Ophthalmology Commons^™

Gene-Agnostic Therapeutic Strategies For Inherited Retinal Diseases: Neuroprotection And Immunomodulation, Lucas W. Rowe, S. Patricia Becerra, Robert E. Maclaren, Robert L. Avery, Charles C. Wykoff, Allen C. Ho, Carl D. Regillo, Dean Eliott, Andrew Osborne, Katie M. Binley, Thomas A. Ciulla

Wills Eye Hospital Papers

Background/Objectives: Inherited retinal diseases (IRDs) represent a genetically heterogeneous group of disorders caused by mutations in over 280 genes with more than 3100 identified variants. While gene-specific replacement therapies have achieved landmark success with voretigene neparvovec (Luxturna) for biallelic RPE65-associated retinal dystrophy, developing individual therapies for each genetic subtype remains impractical. This review examines gene-agnostic therapeutic approaches utilizing neuroprotection and immunomodulation that target common pathophysiological mechanisms shared across multiple IRD genotypes. Methods: We reviewed the literature on neuroprotective and immunomodulatory gene therapy strategies for IRDs, focusing on neurotrophic factors and complement system modulation. Results: Neuroprotective approaches delivering neurotrophic factors—including pigment …

Epidemiology And Follow-Up Adherence Of Ophthalmic Emergencies: A 10-Year Study At A Tertiary Medical Center In Taiwan, Tsung-Ying Tsai, Chunya Kang, Laura Liu, Nan-Kai Wang, Kuan-Jen Chen, Wei-Chi Wu, Chi-Chun Lai, Sunir J. Garg, Eugene Yu-Chuan Kang, Yih-Shiou Hwang

Wills Eye Hospital Papers

PURPOSE: The purpose of the study was to evaluate factors influencing outpatient follow-up adherence among patients receiving ophthalmology consultations in the emergency department (ED).

MATERIALS AND METHODS: This retrospective cohort study collected data from the Chang Gung Research Database. Patients who received ophthalmology consultations at the ED of Chang Gung Memorial Hospital Linkou Medical Center from January 1, 2010, to December 31, 2019, were included. Patients were divided into two groups based on whether they completed outpatient follow-up within 28 days, a timeframe consistent with our hospital's scheduling policy. Demographics, ED visit timing, triage categories, ophthalmic diagnoses, prior visits, and …

Infectious Retinitis Associated With Jak Inhibitors: The Ongoing Duality Of Jak Inhibitors, Jose S. Pulido, Fukutaro Mano, Marcello Casella, Susumu Ishida

Wills Eye Hospital Papers

PURPOSE: To discuss the recent evidence that Janus kinase (JAK) inhibitors can cause viral retinitis.

METHODS: A commentary on the case report in this issue and a review of cases in the literature.

RESULTS: A total of 6 cases have now been reported of cytomegalovirus retinitis associated with Jak inhibitors. Additionally, there was a case of bilateral toxoplasma retinitis and a case of herpetic scleritis.

DISCUSSION: It is important to be aware of the potential blinding complications associated with JAK inhibitors and if the patient complains of acute vision loss and/or floaters, the patient should be emergently referred to a …

Severe Bilateral Retinal Degeneration Following A Twenty-Six-Year Pentosan Polysulfate Sodium Exposure: A Case Report., Aaron T. Zhao, Turner D. Wibbelsman, Martin Calotti, Collin J Richards, Tamara R. Vrabec

Wills Eye Hospital Papers

PURPOSE: To describe an advanced case of pentosan polysulfate sodium (PPS)-associated retinopathy with extensive macular and peripheral retinal involvement following prolonged high-dose exposure.

OBSERVATIONS: An 86-year-old male presented with bilateral hand motion visual acuity and a 26-year history of PPS use (400mg daily, ∼3769g cumulative dose) for treatment of interstitial cystitis. Fundus examination revealed widespread retinal degeneration characterized by confluent nummular patches of retinal atrophy in a radial distribution from the optic nerves. Ocular coherence tomography (OCT) demonstrated severe outer retinal disorganization, and fundus autofluorescence (FAF) showed extensive RPE loss and absence of the Robson Holder ring. Genetic testing excluded …

Lower Gyrification Of The Ventromedial Prefrontal Cortex In Posttraumatic Stress Disorder: An Enigma-Ptsd Study., Ahmed Hussain, C Lexi Baird, Ashley A Huggins, Courtney C Russell, Delin Sun, Leonel Rangel-Jimenez, Chadi G Abdallah, Michael Angstadt, Geoffrey May, Hannah Berg, Jennifer U Blackford, Josh Cisler, Judith K Daniels, Nicholas D Davenport, Richard J Davidson, Maria Densmore, Seth G Disner, Wissam El-Hage, Amit Etkin, Negar Fani, Jessie L Frijling, Evan M Gordon, Daniel W Grupe, Ryan A Herringa, Julia I Herzog, David Hofmann, Anna R Hudson, Tanja Jovanovic, Anthony King, Saskia B J Koch, Ruth A Lanius, Amit Lazarov, Gen Li, Israel Liberzon, Shmuel Lissek, Guangming Lu, Antje Manthey, Adi Maron-Katz, Katie A Mclaughlin, Sven C Mueller, Laura Nawijn, Steven M Nelson, Yuval Neria, Richard W J Neufeld, Jack B Nitschke, Bunmi O Olatunji, Miranda Olff, Matthew Peverill, Rongfeng Qi, Yann Quidé, Orren Ravid, Ivan Rektor, Kerry J Ressler, Pavel Říha, Marisa Ross, Kelly Sambrook, Christian Schmahl, Anika Sierk, Scott R Sponheim, Jennifer S Stevens, Thomas Straube, Benjamin Suarez-Jimenez, Jean Théberge, Nic J A Van Der Wee, Steven J A Van Der Werff, Sanne J H Van Rooij, Mirjam Van Zuiden, Dick J Veltman, Robert R J M Vermeiren, Henrik Walter, Li Wang, Xi Zhu, Ye Zhu, Sigal Zilcha-Mano, Neda Jahanshad, Paul M Thompson, Rajendra A Morey

Faculty, Staff and Students Publications

Background: Cortical gyrification involves the formation of folds in the cerebral cortex, coinciding with key neurodevelopmental processes. Its strong correlation with increased cortical surface area and decreased cortical thickness may improve cortical signaling efficiency by decreasing cortico-cortical distance. Differences in brain structure have been found in posttraumatic stress disorder (PTSD), yet few small studies have examined cortical gyrification.

Methods: Gyrification was quantified using FreeSurfer's Local Gyrification Index (lGI), derived from 3-dimensional T1-weighted volumetric brain magnetic resonance imaging in 1876 participants (PTSD n = 789, control n = 1087) across 24 sites from the ENIGMA-PGC (Enhancing Neuro Imaging Genetics through Meta-Analysis …

Comparison Of Ventilation Support During Laser Treatment Of Retinopathy Of Prematurity, Jason Peng, Raghav Taneja, Barry N. Wasserman, Krystal Hunter, Vineet Bhandari, Alla Kushnir

Wills Eye Hospital Papers

Highlights: What are the main findings? Preterm infants undergoing ROP laser surgery with routine elective intubation had significantly longer durations of post-operative mechanical ventilation. Routine intubation during this procedure did not improve short-term clinical outcomes, such as overall hospital length of stay or timing of laser intervention in the infant’s life. What are the implications of the main findings? Routine intubation strategies may unnecessarily increase exposure to mechanical ventilation without improving clinical outcomes. Standardization of perioperative intubation practices across hospitals may be needed to optimize respiratory support in this vulnerable population. Objective: To compare respiratory outcomes between infants undergoing retinopathy …

Expansion Of A Self-Guided Curriculum And Validation Of A Self-Assessment Tool For Ocular Examination Skills, Maria Lee, Irene Pak, Aryan Chaychian, Isabell Kassaye, Adam Alyafaie, Neeti Parikh, Madeline Yung

Journal of Academic Ophthalmology

Background: Public interest in vision health is growing, yet ophthalmology remains underemphasized in medical education due to time constraints associated with in-person instruction.

Purpose: To demonstrate effectiveness of self-guided e-learning modules for ocular examination skills and to determine whether self-assessments can reliably assess medical student proficiency in these skills.

Methods: Medical students at a single institution participated in a skills workshop. Group 1 completed self-guided modules for visual acuity, confrontational visual field testing, pupil examination, and extraocular motility evaluation. Group 2 completed a self-guided module for the slit lamp anterior segment examination. Afterward, each student completed a …

Green Vessel Signal On Multicolor Imaging As An Early Sign Of Ischemic Vasculitis In Irvan Syndrome: A Case Report, Daniel M. Markowitz, Jirat Nimworaphan, Carl Regillo, James P. Dunn, Robert C. Sergott

Wills Eye Hospital Papers

PURPOSE: Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is typically diagnosed after characteristic intravenous fluorescein angiography (IVFA) findings develop. This case demonstrates that identifying a green intravascular and perivascular signal on multicolor fundus imaging may be a potential noninvasive imaging sign for ischemic retinal vasculitis in IRVAN.

OBSERVATIONS: A 55-year-old female presented with bilateral optic disc edema and subtle peripapillary retinal vascular changes. Multicolor imaging showed a distinct green intravascular and perivascular signal before undergoing IVFA evaluation. Subsequent IVFA ultimately showed peripheral capillary nonperfusion, microaneurysms, and leakage consistent with IRVAN.

CONCLUSIONS AND IMPORTANCE: This case demonstrates the potential utility …

Improving Prediction Accuracy Of Radiation-Induced Temporal Lobe Injury In Nasopharyngeal Carcinoma Using Adc-Based Deep Learning And Dosiomics, Li Wang, Yang Li, Ting Qiu, Junyi Liu, Jiawei Zhou, Han Gao, Hongliang Yu, Yinsu Zhu, Baozhou Sun, Guanyu Yang, Shengfu Huang, Lirong Wu, Li Sun, Xia He

Faculty, Staff and Students Publications

Background: To investigate the potential of apparent diffusion coefficient (ADC) map-based deep learning and dose distribution-based dosiomics in predicting radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC).

Methods: This retrospective study included 3578 NPC patients from Jiangsu Cancer Hospital receiving intensity-modulated radiation therapy (IMRT). Ninety-four RTLI patients were recruited based on inclusion criteria and matched 1:1 with 97 control subjects using propensity scores. Patients were randomly assigned to the training cohort (n = 135) and the validation cohort (n = 59). Deep transfer learning (DTL) features and dosiomics features were extracted from ADC map and three-dimensional dose distribution, respectively. …

Age-Independent Anti-Angiogenic Therapy For Choroidal Neovascularization By Targeting Secretogranin Iii, Chengchi Huang, Hong Tian, Wei Li

Faculty, Staff and Students Publications

Recent studies reported that anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF) alleviate choroidal neovascularization (CNV) in young but not aged animals. We recently developed a disease-targeted anti-angiogenic therapy against secretogranin III (Scg3), which selectively binds to diseased but not healthy vessels in young mice. Herein, using a unique in vivo ligand binding assay, we predicted and confirmed that Scg3 selectively binds CNV vessels in both young and aged mice. In contrast, VEGF with minimal increased binding to CNV vessels exhibited an age-dependent decline in binding to both CNV and healthy vessels with negligible binding in aged mice. Based on …

Investigating The Prevalence Of Astigmatism In Patients With Intermittent Exotropia In Egyptian Children, Zeinab A Saad, Ghada Samir, Osama M. Abdelhay, Mohamed Gaber Abdallah

Journal of Medicine in Scientific Research

Uncorrected refraction is the major cause of visual morbidity among children and can result in the development of strabismus. Although several studies have investigated the risk factors for intermittent exotropia, uncorrected astigmatism, which is critical for prevention and treatment, has not been well estimated. Objectives: To evaluate the association between uncorrected astigmatism and intermittent exotropia in children. Methods: This retrospective, analytical, cross-sectional, population-based study included 90 children with intermittent exotropia X(T) who were followed up for two years; the children were aged from 6 to 12 years old. Patients were retrospectively reviewed to determine the prevalence of astigmatism and amblyopia …

Stimulus-Driven Cerebrospinal Fluid Dynamics Is Impaired In Glaucoma Patients, Ji Won Bang, Carlos Parra, Kevin Yu, Hyun Seo Lee, Gadi Wollstein, Joel Schuman, Kevin Chan

Wills Eye Hospital Papers

Cerebrospinal fluid (CSF), partly driven by sensory stimulation, is crucial for maintaining homeostasis and clearing metabolic waste. Whether such stimulus-driven CSF flow is disrupted in age-related neurodegenerative diseases of the visual system remains unclear. This study examined the CSF flow during visual stimulation in glaucoma patients and healthy older adults using functional magnetic resonance imaging. In glaucoma, CSF inflow becomes progressively decoupled from the visually evoked blood-oxygenation-level-dependent (BOLD) response. Specifically, the characteristic stimulus-locked CSF patterns, which decrease after stimulus onset and increase after offset, diminish with disease severity. Mediation analysis suggests this flattened CSF pattern is driven by a flatter …

Neuromyelitis Optica, Children's Health School Services

School Guides

Educator guide about how to support students with neuromyelitis optica.

Optic Neuritis, Children's Health School Services

School Guides

Educator guide about how to support students with optic neuritis.

Trustworthy Multimodal Ai For Medical Imaging: Enhancing Diagnosis, Reasoning, And Human-Agent Interaction In Extended Reality, Jai Prakash Veerla

Computer Science and Engineering Dissertations

The transition from traditional microscopy to digital pathology has digitized diagnostic data, yet clinical workflows remain constrained by two-dimensional screens and passive, opaque analysis tools that fail to capture the spatial complexity of biological systems. While Foundation Models now promise to reason across histology and genomics, a critical disconnect persists between the richness of this data and the limited cognitive bandwidth of clinicians, who currently lack the immersive interfaces and trustworthy agents necessary to utilize it effectively. This dissertation presents a unified framework for "Embodied Agentic AI," establishing a pipeline that augments physician capabilities through immersive visualization, robust security, and …

Impact Of Gender-Affirming Hormone Therapy On Dry Eye, Keith E. Arnold, Michael J. Foster, Tomasz A. Tabernacki, Chase A. Turner, Peter A. Netland, Kirtishri Mishra

Department of Ophthalmology Faculty Publications

Purpose

To determine whether gender-affirming hormone therapy (GAHT) influences tear system health in transgender individuals.

Methods

This retrospective cohort observational study analyzed data from transgender men and women ages ≥18-years between 2004 and 2024 via electronic medical record (EMR) data. Following propensity score matching, subjects on hormone therapy included 23,623 transgender men, 15,933 transgender women, and an equal number in each matched control group.

Results

Among transgender men and women, respectively, tear system disorders occurred in 0.90% and 0.94% of those using GAHT and 0.90% and 1.17% of those not using GAHT (p = 0.211, p = 0.072). There was …

Real-World Outcomes Of Combined Goniotomy And Canaloplasty Using The Streamline Surgical System, Taylor N. Drake, Kush Shah, Siddharth Bhargava, Constance O. Okeke

Department of Ophthalmology Faculty Publications

Purpose: To evaluate real-world outcomes of combined goniotomy and canaloplasty, performed with the Streamline Surgical System, on intraocular pressure (IOP) and medication burden in patients with ocular hypertension and open-angle glaucoma in a US-based clinical practice.
Patients and Methods: This retrospective, single-center chart review included patients who underwent the Streamline procedure either as standalone or in combination with cataract surgery between January 2022 and December 2023. Outcome measures included change in mean IOP and number of IOP-lowering medications from baseline through 12 months, analyzed in the overall cohort, with exploratory subgroup analyses stratified by race and glaucoma severity (mild, moderate, …

Migration Of Copper Bullet Fragment Through The Orbit And Conjunctiva, Maxwell A. Levi, Mehron G. Kouhestani, Giovanni Disandro, Peter A. Netland

Department of Ophthalmology Faculty Publications

This is a case report of a 31-year-old female who sustained a gunshot wound to the left orbit, resulting in a ruptured globe and retained bullet fragments extending into the frontal lobe. The patient underwent enucleation without orbital implant, and no metallic fragments were recovered intraoperatively. Three months later, she returned with bloody conjunctival discharge. Examination revealed a 1.25-cm copper-colored metallic bullet jacket fragment spontaneously protruding through the conjunctiva. Serial CT imaging confirmed anterior and inferior migration of the bullet fragment over time, with a total migration distance of 32.9 mm through the orbit. The shrapnel was removed in clinic …

Outcomes Of Allogeneic Ocular Surface Stem Cell Transplantation, Albert Y. Cheung, Natalia Quiroz-Casian, Enrica Sarnicola, Gautam C. Ramanathan, Siddharth Nath, Edward J. Holland

Department of Ophthalmology Faculty Publications

Allogeneic ocular surface stem cell transplantation (OSST) is an established therapeutic approach for limbal stem cell deficiency, utilizing techniques such as keratolimbal allograft (KLAL), living-related conjunctival limbal allograft (lr-CLAL), allogeneic cultivated limbal epithelial transplantation (allo-CLET), and allogeneic simple limbal epithelial transplantation (allo-SLET). This review synthesizes evidence from 35 studies encompassing 1, 268 eyes with at least 24 months of follow-up to evaluate intermediate- and long-term outcomes. Overall, OSST is associated with improvement in visual acuity and restoration of ocular surface stability, although success rates vary widely by technique, ranging from 13% to 87%. Outcomes appear to be influenced by the …

Hyphema Associated With Water Bead Projectile Toys: A Retrospective Comparative Study, Aashri I. Aggarwal, Priya K. Singh, Diego E. Arias, Peter A. Netland

Department of Ophthalmology Faculty Publications

Purpose: Superabsorbent water beads can be used in projectile toy guns. We aimed to characterize water bead-related hyphema and compare the prevalence with other causes of traumatic hyphema.

Methods: In this 10-month retrospective review, we identified 35 consecutive patients with traumatic hyphema presenting to the emergency department. Cases were grouped by injury mechanism, water bead-related compared with all other causes. Clinical data on initial presentation and subsequent visits were compared.

Results: In the patients with traumatic hyphema, 8 (23%) cases were due to water bead trauma. Bead-related cases involved significantly younger patients (16 ± 9 years) compared with other cases …