship:Scripps Mercy Hospital (2007) CA
  • Medical Education:Medical University of South Carolina (2006) SC
  • Board Certification: Ophthalmology, American Board of Ophthalmology (2012)
  • Fellowship, Stanford University - Health Policy and Health Services Research and Health Policy, CA (2013)

Teaching

2016-17 Courses


Graduate and Fellowship Programs


Publications

All Publications


  • Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments. JAMA ophthalmology Wedekind, L., Sainani, K., Pershing, S. 2016

    Abstract

    Determining the perceived supply and potential demand for teleophthalmology in emergency departments could help mitigate coverage gaps in emergency ophthalmic care.To evaluate the perceived current need for and availability of ophthalmologist coverage in California emergency departments and the potential effect of telemedicine for ophthalmology triage and consultation.Surveys were remotely administered to 187 of the 254 emergency departments throughout California via the telephone and Internet from June 30 to September 23, 2014. Emergency department nurse managers and physicians from all emergency departments listed in the California Office of Statewide Health Planning and Development database were individually surveyed to assess facility characteristics and resources as well as the perceived usefulness of teleophthalmology consultation. Data analysis was conducted from June 30, 2014, to March 11, 2015.Perceived availability of ophthalmology consultation coverage and perceived effect of telemedicine ophthalmology consultation at each facility.Of the 187 emergency departments surveyed, 18 of 37 rural facilities (48.6%) reported availability of emergency ophthalmology coverage, compared with 112 of 150 nonrural facilities (74.7%). Rural facilities reported a mean (SD) of 23.72 (14.15) miles between the facility and referral location, while nonrural facilities reported a mean of 4.41 (10.23) miles (19.3% difference). On a scale of 1 to 5 (where 1 signifies very low value and 5 signifies very high value), 124 of 187 nurse managers (66.3%) and 80 of 121 physicians (66.1%) rated teleophthalmology as having high or very high value for triage purposes. The most frequently cited potential advantage of emergency teleophthalmology was assistance in patient triage and immediate real-time electronic communication, and the most frequently cited potential disadvantages were unknown cost of contracting and maintenance and concern that eye trauma might make photographs or videos less conclusive.Availability of ophthalmology coverage for emergency eye care is limited, particularly among rural emergency departments in California. Surveyed emergency department nurse managers and physicians indicated moderately high interest and perceived value for a teleophthalmology solution for remote triage and consultation. Overall, the study suggests that teleophthalmology could play a role in mitigating coverage gaps in emergency ophthalmic care and could be further investigated through similar studies in other regions.

    View details for DOI 10.1001/jamaophthalmol.2016.0316

    View details for PubMedID 27010537

  • Defining a Minimum Set of Standardized Patient-centered Outcome Measures for Macular Degeneration. American journal of ophthalmology Rodrigues, I. A., Sprinkhuizen, S. M., Barthelmes, D., Blumenkranz, M., Cheung, G., Haller, J., Johnston, R., Kim, R., Klaver, C., McKibbin, M., Ngah, N. F., Pershing, S., Shankar, D., Tamura, H., Tufail, A., Weng, C. Y., Westborg, I., Yelf, C., Yoshimura, N., Gillies, M. C. 2016

    Abstract

    To define a minimum set of outcome measures for tracking, comparing, and improving macular degeneration care.Recommendations from working-group of international experts in macular degeneration outcomes registry development and patient advocates, facilitated by the International Consortium for Health Outcomes Measurement (ICHOM).Modified Delphi technique, supported by structured teleconferences, followed by online-surveys to drive consensus decisions. Potential outcomes were identified through literature review of outcomes collected in existing registries and reported in major clinical trials. Outcomes were refined by the working-group and selected based upon impact on patients, relationship to good clinical care and feasibility of measurement in routine clinical practice.Standardized measurement of the following outcomes is recommended: visual functioning and quality of life (distance visual acuity, mobility and independence, emotional well-being, reading and accessing information); number of treatments; complications of treatment; and disease-control. Proposed data-collection sources include administrative, clinical data during routine clinical visits and patient-reported sources annually. Recording the following clinical characteristics is recommended to enable risk-adjustment: age; gender; ethnicity; smoking status; baseline visual acuity in both eyes; type of macular degeneration; presence of geographic atrophy, subretinal fibrosis or pigment epithelial detachment; previous macular degeneration treatment; ocular co-morbidities.The recommended minimum outcomes and pragmatic reporting standards should enable standardized, meaningful assessments and comparisons of macular degeneration treatment outcomes. Adoption could accelerate global improvements in standardized data-gathering and reporting of patient-centered outcomes. This can facilitate informed decisions by patients and health care providers, plus allow long-term monitoring of aggregate data, ultimately improving understanding of disease progression and treatment responses.

    View details for DOI 10.1016/j.ajo.2016.04.012

    View details for PubMedID 27131774

  • A Proposed Minimum Standard Set of Outcome Measures for Cataract Surgery JAMA OPHTHALMOLOGY Mahmud, I., Kelley, T., Stowell, C., Haripriya, A., Boman, A., Kossler, I., Morlet, N., Pershing, S., Pesudovs, K., Goh, P. P., Sparrow, J. M., Lundstroem, M. 2015; 133 (11): 1247-1252
  • Reply: To PMID 25486541. American journal of ophthalmology Pershing, S., Vaziri, K., Albini, T. A., Moshfeghi, D. M., Moshfeghi, A. A. 2015; 160 (2): 392-?

    View details for DOI 10.1016/j.ajo.2015.04.037

    View details for PubMedID 26187878

  • Risk Factors Predictive of Endogenous Endophthalmitis Among Hospitalized Patients With Hematogenous Infections in the United States AMERICAN JOURNAL OF OPHTHALMOLOGY Vaziri, K., Pershing, S., Albini, T. A., Moshfeghi, D. M., Moshfeghi, A. A. 2015; 159 (3): 498-504

    Abstract

    To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections.Retrospective cross-sectional study.MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections.Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P < .0001), bacterial meningitis (OR = 3.8; CI, 1.2-12.0; P = .023), fungal meningitis (OR = 59.1; CI, 14.1-247.8; P < .0001), internal organ abscess (OR = 2.9; CI, 1.2-6.4; P = .02), lymphoma/leukemia (OR = 2.9; CI, 1.6-5.3; P < .0001), skin abscess/cellulitis (OR = 1.75; CI, 1.1-2.8; P = .02), pyogenic arthritis (OR = 4.2; CI, 1.8-9.6; P = .001), diabetes with ophthalmic manifestations (OR = 7.0; CI, 1.7-28.3; P = .006), and urinary tract infection (OR = 0.04; CI, 0.3-0.9; P = .023) were each significantly associated with a diagnosis of endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P < .0001), and 55-64 years (OR = 2.9; CI, 1.8-4.8; P < .0001); those having length of stay of 3-10 days (OR = 1.9; CI, 1.1-3.3; P = .01), 11-30 days (OR = 3.1; CI, 1.8-5.5; P < .0001), and 31+ days (OR = 5.3; CI, 2.7-10.4; P < .0001); and those with intensive care unit/neonatal intensive care unit (ICU/NICU) admissions (OR = 1.5; CI, 1.4-1.6; P < .0001) were all more likely to be diagnosed with endogenous endophthalmitis.Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission.

    View details for DOI 10.1016/j.ajo.2014.11.032

    View details for Web of Science ID 000350077100012

  • Treating age-related macular degeneration: comparing the use of two drugs among medicare and veterans affairs populations. Health affairs Pershing, S., Pal Chee, C., Asch, S. M., Baker, L. C., Boothroyd, D., Wagner, T. H., Bundorf, M. K. 2015; 34 (2): 229-238

    Abstract

    While new biologics have revolutionized the treatment of age-related macular degeneration-the leading cause of severe vision loss among older adults-these new drugs have also raised concerns over the economic impact of medical innovation. The two leading agents are similar in effectiveness but vary greatly in price-up to $2,000 per injection for ranibizumab compared to $50 for bevacizumab. We examined the diffusion of these drugs in fee-for-service Medicare and Veterans Affairs (VA) systems during 2005-11, in part to assess the impact that differing financial incentives had on prescribing. Physicians treating Medicare patients have a direct financial incentive to prescribe the more expensive agent (ranibizumab), while VA physicians do not. Medicare injections of the more expensive ranibizumab peaked in 2007 at 47 percent. Beginning in 2009 the less expensive bevacizumab became the predominant therapy for Medicare patients, accounting for more than 60 percent of injections. For VA patients, the distribution of injections across the two drugs was relatively equal, particularly from 2009 to 2011. Our analysis indicates that there are opportunities in both the VA and Medicare to adopt more value-conscious treatment patterns and that multiple mechanisms exist to influence utilization.

    View details for DOI 10.1377/hlthaff.2014.1032

    View details for PubMedID 25646102

  • Predictive modeling of risk factors and complications of cataract surgery. European journal of ophthalmology Gaskin, G. L., Pershing, S., Cole, T. S., Shah, N. H. 2015: 0

    Abstract

    Cataract surgery is generally safe; however, severe complications exist. Preexisting conditions are known to predispose patients to intraoperative and postoperative complications. This study quantifies the relationship between aggregated preoperative risk factors and cataract surgery complications, and builds a model predicting outcomes on an individual level, given a constellation of patient characteristics.This study utilized a retrospective cohort of patients age 40 years or older who received cataract surgery. Risk factors, complications, and demographic information were extracted from the Electronic Health Record based on International Classification of Diseases, 9th edition codes, Current Procedural Terminology codes, drug prescription information, and text data mining. We used a bootstrapped least absolute shrinkage and selection operator model to identify highly associated variables. We built random forest classifiers for each complication to create predictive models.Our data corroborated existing literature, including the association of intraoperative complications, complex cataract surgery, black race, and/or prior eye surgery with increased risk of any postoperative complications. We also found other, less well-described risk factors, including diabetes mellitus, young age (<60 years), and hyperopia, as risk factors for complex cataract surgery and intraoperative and postoperative complications. Our predictive models outperformed existing published models.The aggregated risk factors and complications described here can guide new avenues of research and provide specific, personalized risk assessment for a patient considering cataract surgery. Furthermore, the predictive capacity of our models can enable risk stratification of patients, which has utility as a teaching tool as well as informing quality/value-based reimbursements.

    View details for DOI 10.5301/ejo.5000706

    View details for PubMedID 26692059

  • Clinical-Pathologic Correlation: Vitrectomy With Epiretinal and Internal Limiting Membrane Peel OPHTHALMIC SURGERY LASERS & IMAGING RETINA Demarchis, E. H., Pershing, S., Moshfeghi, D. M. 2014; 45 (3): 218-221
  • Cost-Effectiveness of Treatment of Diabetic Macular Edema ANNALS OF INTERNAL MEDICINE Pershing, S., Enns, E. A., Matesic, B., Owens, D. K., Goldhaber-Fiebert, J. D. 2014; 160 (1): 18-?
  • Restructuring medical education to meet current and future health care needs. Academic medicine Pershing, S., Fuchs, V. R. 2013; 88 (12): 1798-1801

    Abstract

    U.S. health care is changing, and it will continue to change across multiple dimensions: a different mix of patients; more ambulatory, chronic care and less acute, inpatient care; an older population; expanded insurance coverage; a team approach to care; rapid growth of subspecialty care; growing emphasis on cost-effective care; and rapid technological change. These changes demand a corresponding evolution in physician roles and training. However, despite innovation in content and teaching methods, there has been little alteration to the basic structure of medical education since the Flexner Report sparked widespread reform in 1910. Looking to the future, medical education might evolve to include preparation for a team approach to care via practical training for multispecialty collaborative practice and preparing physicians to be leaders of primary care teams that include nonphysician providers; shorter training for some physicians via flexible pathways and "fast tracks" at each phase of training; cost-effective care in clinical practice; increased training in geriatrics; and "on ramps" and "off ramps" along the physician career path for flexible training over a lifetime. Although the challenges facing the health care system are great, meeting changing health care needs must begin at the foundation, in medical education.

    View details for DOI 10.1097/ACM.0000000000000020

    View details for PubMedID 24128642

  • Ocular Hypertension and Intraocular Pressure Asymmetry After Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents OPHTHALMIC SURGERY LASERS & IMAGING Pershing, S., Bakri, S. J., Moshfeghi, D. M. 2013; 44 (5): 460-464

    Abstract

    To evaluate elevated intraocular pressure (IOP) after intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors and contribute toward the recognition and understanding of its mechanisms, pattern, and treatment.Retrospective case series of VEGF-inhibitor injections at two academic centers (Stanford University and Mayo Clinic) over 4 years. Cases were evaluated for IOP elevation (≥ 24 mm Hg) or asymmetry (≥ 3 mm Hg IOP difference between eyes on three visits).Twenty-one eyes were identified with pathologically elevated IOP after treatment. Most had delayed-onset (average: 15 months after treatment, after 10 injections) elevation. IOP-lowering therapy was required in 81%. More consecutive visits with IOP asymmetry occurred in patients developing ocular hypertension (11.1% pre-diagnosis vs 66.7% post-diagnosis; OR = 9.00, P = .003).Elevated IOP may occur after ranibizumab or bevacizumab injections, often exhibiting a delayed and perhaps cumulative effect. The authors found significant bilateral IOP asymmetry in patients developing unilateral glaucoma after VEGF-inhibitor injections, a potential early indicator or proxy for pathologic IOP elevation. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:460-464.].

    View details for DOI 10.3928/23258160-20130909-07

    View details for Web of Science ID 000330192400006

    View details for PubMedID 24044708

  • Trends in ophthalmic manifestations of methicillin-resistant Staphylococcus aureus (MRSA) in a northern California pediatric population JOURNAL OF AAPOS Amato, M., Pershing, S., Walvick, M., Tanaka, S. 2013; 17 (3): 243-247

    Abstract

    To determine pediatric clinical trends of ocular and periocular methicillin-resistant Staphylococcus aureus (MRSA) in a large northern California healthcare system.This study was a retrospective cross-sectional review of all pediatric cases (aged 0-18) with culture-positive ophthalmic MRSA isolates identified between January 2002 and December 2009. Medical record review included history, presentation, infection site, acquisition (community or nosocomial), antibiotic sensitivity/resistance, treatment, and clinical outcome. Incidence was classified by year, sex, and age. Parameters were analyzed for statistical significance by trend and χ(2) analysis.A total of 399 ocular and periocular MRSA cases were included. Cases trended upward from 2002 to 2009, peaking in 2006. Of the 137 pediatric cases (0-18 years), 58% were community acquired. Conjunctivitis was the predominant presentation (40%), followed by stye/chalazion (25%), orbital cellulitis/abscess (19%), dacryocystitis (11%) and brow abscess (3%). Significant predictors for ocular infection with MRSA included male sex (61%), neonates (38%), and multiple infection sites on the body (38%). Resistance was high to bacitracin (80.9%) and ofloxacin (48.3%) but remained low for trimethoprim/sulfamethoxazole (8.7%). Topical therapy was effective in 29% of cases; oral antibiotics, in 47%. Intravenous therapy was required in 12% of cases and incision/drainage or surgery in 19%. Initial oral antibiotic treatment, primarily cephalosporins (24%), was ineffective in 37% of patients. There was a significant increase in resistance to antibiotic therapy (P < 0.001) during the study period. No patients developed permanent visual impairment.Pediatric ocular and periocular MRSA is increasing in incidence and resistance in our patient population. Outcomes can be improved by early recognition, proper antibiotic selection, and obtaining cultures and sensitivities when resistant or severe ocular infections are present.

    View details for DOI 10.1016/j.jaapos.2012.12.151

    View details for Web of Science ID 000321224900004

    View details for PubMedID 23623773

  • The Importance of Keeping a Broad Differential in Retina Clinic: The Spectrum of Ophthalmic Disease Seen by Retina Specialists in a Tertiary Outpatient Clinic Setting OPHTHALMIC SURGERY LASERS & IMAGING Fijalkowski, N., Pershing, S., Moshfeghi, D. M. 2013; 44 (2): 133-139

    Abstract

    To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States.Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011.Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%).Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.

    View details for DOI 10.3928/23258160-20130313-06

    View details for Web of Science ID 000321017200006

    View details for PubMedID 23510039

  • Phacoemulsification versus extracapsular cataract extraction: where do we stand? CURRENT OPINION IN OPHTHALMOLOGY Pershing, S., Kumar, A. 2011; 22 (1): 37-42

    Abstract

    Cataract surgery at present is divisible into two general techniques: manual extracapsular cataract extraction and phacoemulsification--with ECCE further separated into the traditional form and small-incision cataract surgery. This review will discuss updates in surgical techniques, outcome comparisons, cost analysis, and the continued role of extracapsular cataract extraction in Western countries.Surgical techniques for manual extracapsular cataract extraction have undergone much refinement, with numerous descriptions of techniques in a recent literature. Studies that have emerged in the last several years allow us to compare surgical results between different techniques and suggest that there is little difference in final outcome when each surgery is done well. Overall cost-effectiveness and suitability of each technique vary based on location and facilities.Manual extracapsular cataract extraction (especially small-incision versions) occupies an important place in modern cataract surgery, and, while not a replacement for phacoemulsification in Western countries, should be part of a cataract surgeon's overall skill set.

    View details for DOI 10.1097/ICU.0b013e3283414fb3

    View details for Web of Science ID 000285135500009

    View details for PubMedID 21088578

  • Cytomegalovirus Infection with MRI Signal Abnormalities Affecting the Optic Nerves, Optic Chiasm, and Optic Tracts JOURNAL OF NEURO-OPHTHALMOLOGY Pershing, S., Dunn, J., Khan, A., Liao, Y. J. 2009; 29 (3): 223-226

    Abstract

    A 49-year-old woman who had been immunosuppressed after a renal transplant developed bilateral severe visual loss. Visual acuities were finger counting and hand movements in the two eyes. Both optic nerves were pale. There were no other ophthalmic abnormalities. Brain MRI disclosed marked signal abnormalities involving the optic nerves, optic chiasm, and optic tracts. Cerebrospinal fluid polymerase chain reaction (PCR) was positive for cytomegalovirus. Treatment did not restore vision. Such extensive clinical and imaging involvement of the anterior visual pathway, which has been previously reported with other herpes viruses, illustrates the propensity for this family of viruses to track along axons.

    View details for Web of Science ID 000270048700011

    View details for PubMedID 19726946

  • Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation. surgery: A 10-year analysis JOURNAL OF AAPOS Wilson, M. E., Trivedi, R. H., Bartholomew, L. R., Pershing, S. 2007; 11 (5): 443-446

    Abstract

    To analyze the rate of inadvertent anterior lens capsular tears with vitrectorhexis or continuous curvilinear capsulorhexis (CCC) in pediatric cataract and intraocular lens (IOL) implantation surgery between January 1, 1997, and December 31, 2006.Retrospective chart review, collecting for each eye: age at cataract surgery, type of anterior capsulotomy, any tearing of the capsule, and if yes, details of the tear.A total of 737 eyes were reviewed. Cases with a ruptured lens capsule that occurred prior to surgery were excluded. Eyes that received an anterior capsulotomy by any other method (n = 27) or eyes that did not receive an IOL (n = 100) were reviewed but excluded from final comparative analysis. Of the remaining 339 eyes, 19 eyes (5.6%) were noted to develop an anterior capsule tear (vitrectorhexis, 12 of 226 eyes, 5.3%; CCC, 7 of 113, 6.2%). These tears occurred during anterior capsulotomy in seven eyes, hydrodissection in one, cataract removal in three, and IOL insertion/manipulation in eight. In eyes operated for cataract at or before 72 months of age, the manual CCC technique was more likely to develop a tear (relative risk, 3.09) compared with eyes of older children (>72 months of age), where the vitrectorhexis technique was more likely to develop a tear (relative risk, 3.14).Vitrectorhexis is well suited for use in children less than 6 years of age due to their highly elastic anterior lens capsule. For children aged 6 years and older, manual CCC is the best technique because, by that age, capsule control and ease of capsulotomy completion has improved.

    View details for DOI 10.1016/j.jaapos.2007.03.012

    View details for Web of Science ID 000250386400006

    View details for PubMedID 17532240