Faculty Bibliography

PURPOSE/UNASSIGNED:We aim to study a case of pathologic myopia with visible light OCT. DESIGN/UNASSIGNED:Case report. SUBJECTS/UNASSIGNED:We recruit 1 patient with pathologic myopia presenting with an acute lacquer crack with submacular hemorrhage (SMH) in the right eye and a chronic lacquer crack in the left eye. METHODS/UNASSIGNED:We acquire visible light OCT images with 1 μm axial resolution. Images are processed to depict spectral centroid shift, and spectral fitting is performed to determine oxygen saturation. Results are compared to clinical imaging. MAIN OUTCOME MEASURES/UNASSIGNED:Visible light OCT images, spectral centroid shift (redshift), oximetry, and spectral fitting. RESULTS/UNASSIGNED:with spectral evidence of an overlying RPE deficit (deficient red shift) and photoreceptor abnormalities. CONCLUSIONS/UNASSIGNED:As visible light OCT technology advances, its application toward well-characterized human retinal pathology can clarify its utility. We describe the first case of visible light OCT applied to pathologic myopia, a primary RPE-BM-choriocapillaris interface disease. We confirm that extravascular hemoglobin can be subject to spectral fitting, and we quantify the oxygen saturation of acute SMH. We further show that structural changes in chronic lacquer cracks can be characterized with this new technology. FINANCIAL DISCLOSURES/UNASSIGNED:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

OBJECTIVE:Nasolacrimal duct obstruction (NLDO) in children typically resolves without surgery. Endoscopic dacryocystorhinostomy (En-DCR) is considered in cases refractory to irrigation, probing, and/or stent placement. The incidence of revision after pediatric En-DCR ranges from 0% to 22%. The objective of this review is to determine the incidence of revision and failure after pediatric En-DCR. DATA SOURCES/METHODS:In this systematic review, Medline, Embase, and Cochrane databases were searched on 11/21/2025. REVIEW METHODS/METHODS:Studies investigating primary, pediatric En-DCR outcomes were included. Case reports and articles that published no primary data or reported results aggregated with data from adult, revision, or external DCRs were excluded. Two reviewers (M.H. and R.W.) selected studies using these criteria and assessed quality with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. R V4.1.1 and GraphPad Prism 10.3.1 were used in statistical analysis and creation of Forest plots. The study protocol was pre-registered with Prospero. RESULTS:Thirty-one studies were included, involving 1470 ducts in 1230 patients. The mean age of these patients was 5.3 years old, and the study population was 49.5% male. Revision was performed in 9.1% of cases, and surgical failure occurred in 11.7% of cases. The mean follow-up time was 17.4 months. CONCLUSION/CONCLUSIONS:En-DCR is an effective treatment for NLDO. The incidence of revision was found to be lower than that of surgical failure, potentially due to short follow-up times of some studies or reluctance to undergo revision. The calculated incidence of complications and revision may underestimate true values due to significant heterogeneity among studies.

PURPOSE/UNASSIGNED:To quantify the economic burden of vision loss in U.S. children and adolescents aged 0 to 18 years. METHODS/UNASSIGNED:This was a cross-sectional economic analysis study using publicly available data sources from the Centers for Disease Control and Prevention (CDC). This study employed a comprehensive data analysis using the American Community Survey, Medical Expenditure Panel Survey, American Time Use Survey, Bureau of Labor Statistics, National and State Health Expenditure Accounts, and the National Health Interview Survey. Total costs attributed to vision loss among children were categorized into medical expenses, nursing home care, supportive services, and productivity losses. Data were stratified by state to investigate regional differences in economic burden within the continental United States. RESULTS/UNASSIGNED:The study found that in 2017, the average economic burden per-child with vision loss in the United States was $15,150 annually, with a total cost of approximately $9.4 billion annually. This compares to a cost of $13,110 per-person affected age 19 to 64 years and $21,560 per-person affected age 65 years or older. The per-affected child cost for males ($15,210) was slightly higher than for females ($15,090) and generally uniform across geographies. Productivity loss due to informal care requirements represented the largest cost driver at 73.2%. CONCLUSIONS/UNASSIGNED:Vision loss in children and adolescents imposes a significant economic burden, particularly through productivity losses due to informal caregiving. The findings underscore the need for targeted public health strategies that consider the regional disparities in economic impact and focus on preventive measures to reduce the long-term economic and social consequences of pediatric vision loss.

PURPOSE/UNASSIGNED:We examined the choroid in both eyes from a donor with multifocal geographic atrophy (GA), enlarged choroidal vessels, and choroidal neovascularization (CNV) secondary to age-related macular degeneration, using histology and immunohistochemistry, and we correlated the findings with multimodal clinical imaging. METHODS/UNASSIGNED:A Caucasian woman with bilateral GA was followed clinically for 5 years, until 6 years prior to her death at age 93. To correlate clinical and histologic features, the right eyecup was photographed before dissecting the posterior pole. Choroidal blood vessels were labeled with Ulex europaeus agglutinin-1 (UEA-1) lectin following retinal pigment epithelium removal and imaged by confocal microscopy. Selected regions were embedded and sectioned for histologic staining. The left eye was used for ultrastructure analysis. RESULTS/UNASSIGNED:The posterior pole exhibited areas of atrophy surrounded by mottled retinal pigment epithelium overlying calcified drusen. Confocal imaging of the UEA-1 lectin-labeled choroidal flatmounts showed limited visualization of the submacular vasculature, consistent with masking by basal laminar and lipid-rich deposits seen in histologic sections. In well-labeled regions of the posterior pole, the choriocapillaris was attenuated and widely separated by markedly thickened, hyalinized intercapillary pillars. Venules and veins appeared dilated, and arteries exhibited arteriosclerotic changes. A choroidal neovascular complex was observed superior to the optic nerve head near the atrophic border; the adjacent choriocapillaris was attenuated. CONCLUSIONS/UNASSIGNED:In this single case of multifocal GA, choroidal thickening and large-caliber outer choroidal vessels coexisted with marked choriocapillaris degeneration and adjacent neovascularization. These observations suggest that structural choroidal enlargement does not preclude choriocapillaris failure and may be associated with ischemic and neovascular phenotypes.

Perinatal deaths [including fetal death (FD), miscarriage, stillbirth, and early neonatal death (ENND)] referred for forensic investigation are often complex and can involve medical, biological, traumatic, toxicological, and psychosocial components. Further complicating these deaths is the regional and national heterogeneity of statutory requirements, practice conventions, and access to resources. This inconsistency affects the quality of national data and may impact mothers and families by potential criminal prosecution and/or loss of parental rights. Thus, the National Association of Medical Examiners (NAME) convened an expert panel to create a position paper regarding the investigation of perinatal deaths. This paper provides evidence-based guidance to medical examiners, coroners, and death investigators regarding the investigation and certification of perinatal deaths, with specific focus on the settings of maternal substance use disorder and making the determination of live birth versus stillbirth.

PURPOSE/OBJECTIVE:To describe the first successful whole eye transplantation (WET) in a human, performed with concurrent partial face transplantation, and to characterize postoperative outcomes. DESIGN/METHODS:Case report. PARTICIPANT/METHODS:A 46-year-old male with severe facial and ocular deficits following high-voltage electrical injury, including left eye enucleation and extensive soft tissue and aesthetic deformities. METHODS:Comprehensive preoperative evaluation, precise microsurgical techniques including vascular anastomosis and optic nerve coaptation, and serial postoperative assessments with optical coherence tomography (OCT), fluorescein angiography (FA), electroretinography (ERG), and visual evoked potentials (VEP). MAIN OUTCOME MEASURES/METHODS:Sustained globe viability, vascular perfusion, retinal structural integrity, and electrophysiological function. RESULTS:The transplanted globe demonstrated robust vascular perfusion and structural preservation over 12 months. Outer retinal function was maintained, as indicated by ERG, despite retinal nerve fiber layer loss and optic nerve transection. VEP confirmed absence of visual perception. The procedure achieved substantial aesthetic restoration. CONCLUSIONS:This study establishes the feasibility of WET in humans, with sustained globe viability and preserved outer retinal function. These findings serve as a critical step toward future exploration of ocular transplantation.

INTRODUCTION/UNASSIGNED:Vision loss in older adults is largely driven by age-related macular degeneration (AMD), characterized by progressive central visual field damage and functional decline. While current options for wet and dry AMD are limited and expensive, drug repurposing represents a promising strategy to accelerate the discovery of effective, accessible treatment by leveraging medications with established safety profiles. Notably, anti-diabetic agents including metformin, sulfonylureas, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and insulin have emerged as modulators of the retinal pigment epithelium (RPE) function, photoreceptors, and retinal vascular integrity. AREAS COVERED/UNASSIGNED:This review highlights the roles of oxidative stress, inflammation, and complement-mediated immune dysregulation in AMD pathogenesis, alongside preclinical data demonstrating metformin's protective effects via AMP-activated protein kinase (AMPK) activation. Population-based studies and meta-analyses further suggest a modest reduction in AMD risk associated with metformin use in both diabetic and non-diabetic cohorts. Additional pharmacological agents include statins, glyburide, L-DOPA, fluoxetine, dimethyl fumarate, and nutraceuticals such as curcumin, melatonin, and N-acetylcysteine. EXPERT OPINION/UNASSIGNED:Early AMD prevention through repurposed therapeutics, guided by AI-driven design and systems biology, may enable personalized care via multimodal risk stratification incorporating genetic, metabolomic, and microbiome data. Rigorous, stratified clinical trials integrating bioinformatics and precision medicine are essential to validate the most effective candidates.

BACKGROUND AND OBJECTIVE/UNASSIGNED:This study aimed to develop machine learning algorithms to predict visual and anatomic outcomes and treatment frequency in patients with macular edema following central retinal vein occlusion (MEfCRVO) after intravitreal aflibercept injections (IAI). PATIENTS AND METHODS/UNASSIGNED:= 91) trials treated with monthly IAI 2 mg for 24 weeks then pro re nata (PRN) through week 52 were used to develop machine learning algorithms. RESULTS/UNASSIGNED:= 0.76). PRN injection frequency from week 24 to 52 was predicted with high accuracy (AUC = 0.83). Univariate analyses confirmed all predictive factors. CONCLUSION/UNASSIGNED:Machine learning algorithms predicted outcomes and dosing frequency with high accuracy and may help inform patients' and clinicians' expectations during MEfCRVO management.

PURPOSE/OBJECTIVE:To report on the presentation, treatment, and visual outcome of stromal keratitis (SK) in the Zoster Eye Disease Study (ZEDS). DESIGN/METHODS:Secondary analysis of SK endpoint of randomized clinical trial. SUBJECTS/METHODS:Herpes Zoster Ophthalmicus (HZO) patients were randomized in a double-masked clinical trial of oral valacyclovir 1g daily or placebo for 1 year. They were followed prospectively every 3 months for 18 months for endpoints of SK, iritis (IR), endothelial keratitis (EK), or dendritiform epithelial keratitis (DEK). METHODS:Presentation of recurrent, new, or worsening SK was evaluated retrospectively by treatment assignment, randomization strata, and use of topical steroids. Investigators had been allowed discretionary treatment of endpoints including open label valacyclovir and topical steroids. Visual outcome and treatment with open label oral valacyclovir and topical steroids were evaluated. MAIN OUTCOME MEASURES/METHODS:Use of open label valacyclovir and topical steroid treatment of recurrent, new, or worsening SK, and visual acuity at 12 months. RESULTS:Recurrent, new, or worsening SK occurred in 105/527(20%) participants. Randomization group was not associated with this complication. Mean best corrected visual acuity at enrollment was logMAR 0.10±0.14 with no difference at 1 year, logMAR 0.13±0.2, and no difference between valacyclovir and placebo groups at enrollment or at 1 year. Among the 105 instances of SK, 79(75%) were recognized at scheduled study visits rather than at episodic visits. In only 11/105(10%) of recurrent, new, or worsening SK, did masked investigators opt to treat with open label oral antiviral. At the time of SK complication, 52/105(50%) were on topical steroid, but 47/52(90%) on topical steroids were using 1x daily or less, 21/47(45%) high potency and 26/47(55%) low potency (p=0.47). Of 48/105(47%) on no topical steroids at recurrent, new, or worsening SK, 18/48(38%) had discontinued steroids in the prior 3 months. 38/48(75%) on no topical steroids at complication SK were subsequently treated with high potency steroids 2x daily or more. Of 26/52(50%) on low potency steroids at complication SK, 23/26(88%) were treated with increase in frequency only. CONCLUSIONS:Individuals with ocular complications of HZO who develop SK generally maintain very good vision without use of oral antiviral therapy when monitored closely and SK is recognized and treated. Low potency topical steroids should be considered for treatment and ongoing suppression of SK in HZO.