Faculty Bibliography

PURPOSE/OBJECTIVE:The authors performed a cost analysis comparing the use of disposable and reusable tonometry equipment and gonioscopy lenses. METHODS:All adult patient (16 years old) visits in a one-year period were included. Scenario analysis was employed to calculate the cost of disposable (Goldmann applanation tonometry (GAT) tips, rebound tonometry tips, gonioscopy lenses) and reusable equipment (GAT tips and gonioscopy lenses) as well as sanitization over 2, 5, and 10 years at a single institution. To account for variability in scenario modeling, a sensitivity analysis was additionally performed. The main outcome measure was cost differences for disposable equipment compared to reusable equipment with sanitization. RESULTS:The total volume included was 80,356 patient visits. Accounting for variable costs, the additional cost associated with disposable tonometry (GAT or rebound tonometry tips) instead of reusable GAT was $118,723 over 2 years and $603,924 over 10 years. Assuming a gonioscopy frequency of 3.2%, the additional cost associated with disposable gonioscopy lenses was $171,100 at 5 years and $361,237 at 10 years. At a gonioscopy frequency of 10%, the additional cost associated with disposable lenses was $1,208,096 without inflation at 10 years. Overall, the total additional cost associated with disposable tonometry tips and gonioscopy lenses over reusable versions of this equipment was $965,161 over 10 years at a single institution. CONCLUSION/CONCLUSIONS:A widespread transition from reusable to disposable tonometry and gonioscopy equipment was associated with an additional cost of $965,161 over a 10- year period at a single institution.

PURPOSE/OBJECTIVE:To examine whether delayed rod-mediated dark adaptation (RMDA) in healthy older eyes and those with early age-related macular degeneration (AMD) is associated with AMD incidence and progression at follow-up, as compared with other visual functions reliant on rods, cones, or mixed rod-cone mediation. DESIGN/METHODS:Longitudinal study over 3 years. PARTICIPANTS/METHODS:Eyes from adults ≥60 years of age with normal macular health or with early AMD at baseline. METHODS:At baseline, eyes underwent fundus photography to establish AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step classification system. The following visual functions were tested in 1 eye at baseline (the study eye): RMDA, scotopic sensitivity, low-luminance acuity, mesopic contrast sensitivity, mesopic light sensitivity, visual acuity, and contrast sensitivity. Three years later at follow-up, fundus photography and the AREDS classification were repeated. Age-adjusted relative risks and 95% confidence intervals measured the association between visual functions and AMD incidence and progression for the study eye and the fellow eye at follow-up. MAIN OUTCOME MEASURES/METHODS:Presence and severity of AMD at the 3-year follow-up visit in the study and fellow eyes. RESULTS:Healthy older eyes at baseline with delayed RMDA were 3.54 or 3.40 times more likely to have incident AMD at the 3-year follow-up in the study eye and the fellow eye, respectively, compared with eyes without delays. No other visual functions were associated with AMD incidence, except for low-luminance visual acuity in the study eye. Eyes with early AMD at baseline with delayed RMDA were 3.89 or 2.65 times more likely to have progressed at follow-up for the study and fellow eye, respectively. No other visual functions were associated with AMD progression at follow-up. CONCLUSIONS:Rod-mediated dark adaptation is the only visual function of those tested that was associated with AMD incidence and progression over 3 years in healthy eyes or those with early AMD at baseline. Our results suggest that other visual functions are not useful for understanding AMD incidence and early progression risk. Interventions that eventually are designed to arrest early AMD progression or preventative measures in those at risk should consider RMDA a functional outcome measure. FINANCIAL DISCLOSURE(S)/BACKGROUND:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE/UNASSIGNED:To describe a new surgical technique to treat corneal allogenic ring segments (CAIRS) shaped by a femto-second laser with extracorporeal ultra-high-fluence corneal cross-linking (CXL) before insertion into the corneal stroma (ECO-CAIRS). METHODS/UNASSIGNED:ultraviolet (UV) light fluences, and inserted without air-drying or extended dehydration. RESULTS/UNASSIGNED:Insertion was uneventful in all cases. CAIRS subjected to ultra-high-fluence CXL remained stiff during the entire insertion process and showed no tendency to soften. The initial ring segment thickness was approximately halved immediately after the high-fluence CXL treatment compared to pre-CXL levels; thickness levels increased within days after insertion. CONCLUSIONS/UNASSIGNED:This new technique may provide multiple advantages over unmodified or air-dried CAIRS, including an easier insertion due to greater stiffness and resistance to re-swelling during insertion. The high UV fluences used should eliminate viable keratocytes, essentially transforming the segment into an acellular collagen scaffold. Finally, the marked transitory decrease in thickness may allow for the insertion of ring segments with greater overall volume, potentially increasing the corneal topographical effect. Further clinical research is required to assess the extent to which the effect on corneal topography is driven by the CAIRS volume and/or by its intrinsic stiffness.

Focused transcranial ultrasound stimulation (TUS) can affect neural activity with high spatial precision, advancing noninvasive neuromodulation toward targeted treatment of brain disorders. Direct monitoring of TUS responses is crucial for ensuring optimal outcomes. Blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging has primarily been used for studying TUS effects in both human and nonhuman primate brains. However, the physiology and mechanisms underlying BOLD remain largely unknown due to its highly convoluted nature. To address these limitations, we developed a hybrid system for concurrent optoacoustic and magnetic resonance imaging of TUS (OMRITUS) to comprehensively characterize the hemodynamic changes in murine brains. Our findings reveal paradoxical negative BOLD signals in the activated cortical regions, coupled with increased total hemoglobin levels simultaneously monitored with optoacoustic tomography. Multispectral optoacoustic readings further demonstrated a stronger increase in deoxygenated versus oxygenated hemoglobin, suggesting a potential molecular basis for the negative BOLD responses. OMRITUS enables the study of complex TUS-hemodynamic interactions, paving the way for precise neuromodulatory interventions.

A 59-year-old man presented with bilateral chalazia refractory to conservative management. Following excision, histopathology confirmed the diagnosis. Seven days postoperatively, he developed spontaneous, painless bleeding from the left upper eyelid. Follow-up examination suggested a small pyogenic granuloma, which was excised, but recurrent hemorrhage persisted. Further hematologic workup was unremarkable. A short course of oral tranexamic acid was initiated, leading to complete resolution of bleeding within 24 hours. Delayed hemorrhage following chalazion excision is rare, with limited cases reported, and this case demonstrates successful noninvasive management with oral tranexamic acid. While tranexamic acid is widely used in major surgeries, its role in minor ophthalmic procedures remains off-label. This case supports its potential utility as a hemostatic agent in select ophthalmic cases, warranting further investigation into its efficacy and safety in this context.

BACKGROUND:Take-home methadone (THM) flexibility has increased since 2020, representing innovation in opioid use disorder treatment. There are no established approaches to measuring THM using insurance claims data. We proposed and validated candidate measures of THM. METHODS:Using 2020 Medicaid data from 4 states, we constructed treatment episodes for enrollees aged 18-64. Episodes started after July 1, 2020 and lasted at least 60 days. We labelled individuals as receiving THM if they received ≥6 consecutive days of THM in their 2nd month of treatment, as defined by presence of claims with a modifier code indicating THM (the "gold-standard" indicator). We defined 4 candidate indicators of THM based on intervals between in-clinic methadone administrations. We assessed performance of each candidate indicator against the gold-standard. We assessed the extent to which between-program variation explained total variation in measured THM. RESULTS:The study sample included 4836 episodes for 4801 individuals. THM was present in 14 % of episodes. Sensitivity of candidate indicators ranged from 65 to 100 %, with the most sensitive being an indicator that was true if any two adjacent in-clinic service dates had a gap of ≥7 days. Specificity ranged from 80 to 96 %, with the most specific measure being one requiring 2 consecutive intervals of ≥7 days that were of the same length. Between-program variation explained 38.6-48.3 % of variation in THM receipt. CONCLUSIONS:Two indicators of THM using Medicaid data presented excellent performance when evaluated against a gold-standard indicator. Our approach can be used to assess uptake and outcomes of THM.

PURPOSE/OBJECTIVE:To characterize and classify different forms of peripapillary retinoschisis (PPRS), and to clarify the nomenclature of this condition. METHODS:A retrospective, multicenter, multinational case series of PPRS was performed from August 2021 to September 2024. Cases were included if they demonstrated retinoschisis contiguous with and thought to be originating from the optic disc. Demographic and clinical data collected included age, gender, visual acuity, intraocular pressure, axial length, refraction and referring symptoms. Mandatory investigations included optical coherence tomography of the optic disc and macula with radial scans, colour fundus photography, and fundus autofluorescence. Select cases underwent fundus fluorescein and/or indocyanine green angiography. Retinoschisis was characterised by the meridian in relation to the optic disc, layer(s) of the retina affected and associated conditions. A literature review was performed to identify all causes of PPRS. RESULTS:A total of 47 eyes from 41 patients with PPRS were identified, comprising of 22 (54%) females and a mean age of 56 years (range 14-92 years). These were classified into nine aetiologies: Congenital Disc Abnormalities (CDA, n=16 eyes), peripapillary chorioretinal coloboma (n=1), peripapillary atrophy (n=3), glaucoma (n=7), Peripapillary Pachychoroid Syndrome (PPS, n=4), peripapillary choroidal neovascularization (PP-CNV, n=3), high/ pathological myopia (n=5), vitreopapillary traction (VPT, n=4) and idiopathic (n=4). CONCLUSION/CONCLUSIONS:The nine aetiologies of peripapillary retinoschisis can be classified into five groups: non-glaucomatous optic disc abnormalities (CDA, PP-coloboma, PP-atrophy), glaucomatous optic disc abnormalities, peripapillary choroidal diseases (PPS and PP-CNV), vitreous optic disc interface abnormalities and idiopathic. A new entity, "Focal Optic Disc Dome" (FODD) was identified. Understanding the full spectrum of PPRS can assist in correct diagnosis and management.

PURPOSE/OBJECTIVE:To establish consensus-based guidelines on the diagnosis, classification, and management of central serous chorioretinopathy (CSC) through a structured expert panel initiated by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), and the Academia Retina Internationalis (ARI), addressing the existing clinical controversies. METHODS:An international panel of 26 experts from 13 countries collaboratively drafted consensus statements spanning five key areas: disease definition, pathophysiology, investigations, current management, and future developments. Consensus was reached through an iterative Delphi process and anonymous voting using a five-point Likert scale. Statements were accepted when >75 % agreement ('agree' & 'strongly agree') was achieved. RESULTS:Consensus was achieved for all 25 statements, reflecting strong alignment among experts. Key agreements included defining CSC as a pachychoroid-driven chorioretinal disorder characterized by neurosensory retinal and/or RPE detachment, with multimodal imaging (optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography) recognized as essential for diagnosis. Half-dose photodynamic therapy (PDT) was unanimously endorsed as the first-line treatment for chronic CSC. Oral mineralocorticoid receptor antagonists (MRAs) lacked consensus for therapeutic benefit, aligning with evidence from the VICI and SPECTRA trials. Anti-vascular endothelial growth factor receptor therapy was recommended solely for CSC complicated by a macular neovascularization. Future priorities highlighted standardizing disease classification and exploring targeted therapies through genetic and nanomedicine research. CONCLUSION/CONCLUSIONS:This consensus initiative provides a robust, evidence-based framework for the diagnosis and management of CSC, promoting standardization across clinical practices and guiding future research directions to address persistent gaps in CSC care.