Faculty Bibliography

PURPOSE/OBJECTIVE:To identify topographic and wavefront aberration parameters that distinguish early post-LASIK (PL) ectasia (PLE) from stable PL corneas, keratoconus (KC), and normal eyes when matched for mean central keratometry. METHODS:This retrospective comparative study included 200 patients (n = 50 per group): early PLE, stable PL, early KC, and normal eyes, matched for mean central keratometry (∼41.0 D). Corneal topographic indices [index of surface variance (ISV), index of vertical asymmetry (IVA), index of height asymmetry (IHA), index of height decentration, central keratoconus index], keratometric parameters (flat K, steep K, K_max), pachymetry, higher-order aberrations (HOAs), coma, astigmatism, and a novel asymmetry-to-symmetry (A/S) aberration ratio. RESULTS:PLE exhibited higher K_max (46.9 ± 3.1 D) compared with PL (45.2 ± 1.7 D; P <0.01), although lower than early-KC (48.2 ± 4.3 D). Pentacam indices showed elevated ISV (40.98 vs. 23.68), IVA (0.38 vs. 0.16), and IHA (10.22 vs. 6.41) in PLE versus PL (all P < 0.001). PLE eyes had higher anterior HOA RMS (∼3.5 μm) than PL (∼2.5 μm) and normal (∼1.1 μm), approaching early KC (∼5.1 μm). Asymmetric aberrations (coma, astigmatism, trefoil) were disproportionately increased in PLE, whereas symmetric aberrations (spherical aberration, defocus) remained comparable (P ≈ 0.9). The A/S ratio was higher in PLE (0.60 ± 0.44) versus PL (0.30 ± 0.16, P < 0.001). Receiver-operator-characteristics analysis identified IVA (area under the receiver-operator-characteristics curve 0.802), ISV (0.786), coma (0.771), HOA RMS (0.740), and A/S ratio (0.728) as useful discriminators of PLE. An A/S ratio >0.54 yielded 96% specificity for ectasia detection. CONCLUSIONS:Early PLE shows distinctive disproportionate increases in asymmetric aberrations, quantified by the A/S ratio. In combination with ISV, IVA, and coma, this metric may facilitate early diagnosis of PLE, enabling timely intervention to prevent progression.

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.

PURPOSE/OBJECTIVE:To describe a patient with progressive visual symptoms and reduced retinal sensitivity corresponding to dark without pressure (DWP). METHODS:Retrospective chart review of a single patient. Comprehensive ophthalmic examinations and multimodal imaging techniques, including optical coherence tomography (OCT), OCT-angiography, and microperimetry, were analyzed. RESULTS:A 23-year-old male presented with progressive peripheral areas of blurred vision superiorly in his right eye and temporally in his left eye. These disturbances corresponded with dark areas of retina inferiorly in his right eye and nasally in his left eye having characteristic features of DWP on multimodal imaging. Although Humphrey visual field (HVF) 24-2 testing was normal, microperimetry showed decreased retinal sensitivity in areas of DWP relative to adjacent areas without DWP. CONCLUSION/CONCLUSIONS:Prior descriptions of DWP have described it as a benign retinal finding showing no functional deficits. We demonstrate that DWP can be associated with progressive visual complaints showing decreased retinal sensitivity on microperimetry and undetected with HVF 24-2 testing.

Interferometric diffuse optics (iDO) has recently emerged as a promising class of near-infrared (NIR) light technologies for monitoring human brain signals associated with coherent light fluctuations. In this work, we demonstrate a line scan interferometric diffusing wave spectroscopy (iDWS) system at 1060 nm, a wavelength that has a multitude of benefits for high-speed cerebral blood flow index (BFI) monitoring. Pulsatile BFI measurements on the forehead of a moderately dark-skinned (Fitzpatrick Type V) subject with medium-length black hair up to a source-collector (S-C) separation of 5.5 cm on the forehead and 4.0 cm over the parietal cortex are demonstrated in continuous wave (CW) mode. On this high-throughput platform, we further implement a simple time-of-flight filter (TOF) via source wavelength tuning. The TOF filter can be turned on and off, and its width can be changed electronically, enabling probing different sample depths without requiring multiple S-C separations. At 4 cm S-C separation, an electronic TOF filter afforded a 2.92-fold reduction in scalp sensitivity over CW mode. With further optimization, the combination of TOF filtering with highly parallel detection in the 1060 nm range promises to improve depth sensitivity and signal-to-noise ratio of iDO in neuromonitoring applications.

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:We present a patient with a primary vasoproliferative tumor (VPT) accompanied by vitreous haze and an epiretinal membrane (ERM). We report for the first time the vitreous cytokine profile from an eye with a primary VPT to explore the relationship between intraocular inflammation and these tumors. METHODS:Retrospective chart review of a single patient case. RESULTS:25-gauge pars plana vitrectomy with membrane peel and vitreous biopsy was performed. Peripheral vitreous shave exposed an inferior grey-red mass located at the ora serrata, consistent with VPT. Treatment with confluent, long duration endolaser was performed. Vitreous cytology was negative for malignancy. A 13-cytokine panel (Associated Regional and University Pathologists, Inc. Laboratories, Salt Lake City, UT) revealed elevated interleukin 6 (13.3 pg/mL; normal <=2.0) and interleukin 8 (6.0 pg/mL; normal <=3.0). At one month post-operative, visual acuity improved from 20/40 to 20/25 OD, with mild anterior vitreous inflammation and regression of the VPT. CONCLUSION/CONCLUSIONS:Pro-inflammatory and pro-angiogenic cytokines were elevated in the vitreous of this patient's eye with a primary VPT. We suggest that the endothelial cells and macrophages which comprise VPTs could secrete these cytokines into the vitreous, resulting in vitreous haze and an overzealous fibrotic response manifested as ERM formation.

Bessel beams are commonly used in two-photon microscopy to extend the depth of field and thereby achieve functional volumetric imaging of the living brain. In practice, this approach suffers from background signals and limited lateral resolution due to the Bessel beam's strong side lobes. We introduce and demonstrate a new approach to side lobe suppression based on non-degenerate two-photon excitation, in which dual wavelength illumination produces an imaging point-spread function that is the product of the two coaxial Bessel beams. This technique can reduce the main side lobe intensity of a Bessel beam by 50% or more. We illustrate the approach conceptually with an analytical paraxial model and use detailed physical simulation to show that the approach is effective in the presence of the symmetry-breaking aberrations that amplify side lobes in high NA systems. We experimentally demonstrated the technique using a refractive axicon and the pump and tunable beams of a femtosecond laser. This work establishes non-degenerate two-photon excitation as a practical and broadly applicable strategy for improving point spread-function quality in high-resolution volumetric microscopy.