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Conference paper
Leon Nehmad OD, FAAO; Andrea Yang OD, FAAO; Munish Sharma OD; Stephen Pereira BSc, FAAO
American Academy Optometry 2013


Consistent with other studies (Tanna, 2012) both clinicians were more likely to label fields as having progressed than either EA or TA, with the latter specifying the least progression. The level of agreement, based on Kappa, among all classifiers ranged from fair to moderate, although the 95% confidence intervals were quite large. The clinicians differed from one another with respect to their agreement with EA and TA. Further investigations employing larger sample sizes may be beneficial in yielding more robust findings.


Case of concurrent CME and Primary Open Angle Glaucoma responding positively to single medication: Topical Carbonic Anhydrase Inhibitors

Conference paper
Sharma M, Bass S, Chirumbolo A
American Academy Optometry 2013

CME is end product of breakdown of anatomical or functional integrity of blood retinal barrier either from vascular or avascular processes with RPE diseases and vitreous traction as major subcategories of avascular pathologies. Most recent research has been focused on treatment of more common vascular pathologies with antiVEGF or antiinflammatory medications and on surgical treatment of avascular pathologies from vitreous traction .CME in this case was secondary to cellophane maculopathy and he was poor candidate for surgical intervention due to relatively good vision, low grade traction and progressive reduction of CME without any surgical intervention. CME usually occurs in isolation of other ocular disease. In this case, the patient also had glaucoma, an optic neuropathy. This case presented a unique opportunity to successfully treat two diseases with one medication.

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Adjustable suture strabismus surgery in infants and children.

Journal paper
Ahmed Awadein, MD, Munish Sharma, MD, Marlet G. Bazemore, MD, Hatem A. Saeed, MD, and David L. Guyton, MD
J AAPOS 2008;12:585-590


PURPOSE To evaluate the success rate of adjustable suture techniques in horizontal eye muscle surgery in children aged 10 years and younger.

METHODS A retrospective review of children who had horizontal eye muscle surgery at or before the age of 10 years. Patients were divided into 1 of 2 groups according to whether a nonadjustable or an adjustable technique was used. The preoperative measurements, type of strabismus, and postoperative results were analyzed.

RESULTS A total of 98 cases in the nonadjustable group and 298 cases in the adjustable group were identified. Early success rate, defined as alignment within 8

Comparison of Single-Segment and Double-Segment Intacs for Keratoconus and Post-LASIK Ectasia

Journal paper
American Journal of Ophthalmology. 2006 May;141(5):891-5.


PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment Intacs in sub- jects with post-LASIK ectasia and keratoconus.

DESIGN: Retrospective comparative analysis.

METHODS: SETTING: Boxer Wachler Vision Institute, Beverly Hills, California, USA. STUDY POPULATION: Thirty-seven eyes of 28 patients with keratoconus and post-LASIK ectasia classified into two groups: single- segment group (17 eyes, 11 patients) and double-segment group (20 eyes, 17 patients). Both groups were matched for age, visual acuity (uncorrected, UCVA; best specta- cle-corrected, BSCVA), refractive error (sphere, cylin- der, spherical equivalent), and keratometry (K) value (flat, steep, average) by t test for equality of means. INTERVENTION: Single- or double-segment Intacs proce- dure with axis of incision for insertion in the steep axis of manifest refraction. MAIN OUTCOME MEASURE: Improve- ment of acuity, refractive error, K values, and inferior- superior (I-S) ratio.

RESULTS: There was more improvement in UCVA in the single-segment group (nine lines) than the double- segment group (2.5 lines), P < .01; in BSCVA in the single-segment group (2.5 lines) than the double-segment group (<1 line), P < .01; in steep K values in the single-segment group (2.76 diopters)

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Effect of inferior-segment Intacs with and without C3-R on keratoconus.

Journal paper
Colin C.K. Chan, MD, FRANZCO, Munish Sharma, MD, MBBS, Brian S. Boxer Wachler, MD
J Cataract Refract Surg. 2007 Jan;33(1):75-80.


PURPOSE: To determine whether corneal collagen cross-linking with riboflavin (C3-R) augments the effect of inferior-segment Intacs (Addition Technology) in the treatment of keratoconus.

SETTING: Private practice, Beverly Hills, California, USA.

METHODS: A retrospective nonrandomized comparative case series comprised 12 eyes of 9 patients who had inferior-segment Intacs placement without C3-R (Intacs-only group) and 13 eyes of 12 pa- tients who had inferior-segment Intacs placement combined with C3-R (Intacs with C3-R group). The 2 groups were matched preoperatively. All patients had inferior-segment Intacs placed with the incision in the steep axis of manifest refraction. Corneal collagen cross-linking with riboflavin was performed after the Intacs segments were inserted. Outcome measures were topographic kera- tometry values and the lower–upper (L–U) ratio, which is a topographic measure of the degree of keratoconus. Preoperative data were compared to results 1 day postoperatively and measurements at the last postoperative visit.

RESULTS: The Intacs with C3-R group had a significantly greater reduction in cylinder than the Intacs- only group (P<.05). Steep and average keratometry were reduced significantly more in the Intacs with C3-R group (P<.05). There was a greater reduction in L–U ratio in the Intacs with C3-R group (P<.05).

CONCLUSION: The addition of C3-R to the Intacs procedure resulted in greater keratoconus improve- ments than Intacs insertion alone.


  • Intacs;
  • keratoconus;
  • inferior-segment Intacs;
  • C3-R
  • Corneal collagen Cross-linking with Riboflavin

Higher Order Aberrations and Relative Risk of Symptoms After LASIK

Conference paper
Munish Sharma, MD; Brian S. Boxer Wachler, MD; Colin C.K. Chan, MD, FRANZCO
Journal of Refractive Surgery. 2007 Mar;23(3):252-6.


PURPOSE: To understand what level of higher order ab- errations increases the relative risk of visual symptoms in patients after myopic LASIK.

METHODS: This study was a retrospective compara- tive analysis of 103 eyes of 62 patients divided in two groups, matched for age, gender, pupil size, and spherical equivalent refraction. The symptomatic group comprised 36 eyes of 24 patients after conventional LASIK with different laser systems evaluated in our re- ferral clinic and the asymptomatic control group con- sisted of 67 eyes of 38 patients following LADARVision CustomCornea wavefront LASIK. Comparative analysis was performed for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sen- sitivity, refractive cylinder, and higher order aberrations. Wavefront analysis was performed with the LADARWave aberrometer at 6.5-mm analysis for all eyes.

RESULTS: Blurring of vision was the most common symptom (41.6%) followed by double image (19.4%), halo (16.7%), and fluctuation in vision (13.9%) in symp- tomatic patients. A statistically significant difference was noted in UCVA (P=.001), BSCVA (P=.001), contrast sensitivity (P

A new removable sliding noose for adjustable-suture strabismus surgery .

Conference paper
Sharma M, Tarczy-Hornoch K, Klink DF, Guyton DL
AAPOS meeting 2006

Purpose: To describe a reliable sliding VicrylTM noose for use in post-operative suture adjustment of extraocular muscles that can be easily removed once adjustment has been completed.

Methods: We have developed a removable noose based on a lark’s head knot (cow hitch), and have used it with a cul-de-sac conjunctival incision approach in over 500 patients in the last three years. Fashioning, applying, and removing the noose is best shown in a video presentation. Removing the noose leaves no excess suture material. The result is minimal inflammation, less discomfort, earlier healing, and less conjunctival scarring than with the conventional sliding noose which cannot be removed.

Results: The surgical alignment success rate with the new removable noose appears the same as with the conventional sliding VicrylTM noose. The noose was easily removed in all but 5 cases (~1%).

Conclusions: The removable sliding noose is a useful aide to small-incision, minimal trauma, adjustable strabismus surgery.