meeting of the new england ophthalmological society...patients with a previous history of trauma,...

780thmeeting of the

New England Ophthalmological SocietyOCULAR TRAUMA: WHAT WE SHOULD KNOW FOR OUR NEXT PATIENT

SUBSPECIALTY SESSIONS:CUTTING EDGE AND INVESTIGATIONAL THERAPIES IN NEURO-OPHTHALMOLOGY

ADVANCED TOPICS IN STRABISMUS

AIMING FOR 20/20: HOT TOPICS IN UVEITISDIAGNOSIS AND MANAGEMENT

NEOS ANNUAL HECHT POSTER CONTESTDonna Siracuse-Lee, MD, Moderator

June 5, 2020Virtual meeting available atWWW.NEOS-EYES.ORG

New England Ophthalmological Society PO Box 549127, Waltham, MA 02454-9127 | tel: 781-434-7656

email: [email protected] | www.neos-eyes.org

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AMA Credit Designation StatementThe New England Ophthalmological Society designates this enduring material for a maximum of 10.5 AMA

PRA Category 1 Credits™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for continuing Medical Education. The New England Ophthalmological Society is

accredited by the Massachusetts Medical Society to provide continuing medical education for physicians.

the 780th meeting of

The New England Ophthalmological Society, Inc.A Public Foundation for Education in Ophthalmology

VIRTUAL MEETING AVAILABLE ATWWW.NEOS-EYES.ORGJune 5, 2020

OCULAR TRAUMA: WHAT WE SHOULD KNOW FOR OUR NEXT PATIENTMagdalena Krzystolik, MD, Moderator

Fina Barouch, MD, Program Committee Coordinator

SUBSPECIALTY SESSIONS:

CUTTING EDGE AND INVESTIGATIONAL THERAPIES IN NEURO-OPHTHALMOLOGYCrandall Peeler, MD, Moderator

Gena Heidary, MD, PhD, Program Committee Coordinator

ADVANCED TOPICS IN STRABISMUS Oren Weisberg, MD, Moderator


AIMING FOR 20/20: HOT TOPICS IN UVEITIS DIAGNOSIS AND MANAGEMENTNinani C. Kombo, MD, Moderator


NEOS ANNUAL HECHT POSTER CONTESTDonna Siracuse-Lee, MD, Moderator

2 | New England Ophthalmological Society

MESSAGE FROM THE PRESIDENT

MARY K. DALY, MD

Dear NEOS Membership,

Welcome to the Virtual 780th Meeting of the New England Ophthalmological Society which will be available starting on June 5th. Our first ever virtual sessions on April 24th had a record level registration of 415 attendees! We are

hopeful that this new format continues to offer increased accessibility and flexibility to all our members and those interested in our educational programs.

Many sincere thanks go out to the moderators, guest-of-honor, the speakers, the Program and IT committees, and our executive assistant, Miguel Ocque, for their diligence and innovation in providing this novel and evolving meeting format. We are pleased to have James Banta, MD, as the guest-of-honor for the session Ocular Trauma: What We Should Know for Our Next Patient, and to offer subspecialty sessions in NeuroOphthalmology, Strabismus, and Uveitis. Trainees from across New England have submitted their posters for the Annual NEOS Scientific Poster Program which can be viewed online. This special program is made possible by the NEOS Education Endowment Fund honoring the late Sanford Hecht, MD, and is to be recognized once again for its support of the awards which will be given to the 1st, 2nd, 3rd place winners along with 3 honorary mentions. Congratulations to all our trainees for their innovative research and for sharing it with us! As always, our vendors are very important to NEOS. Please visit the Virtual Exhibit Hall for infor-mation from our valued supporters.

On a personal note, I have had two great privileges in my career. One is to serve and care for the Veterans of the United States, and the other is to have served as the President of this wonderful Society. It was not the year I had predicted! It is one that I will always remember with great pride and deep respect for a Society, which though steeped in tradition, has shown itself to be quite sprite and able to adapt with grace and innovation when tasked to do so! It is the people that make up the Society: the Executive Board, the committees and their chairs, and most importantly, you the members who make it so special. It has been an honor sharing this year with you. I cannot think of a more capable individual to take over as President than Jorge Arroyo, MD. Dr. Arroyo, I (virtually) hand over the NEOS President’s gavel to you!

With warmest Regards,Mary K. Daly, MD President of NEOS

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GUEST OF HONOR

James Banta, MD

Dr. Banta was born, raised and educated in Oklahoma. He compiled numerous awards throughout his education includ-ing Phi Beta Kappa as an undergrad and Alpha Omega Alpha as a medical student. After completing an ophthalmology residency at Bascom Palmer Eye Institute, he remained on the faculty there for 15 years. He was voted Professor of the Year in 2018. He has authored over 28 book chapters and

numerous scientific publications.

He has served the American Academy of Ophthalmology (AAO) as Chairman of the Practicing Ophthalmolgists’ Curriculum (POC), Cataract section, for the last 6 years and has served as an oral board examiner for the American Board of Ophthalmology since 2008. He is a recipient of the AAO’s Achievement and Secretariat awards.

Dr. Banta has performed over 18,000 cataract surgeries and has taught cataract surgery around the country. He has expertise in complex forms of cataract surgery including patients with a previous history of trauma, eye surgery or eye inflammation. Dr. Banta also performs pterygium surgery, intraocular lens exchange and anterior segment re-construction.

Dr. Banta most enjoys spending time with his wife, Andrea, and their two boys Wyatt and Luke. He is an avid fly fisherman and collects antique radios, flags and maps.


MORNING SESSION

OCULAR TRAUMA: WHAT WE SHOULD KNOW FOR OUR NEXT PATIENTMagdalena Krzystolik, MD, Moderator

Fina Barouch, MD, Program Committee Coordinator

Professional Practice Gaps: We obtained feedback from NEOS members, reviewed evaluations from prior NEOS meetings, and discussed with the Program Committee to identify potential practice gaps that include an update on the evaluation and manage-ment of trauma patients.

Program Objectives: The content and format of this educational activity has been specifically designed to fill the practice gaps in the audience’s current potential scope of professional activities by:

1. Providing information useful and applicable to both comprehensive and subspe-cialist NEOS ophthalmologists in the subject of ocular trauma.

2. Covering a wide variety of eye trauma topics including initial triaging, treatment, and management of ocular injuries including topics in oculoplastics and the management of trauma sequelae.

3. Presenting eye injuries in intimate partner abuse and strategies for eye trauma prevention.

Introduction of Program ....................................... PC Coordinator: Fina Barouch, MD Triage, Evaluation, and Surgical Preparation of the Eye Trauma Patient ................................................................... Matthew Gardiner, MDAntibiotic Prophylaxis in Eye Trauma Patients and Treatment of Traumatic Eye Infections ..............................................................Miriam Barshak, MDMidnight Approach to Lid Lacerations and Orbital Trauma ........Michael Migliori, MDIntroduction of Guest of Honor ....................................................... Fina Barouch, MDTraumatic Cataract Surgery and Iris Reconstruction, Part 1................ James Banta, MDTraumatic Posterior Eye Injuries ..........................................................Lucy Young, MDTraumatic Optic Neuropathy and Ocular Motor Dysfunction .......Crandall Peeler, MDTraumatic Glaucoma ..................................................................Christopher Teng, MDIntimate Partner Violence - What an OphthalmologistNeeds to Know............................................................................... Judith Linden, MDTraumatic Cataract Surgery and Iris Reconstruction, Part 2................ James Banta, MD

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Panel discussion: Ocular Trauma, What Would You Do?.......................................................................................Moderator: Fina Barouch, MD James Banta, MDMiriam Barshak, MDMatthew Gardiner, MDMichael Migliori, MDCrandall Peeler, MDChristopher Teng, MD


SUBSPECIALTY SESSION

CUTTING EDGE AND INVESTIGATIONAL THERAPIESIN NEURO-OPHTHALMOLOGYCrandall Peeler, MD, Moderator Gena Heidary, MD, PhD, Program Committee Coordinator

Professional Practice Gaps: Feedback from NEOS members and Program committee review identified.


1. Cross-specialty discussions

2. Update on treatments and when to refer patients

3. Deeper focus on particular conditions

Introduction of Program .............................................. Moderator: Crandall Peeler, MDTeprotumumab for Treatment of Thyroid Eye Disease ................... Elizabeth Houle, MDTreatment if GCA in the Era of Tocilizumab ................................ Elizabeth Fortin, MDWhat You Need to Know About Sarcoid Optic Neuropathy............Sashank Prasad, MDNovel Biologic Treatments for Neuromyelitis Optica:Satralizumab, Inebilizumab, and Eculizumab ...................................Marc Bouffard, MDNeuroprotection in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) .......................................................Danielle Rudich, MDThe Utility of OCT-Angiography in Neuro-Ophthalmology ........ Eric Gaier, MD, PhDNew Surgical Treatments for Idiopathic Intracranial Hypertension .... Laurel Vuong, MD

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ADVANCED TOPICS IN STRABISMUSOren Weisberg, MD, ModeratorGena Heidary, MD, PhD, Program Committee Coordinator

Professional Practice Gaps: This session will provide an in-depth discussion of treat-ment techniques for complicated strabismus cases and how to approach determining standards for success of surgical outcomes in strabismus.


1. Addressing advanced techniques in treating complicated strabismus

2. Identifying methods of determining success of strabismus surgery

3. Identifying functional impact of strabismus on patients

Introduction of Program ..............................................Moderator: Oren Weisberg, MDPartial Tendon Recession for Small-Angle Vertical Strabismus ....... Catherine Choi, MDBotox for Esotropia in Children ..................................................... Melanie Kazlas, MDAdjustable Sutures ...................................................................Gena Heidary, MD, PhDReconsidering Rectus Muscle Resection in Graves’ Ophthalmology .......Sylvia Yoo, MDNasal Transposition of the Split Lateral Rectus Muscle .............Ankoor Shah, MD, PhDGoal-Determined Metrics to Assess Outcomes of Strabismus Surgery.............................................................................................................Linda Dagi, MDFunctional Impact of Strabismus ....................................................Jennifer Galvin, MD

AFTERNOON SUBSPECIALTY SESSION


AFTERNOON SUBSPECIALTY SESSION

AIMING FOR 20/20: HOT TOPICS IN UVEITIS DIAGNOSISAND MANAGEMENTNinani C. Kombo, MD, Moderator Gena Heidary, MD, PhD, PC Coordinator

Professional Practice Gaps: Feedback from NEOS members and Program committee review identified.

The goal is to understand the work up of pediatric and adult patients with Uveitis and implement or assist the patients with obtaining appropriate diagnosis and care to pre-vent irreversible vision loss. Uveitis is a rare entity however it accounts for approximately 15-20% of blindness in the United States.


1. Diagnosis and treatment of pediatric uveitis

2. Advances in the diagnosis and treatment of viral associated uveitis

3. Understanding the Emerging causes of uveitis

Introduction of Program ......................................... Moderator: Ninani C. Kombo, MDPediatric Uveitis: Epidemiology and Workup .............................Ninani C. Kombo, MDPediatric Uveitis: Updates in Treatment ............................................KC LaMattina, MD Which Herpes Virus is the Culprit? ......................................................Lana Rifkin, MDNon-infectious Uveitis: What you Shouldn’t Miss ...............................Paul Gaudio, MDInfectious Retinitis in 2020 .....................................................................Jay Duker, MDParaneoplastic Retinopathies: Diagnosis and Treatment ...................... Lucia Sobrin, MDThe Mission is Remission: A Pathway to prevention of Blindness from Uveitis .....................................................................Stephen Foster, MD

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TRIAGE, EVALUATION, AND SURGICAL PREPARATIONOF THE EYE TRAUMA PATIENT

Matthew Gardiner, MD

MEEI, BOSTON, MA

Objective: Describe the steps for identifying and preparing the eye trauma patient for treat-ment

The on-call ophthalmologist should be uniquely adept at assessing ocular trauma. Phy-sicians must be comfortable with identifying, triaging and knowing when to refer trau-ma victims for more specialized care. The patient must be evaluated as a whole first to check for life-threatening injuries. Many seemingly isolated eye injuries are associated with occult CNS trauma that can be easily missed. Once the patient has been stabilized medically, there is a core group of diagnoses that must be identified quickly and treated or referred promptly. The exam must be complete and thorough with equal attention paid to the apparently uninjured eye. Having a robust protocol for the evaluation and preparation of open globe patients for the OR is critical for good outcomes. Even patients being transferred to another facility for repair must have an established checklist of items set in motion by the referring physician. With a careful, methodical approach, patients can retain excellent visual function even after devastating injuries.

References: Gardiner, MF. Overview of eye injuries in the emergency department. UpTo-Date, 2019 Andreoli C, Gardiner MF. Open globe injuries: Emergent evaluation and ini-tial management. UpToDate, 2010 North VN, Gardiner MF. Pre-operative Management of Open Globe Injuries. Grob S, Kloek C 2018. Management of Open Globe Injuries. Springer. Cham, Switzerland.


ANTIBIOTIC PROPHYLAXIS IN EYE TRAUMA PATIENTS ANDTREATMENT OF TRAUMATIC EYE INFECTIONS

Miriam Barshak, MD

MGH/MEEI, BOSTON, MA

Objective: To review new developments in prophylaxis against infections in eye trauma pa-tients and treatment of traumatic eye infections

Eye trauma increases the risks of ocular infections, including keratitis and endophthal-mitis. Effective prevention and medical treatment of these infections requires the ability to identify high-risk patients, understand the microbiology and antibiotic options that provide both appropriate spectrum of coverage and adequate delivery to the site of con-cern, and pursue the interventions that may be beneficial. This talk will highlight new literature on infections following eye trauma, which focuses on updating understanding of the microbiology and approaches to prevention--including systemic and intraocular antibiotics, sealing small corneal perforations with a stromal cefuroxime hydration tech-nique--and treatment, including antibiotics and interventions. This talk will also review newer antibiotics that may be considered for gram positive bacteria particularly in regard to the concern about hemorrhagic occlusive retinal vasculitis (HORV) following intraoc-ular vancomycin injections.

References: 1. Mishra D, Satpathy G, Chawla R, et al. Utility of broad-range 16S rRNA PCR assay versus conventional methods for laboratory diagnosis of bacterial endophthal-mitis in a tertiary care hospital. Br J Ophthalmol. 2019; 103;152. 2. Allon G, Shapira Y, Beiran I, et al. Hydration of small leaking corneal perforations with cefuroxime. In Ophthalmol. 2019; 39;2401. 3. Thevi T and Abas AL. Role of intravitreal/intracameral antibiotics to prevent traumatic endophthalmitis-Meta-Analysis. Indian J Ophthalmol. 2017; 65: 920. 4. Abouammoh MA, Al-Mousa A, Gogandi M, et al. Prophylactic intra-vitreal antibiotics reduce the risk of post-traumatic endophthalmitis after repair of open globe injuries. Acta Ophthalmol. 2018; 96:e361. 5. Lim BX, Koh VTC, and Ray M. Microbial characteristics of post-traumatic infective keratitis. Eur J Ophthalmol. 2018; 28: 13. 6. Du Toit N, Mustak S, and Cook C. Randomised controlled trial of prophylac-tic antibiotic treatment for the prevention of endophthalmitis after open globe injury at Groote Schuur Hospital. Br J Ophthalmol. 2017; 101:862. 7. Asencio MA, Huertas M, Carranza R, et al. A case-control study of post-traumatic endophthalmitis at a Spanish hospital. Int Ophthalmol. 2016; 36: 185.

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MIDNIGHT APPROACH TO LID LACERATIONS AND ORBITAL TRAUMAMichael E. Migliori, MD

LPG OPHTHALMOLOGY, PROVIDENCE, RI

Objective: Attendees should be able to determine which periocular injuries require immedi-ate treatment or referral, and which can be deferred/

Acute eyelid and orbital trauma can pose significant challenges, and if the ophthalmolo-gist on call for the emergency department is not comfortable with managing these inju-ries, these cases can also induce significant anxiety. This presentation will try to alleviate some of that anxiety by helping to identify those cases that are true emergencies, those that may need urgent or semi-urgent intervention, and those that can be referred for later follow up.

References: Bailey LA, van Brummen AJ, Ghergherehchi LM, Chuang AZ, Richani K, Phillips ME. Visual Outcomes of Patients With Retrobulbar Hemorrhage Undergoing Lateral Canthotomy and Cantholysis. Ophthalmic Plast Reconstr Surg. 2019;35(6):586-9. Scawn RL, Lim LH, Whipple KM, Dolmetsch A, Priel A, Korn B, et al. Outcomes of Orbital Blow-Out Fracture Repair Performed Beyond 6 Weeks After Injury. Ophthalmic Plast Reconstr Surg. 2016;32(4):296-301 Singh S, Ganguly A, Hardas A, Tripathy D, Rath S. Canalicular lacerations: Factors predicting outcome at a tertiary eye care centre. Orbit. 2017;36(1):13-8.


TRAUMATIC CATARACT SURGERY AND IRIS RECONSTRUCTIONJames Banta, MD

BEND OPHTHALMOLOGY, BEND, OR

Objective: Discuss the approach to the trauma patient with anterior segment injuries and elucidate current strategies for surgical correction of iris damage and traumatic cataract. Closed and open globe injuries can lead to symptomatic iris damage and traumatic cataract. Through a series of video case presentations, the management of these complex patients will be discussed. Specific topics regarding anterior segment repair will include surgical repair of iridodialysis and traumatic mydriasis, and the Siepser sliding knot technique. Specific topics regarding traumatic cataract surgery will include the use of trypan blue and intraretinal scis-sors to accomplish a capsulorhexis, visco-compartmentalization of vitreous prolapse, the use of anterior vitrectomy via the pars plana vitrectomy, slow motion phaco settings, capsular tension rings, and alternate fixation techniques in the absence of adequate capsular support.

References: Siepser SB. The closed-chamber slipping suture technique for iris repair. Ann Ophthalmol 1994;26:71-72 Osher RH, Snyder ME, Cionni RJ. Modification of the Siepser slip-knot technique. Melles GR, de Waard PW, Pameyer JH, Houdijn Beekhuis W. Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery. J Cata-ract Refract Surg. 1999 Jan;25(1):7-9.

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TRAUMATIC POSTERIOR EYE INJURIESLucy Young, MD

MEEI, BOSTON, MA

Objective: To review posterior segment manifestations following eye trauma.

Ocular trauma is a common cause of visual loss. Prior to examination, a detailed history is crucial and may offer clues to the nature of the ocular injury. The initial examination should be as thorough as possible, but it is important to avoid any further trauma to the globe. Computed tomography and ultrasonography can be very useful when there is no visualization of the posterior segment. Injuries such as commotio retinae, choroidal rupture, retinitis sclopetaria, optic nerve avulsion, vitreous hemorrhage and macular hole do not require immediate attention. However, retinal tears in the presence of vitreous hemorrhage, intraocular foreign bodies, macula-sparing retinal detachment and traumat-ic endophthalmitis are indications for urgent vitreoretinal surgical intervention. Accurate diagnosis and timely management of posterior segment injuries may reduce the magni-tude of visual loss in injured eyes.

References: N/A


TRAUMATIC OPTIC NEUROPATHY AND OCULAR MOTOR DYSFUNCTIONCrandall Peeler, MD

BOSTON MEDICAL CENTER, BOSTON, MA

Objective: The aim of this talk is to provide an overview of traumatic optic neuropathy and ocular motor palsies with a focus on imaging and treatment options.

Some degree of vision loss due to optic nerve injury is thought to occur in 2-5% of all head injury cases (1). The most common mechanism of injury is “indirect,” with impact forces transmitted via bone from the brow to the optic foramen. These forces cause vision loss through compression, stretching, or contusion of the optic nerve but often leave no ophthalmoscopic or radiographic signs of injury in the acute phase (2). “Direct” injury to the optic nerve by penetrating objects entering the orbit or optic canal is less common but important to rule out as surgical intervention can sometimes recover vision in these cases. Ocular motor dysfunction from injury to cranial nerves III, IV, or VI may also occur in the setting of trauma. Cranial nerve IV is most susceptible to injury even from relatively mild head trauma given the close anatomic relationship of its posterior decussation to the tentorium. Cranial nerves III and VI may be injured in more severe head trauma from traction or disruption at their peripheral attachments to the skull base or centrally from brainstem shearing or hemorrhage. The aim of this talk is to provide an overview of trau-matic optic neuropathy and ocular motor palsies with a focus on imaging and treatment options.

References: 1. Lessell S. Indirect optic nerve trauma. Arch Ophthalmol 1998;116:540-541. 2. Anderson RL, Panje Gross CE. Optic nerve blindness following blunt forehead trauma. Ophthalmology 1982;89:445-455.

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TRAUMATIC GLAUCOMAChristopher Teng, MD

YALE OPHTHALMOLOGY AND VISUAL SCIENCE, NEW HAVEN, CT

Objective: To review traumatic glaucoma, its various presentations, diagnostic techniques and approach to surgery.

The incidence of ocular trauma is around 2.5 million patients every year in the United States. The risk of developing glaucoma after penetrating injury in the United States is es-timated to be 2.67% while it is 3.39% after blunt trauma. This constitutes a fair number of patients at risk for glaucoma after eye trauma. This talk will briefly review ocular trau-ma, and discuss various manifestations of traumatic glaucoma, such as traumatic iritis, hyphema, angle recession glaucoma, and inflammatory glaucoma. It will discuss imaging techniques such as UBM and anterior segment OCT to aide in the diagnosis of angle recession glaucoma and will show a case and video on cataract surgery in a patient with phacoantigenic glaucoma after penetrating trauma.

References: 1. Traumatic glaucoma. Mikhael M, Khouri AS. AAO EyeWiki, accessed May 9, 2020. 2. Yanoff, Myron, MD, Duker, Jay S., MD. Ophthalmology, Fifth Edition.Philadelphia, Pennsylvania: Elsevier Inc; 2019:1089-1094. 3. Ramirez DA, Porco TC, Lietman TM, Keenan JD. Ocular Injury in United States Emergency Departments: Sea-sonality and Annual Trends Estimated from a Nationally Representative Dataset. Am J Ophthalmol. 2018 Jul;191:149-155.


INTIMATE PARTNER VIOLENCE - WHAT AN OPHTHALMOLOGISTNEEDS TO KNOWJudith Linden, MD

BOSTON UNIVERSITY SCHOOL OF MEDICINE, BOSTON, MA

Objectives: At the end of this session, participants will be able to: 1) Recall the prevalence/risk factors for IPV 2) Perform a targeted screening of high-risk patients 3) Use a trauma informed approach to assist survivors.

Studies show 1 in 4 women, and 1 in 5 men in the U.S. report being a victim of IPV in their lifetime. Intimate partner violence (IPV) is more prevalent in patients presenting for medical treatment. One study showed 38% or patients in a family medicine clinic, and 40% or women in the ED reported lifetime IPV. Although IPV can affect all patients of any demographic, including gender, age, socio-economic status or race, the prevalence is somewhat higher in certain populations, including those with trauma, women, younger age, lower socioeconomic status, and those with mental health issues and disabilities. Al-though physicians are often uncomfortable inquiring about IPV, studies show that most women prefer to be asked. This talk will assist the ophthalmologist in confidently in-quiring about IPV, and supporting the patient in an effective, trauma-informed manner, whether the patient chooses to disclose the violence or not. I will discuss targeted screen-ing, available resources, and engaging a team of support.

References: 1) Miller E, McCaw B. Intimate Partner Violence. N Engl J Med. 2019 Feb 28;380(9):850-857 2) Wu V, Huff H, Bandhari M. Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis. Trauma Violence Abuse. 2010 Apr;11(2):71-82. 3) Director TD, Linden JA. Domestic violence: An approach to identification and interven-tion. Emerg Med Clin North Am. 2004 Nov;22(4):1117-32.

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NEOS SCIENTIFIC POSTER PROGRAM

Residents and fellows from all the New England ophthalmologic teaching programs have submitted abstracts for our annual scientific poster presentation contest being conducted today. Posters will be judged on originality and scientific merit. Awards will be made for the first prize $500.00, second prize $300.00, third prize $200.00 and three honorable mentions of $50.00 each. Funding for the awards is derived from a gift to the NEOS Education Endowment Fund honoring the late Sanford Hecht, MD.

Please take some time to visit these interesting posters on our virtual poster section. You’ll be able to watch a short presentation from their authors.

NEOS thanks Donna Siracuse-Lee, MD, the Moderator of the Poster Contest

AND THIS YEAR’S JUDGESPriya Janhardhana, MD, Courtney Ondeck, MD and Melissa Wong, MD.


Poster #1

OCULAR SYPHILIS TREND IN URBAN UNDERSERVED COMMUNITYIN THE UNITED STATES

Emily K. Tam, MD, MPH1; Alexander Port, MD1; Diana Martin, BA1;

Gabrielle Fridman, MD1; Steven Ness, MD1; Nicole H. Siegel, MD1

BOSTON MEDICAL CENTER, BOSTON, MASSACHUSETTS1

Objective: This study aims to describe the risk factors, presentation and prevalence of thus resurfacing disease.

Purpose: This study aims to describe the risk factors, presentation and prevalence of thus resurfacing disease. Methods: Retrospective chart review was performed on patients with diagnosis codes correlating with syphilis or syphilis related ocular diseases at Boston Med-ical Center, an urban teaching hospital, between 2010-2019. Results: 229 tested positive for syphilis and 40 patients were diagnosed with ocular syphilis. Among patients with ocular syphilis, 50% had vision 20/60 or better. 50% presented with anterior uveitis as their initial presentation. 49% patients had involvement of posterior segment. Neovascu-lar glaucoma, papillitis, vasculitis, and retinal detachment were rarer presentations. Con-clusion: This study provides insight to recognize ocular manifestations of this resurgent disease.

References: Oliver SE, Cope AB, Rinsky JL, et al. Increases in Ocular Syphilis-North Carolina, 2014-2015. Clin Infect Dis. 2017;65(10):1676-1682. Furtado JM, Arantes TE, Nascimento H, et al. Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection. Sci Rep. 2018;8(1):12071. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017 - Syphilis. Updated July 24, 2018. Accessed: https://www.cdc.gov/std/stats17/syph-ilis.htm

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POSTER #2

SHARED MEDICAL APPOINTMENTS IN OPHTHALMOLOGYEmily K Tam, MD, MPH 1; Sofia De Arrigunaga, MD, MPH 2; Madhura Shah, BS 3;

Haben Kefella, MD 1; Scarlett Soriano, MD 1, Susannah Rowe, MD, MPH, FACS 1

BOSTON UNIVERSITY MEDICAL CENTER 1; HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH 2;

BOSTON UNIVERSITY SCHOOL OF MEDICINE 3

Objective: This study describes the feasibility of conducting shared medical appointments in ophthalmology

Purpose: Shared medical appointments (SMAs) are becoming popular as a tool in prima-ry care to improve access. As little is known about its potential in ophthalmology, this study describes the feasibility of conducting SMAs in ophthalmologic practice. Methods: Glaucoma patients who were not compliant with glaucoma medications were recruited to participate, and a total of 5 patients attended the SMA. The 1.5 hour session included a basic eye exam, glaucoma education, peer to peer discussion, demonstration of eye use, medication refill, and pre and post survey administration for patients and staff members. Results: Positive responses from patients and staff members (physicians, ophthalmic tech-nicians, pharmacists) alike demonstrate that SMAs would be a feasible option in oph-thalmology practice. Conclusions: SMAs are a new concept to ophthalmology. As more programs incorporate SMAs into their visits, ophthalmologists should consider the role of SMAs in advancing patient care.

References: Kirsh S, Watts S, Pascuzzi K, et al. Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk. Qual Saf Health Care. 2007;16(5):349-53. Wagner E, Austin B, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–44. Kelly F, Liska C, Morash R, et al. Shared medical ap-pointments for patients with a nondiabetic physical chronic illness: A systematic review. Chronic Illn. 2019;15(1):3-26.


POSTER #3

FEATURES OF PENTOSAN POLYSULFATE SODIUM-ASSOCIATEDMACULOPATHY IN A DIVERSE PATIENT POPULATION

Gabrielle Fridman, MD; Emily K. Tam, MD, MPH; Alexander Port, MD;

Nicole H. Siegel, MD

BOSTON MEDICAL CENTER, BOSTON, MASSACHUSETTS

Objective: This study aims to characterize a series of patients with presumed pentosan poly-sulfate (PPS) associated maculopathy.

Purpose: To characterize clinical features of presumed pentosan polysulfate sodium (PPS)-associated maculopathy in a diverse patient population. Methods: Retrospective chart review of 254 charts. The electronic medical record (EMR) was queried to identify all patients with a history of pentosan polysulfate sodium exposure and a documented dilated eye examination between 2011-2019. Patient demographics, ocular findings, PPS exposure and dosage were reviewed. Subjects were included in analysis if PPS exposure, eye examination and optical coherence tomography (OCT) imaging were documented in the EMR. Results: Seven patients were identified who had both exposure to PPS and a pigmentary maculopathy on the fundus exam (Table 1). Similar to prior reports, our patients described symptoms of blurry vision at either distance or near despite having ex-cellent Snellen best corrected visual acuity (BCVA). Age of presentation was comparable to prior reports with a mean of 53 years and a range from 43 to 73 years. All patients showed macular retinal pigment epithelium (RPE) mottling or atrophy on the clinical exam and OCT. Unique to our series we identified a larger proportion of non-Caucasian females and the second male, to the authors knowledge, to be affected by PPS.

Conclusions: PPS-associated maculopathy is a recently described condition with poorly characterized risk factors and natural history. PPS-maculopathy appears to affect both men and women. Clinicians should inquire about PPS, which is most commonly pre-scribed for interstitial cystitis, in patients with macular changes or RPE atrophy of unclear cause or atypical presentation. Increased awareness of this condition will help to ensure proper screening, diagnosis and treatment. Further investigation is warranted to elucidate the pathophysiology as well as establish screening and treatment guidelines.

References: 1. Hanif AM, Shah R, Yan J, et al. Strength of Association between Pentosan Polysulfate and a Novel Maculopathy. Ophthalmology 2019;126:1464–1466. 2. Pearce WA, Chen R, Jain N. Pigmentary Maculopathy Associated with Chronic Exposure to Pentosan Polysulfate Sodium. Ophthalmology 2018;125:1793–1802. 3. Jain N, Li AL, Yu Y, VanderBeek BL. Association of macular disease with long-term use of pentosan polysulfate sodium: findings from a US cohort. Br J Ophthalmol 2019

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Poster #4

CENTRAL GEOGRAPHIC ATROPHY VS. NEOVASCULAR AGE-RELATEDMACULAR DEGENERATION: DIFFERENCES IN LONGITUDINAL

VISION-RELATED QUALITY OF LIFEAneesha Ahluwalia, BS,1 Liangbo L. Shen, BS,1 Lucian V. Del Priore, MD, PhD1

YALE UNIVERSITY SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT 1

Objective: To assess the natural progression of vision-related quality of life in the two forms of advanced age-related macular degeneration.

Prior studies of vision-related quality of life (VRQoL) have examined advanced AMD as a single group or focused on neovascular AMD (nAMD), despite the fact that advanced AMD can refer to either central geographic atrophy (GA) or nAMD. We compared the natural progression of VRQoL in central GA versus nAMD.

Methods: We included Age-Related Eye Disease Study (AREDS) participants with cen-tral GA (n=206) or nAMD (n=198) who completed the National Eye Institute Visual Function Questionnaire (NEI-VFQ). The rate of change of VRQoL was calculated as the slopes of linear models fit to longitudinal individual-level NEI-VFQ scores. Multivariable regressions identified factors associated with experiencing a decline in VRQoL during the study period and cross-sectional VRQoL score.

Results: In nAMD, there was a minor decline in VRQoL prior to conversion but a sig-nificantly steeper decline after conversion (0.49 ± 2.91 vs. 3.30 ± 5.58 NEI-VFQ units/year; p<0.001). For central GA, the rate of VRQoL decline was similar before and after the development of advanced disease (1.99 ± 4.97 vs. 1.68 ± 4.65 NEI-VFQ units/year; p=0.66). Prior to conversion to advanced disease, the rate of VRQoL decline was greater for patients destined to develop central GA versus nAMD (p=0.007), while post-conver-sion, the rate was greater in nAMD compared with central GA (p=0.012). Female gender (OR 2.61, 95% CI 1.38-5.06; p=0.0029) and higher baseline VRQoL score (OR 1.03, 95% CI 1.01-1.06; p=0.0058) were independently associated with experiencing a longi-tudinal decline in VRQoL.

Conclusion: The natural progression of VRQoL differed in central GA versus nAMD, both before and after the conversion to advanced disease, suggesting that future studies should separate these phenotypes. Females and those with a higher baseline VRQoL were more likely to experience a longitudinal decline in VRQoL after conversion to advanced disease.

References: N/A


POSTER #5

AN EYE FOR DETAIL: EXAMINING THE ROLE OF CORNEAL SCHWANN CELLS

Gwendolyn Schultz, UConn School of Medicine; Paola Bargagna-Mohan, Neuroscience, UConn Health; Bruce Rheaume, Neuroscience, UConn Health; Paul Robson, The Jackson

Laboratory for Genomic Medicine; Royce Mohan, Neuroscience, UConn Health

Objective: To examine the function of corneal Schwann cells and lay a groundwork for future study.

Purpose: The cornea is densely innervated by an intricate network of nerve axons. Injury to the central cornea, whether by surgical procedure or by accident, can disrupt these ax-ons and lead to a loss of sensitivity. However little is known about corneal Schwann cells (cSCs), the resident glial cells which protect and support corneal axons. Specifically, we were interested in the contributions of cSCs to axon regeneration as this has never before been explored. To study this unique cell population, we used single cell RNA-sequence (scRNA-seq) analysis and validated our findings using antibody staining in whole corneal tissue.

Methods: We employed rabbit corneas to derive a single cell preparation that was sub-jected to droplet-based scRNA-seq (10X Genomics) generating data on 7,555 individual cells. The entire procedure was replicated from a different batch of corneas generating data on another 10,057 individual cells. The gene expression matrix output from CellRanger (10X Genomics) of the aggregated data was subjected to unsupervised clustering and dimensionality reduction. Specifically, the 1500 most highly variable genes were used for neighborhood graph generation (using 20 nearest-neighbors) and dimensionality reduc-tion with UMAP. A specific SC cluster represented by conserved SC-genes was obtained. Antibody staining for the cSC proteins L1CAM, SCN7a, and SOX10 was done using corneas from wild-type adult C57/Bl6 mice and whole mount stained tissue was sub-jected to confocal microscopy. To model corneal injury, wild-type adult C57Bl6 male and female mice were subjected to a penetrating stab injury under systemic and ocular anesthesia that produced a focal lesion through the epithelium, basement membrane and a significant part of the corneal stroma. Eyes were enucleated at 4 and 7 days post injury and whole corneas were stained using antibodies. B3-tubulin was used for marking axons.

Results: The scRNA seq analysis of rabbit corneas produced 4 cell clusters, including those representing keratocytes, epithelial cells, inflammatory cells, and Schwann cells. The corneal SC cell cluster revealed that Scn7A, Plp1, Gfra3, Sox10, and L1cam tran-scripts were highly expressed, identifying for the first time targets for investigation. In undisturbed central corneas, cSC markers showed distinct staining around axon processes co-stained for ?3-tubulin. SOX10 staining was distinctly nuclear in SCs. Following injury to the cornea in which axons are severed, cSCs remained at the injury site. In injured corneas, we also found co-staining for alpha-smooth muscle actin co-staining with cSC markers revealing some cSCs had differentiated into myofibroblastic cells.

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Conclusions: cSCs are closely associated with nerve axons in the central cornea. Upon injury, these cells remain at the injury site. Our characterization of these cells will allow us to study how these glial cells respond to corneal injury, and how their role can inform clinical practice.

References: N/A


POSTER #6

ORAL AREDS SUPPLEMENTS (ANTIOXIDANTS AND ZINC)DO NOT SIGNIFICANTLY AFFECT THE GEOGRAPHIC ATROPHY

GROWTH RATE IN THE CENTRAL ZONELiangbo Linus Shen, BS 1; Mengyuan Sun 2; Aneesha Ahluwalia 1; Benjamin Young 1;

Michael Park 1; Lucian V. Del Priore MD, PhD 1

DEPARTMENT OF OPHTHALMOLOGY AND VISUAL SCIENCE, YALE SCHOOL OF MEDICINE, NEW HAVEN, CT 1

DEPARTMENT OF MOLECULAR BIOPHYSICS AND BIOCHEMISTRY, YALE SCHOOL OF MEDICINE, NEW HAVEN, CT 2

Objective: To determine the macular region that best correlates geographic atrophy (GA) area and visual acuity (VA), and the impact of oral supplements on GA progression in the region.

Purpose: Previous studies demonstrated that the total GA area was a poor predictor of visual acuity,1-3 but it is unclear if GA area in a macular subfield can provide a much better predictive power for visual acuity. Moreover, the impact of oral antioxidants on GA progression in the macular center is unknown. Methods: We manually segmented GA lesions on 1654 visits of 365 eyes with GA using data from the Age-Related Eye Disease Study (AREDS). We determined GA areas in 9 macular subfields (defined by the Early Treatment Diabetic Retinopathy Study grid) and correlated them with VA using a multivariate linear mixed model. Patients were assigned by AREDS into 1 of 4 oral sup-plements (placebo, antioxidants, zinc, and antioxidants plus zinc). Results: The total GA area correlated poorly with VA (r2 = 0.07). Among 9 subfields, only the central zone had a significant association between GA area and VA (P < 0.001). By varying the diameter of the central zone from 0 to 10 mm, we determined 1 mm as the optimal diameter for the central zone that had the highest correlation (r2) with VA (r2 = 0.45). The decline rate of central residual area was comparable between placebo and supplements (placebo: 0.074 mm2/year [95%CI = 0.059-0.090]; antioxidants: 0.067 mm2/year [95%CI = 0.049-0.086]; zinc: 0.066 mm2/year [95%CI = 0.051-0.082]; antioxidants + zinc: 0.061 mm2/year [95%CI = 0.046-0.078]; P = 0.41-0.64). Conclusion: GA area in the central 1 mm zone is significantly correlated with VA and may serve as a surrogate anatomic endpoint in trials. Oral supplements do not affect the GA growth rate within the central 1 mm zone.

References: 1. Bagheri S, Lains I, Silverman RF, et al. Percentage of Foveal vs Total Mac-ular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degen-eration. Journal of vitreoretinal diseases 2019;3:278-282. 2. Lindner M, Nadal J, Maus-chitz MM, et al. Combined Fundus Autofluorescence and Near Infrared Reflectance as Prognostic Biomarkers for Visual Acuity in Foveal-Sparing Geographic Atrophy. Invest Ophthalmol Vis Sci 2017;58:BIO61-BIO67. 3. Heier JS, Pieramici D, Chakravarthy U, et al. Visual Function Decline Resulting from Geographic Atrophy: Results from the Chroma and Spectri Phase 3 Trials. Ophthalmology Retina 2020.

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POSTER #7

OPHTHALMIC MEDICATION EXPENDITURES AND OUT-OF-POCKETSPENDING: AN ANALYSIS OF US PRESCRIPTIONS FROM 2007-2016

Evan Chen, Ninani Kombo, Christopher Teng, Prithvi Mruthyunjaya,

Kristen Nwanyanwu, Ravi Parikh

YALE DEPARTMENT OF OPHTHALMOLOGY & VISUAL SCIENCE, NEW HAVEN, CT

Objective: To estimate temporal trends in total and out-of-pocket (OOP) expenditures for ophthalmic prescription medications among adults in the United States.

Design: A retrospective longitudinal cohort study. Participants: Participants in the 2007-2016 Medical Expenditure Panel Survey (MEPS), age 18 years or older. The MEPS is a nationally representative survey of the non-institutionalized, civilian US population.

Methods: We estimated trends in national and per capita annual ophthalmic prescription expenditures by pooling data into 2-year cycles and using weighted linear regressions. We also identified characteristics associated with greater total or OOP expenditure with multivariable weighted linear regression. Costs were adjusted to 2016 US dollars using the Gross Domestic Product Price Index. Main Outcome Measures: Trends in total and OOP annual expenditures for ophthalmic medications from 2007-2016 as well as factors associated with greater expenditure.

Results: From 2007-2016, 9,989 (4.2%) MEPS participants reported ophthalmic med-ication prescription use. Annual ophthalmic medication utilization increased from 10.0 to 12.2 million individuals from 2007-2008 to 2015-2016. In this same time period, national expenditures for ophthalmic medications increased from $3.39 billion to $6.08 billion and OOP expenditures decreased from $1.34 to $1.18 billion. While the average number of ophthalmic prescriptions did not change over the study period (4.2, p=0.10), the average expenditure per prescription increased significantly from $72.30 to $116.42 (p<0.001). Per capita expenditure increased from $338.72 to $499.42 (p<0.001) and per capita OOP expenditure decreased from $133.48 to $96.67 (p<0.001) from 2007-2008 to 2015-2016 respectively. In 2015-2016, dry eye (29.5%) and glaucoma (42.7%) med-ications accounted for 72.2% of all ophthalmic medication expenditures. Patients who were older than 65 (p<0.001), uninsured (p<0.001), and visually impaired (p<0.001) were significantly more likely to have greater OOP spending on ophthalmic medications.

Conclusion: Total ophthalmic medication expenditure in the United States increased significantly over the last decade while OOP expenses decreased. Increases in coverage, copayment assistance and utilization of expensive brand drugs may be contributing to these trends. Policy makers and physicians should be aware that rising overall drug expen-ditures may ultimately increase indirect costs to the patient and offset a decline in OOP prescription drug spending.

References: N/A


POSTER #8

EVALUATION OF RETINAL NERVE FIBER LAYER, GANGLION CELL-INNER PLEXIFORM LAYER, AND OPTIC NERVE

HEAD IN GLAUCOMA SUSPECTS WITH VARYING MYOPIA

Gregg Miller, Tufts University School of Medicine; Abu-Qamar Omar, New England Eye Center- Tufts; Sarwat Salim, New England Eye Center - Tufts University School of Medicine

Objective: To evaluate the effect of low (LM), moderate (MM), and high (HM) myopia on retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and optic nerve head (ONH) parameters in glaucoma suspects.

Purpose: To assess the effect of myopia on retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and optic nerve head (ONH) parameters in glauco-ma suspects.

Methods: 76 eyes studied with Cirrus-HD OCT were divided into low (LM; n=27), moderate (MM; n=25), and high myopia (HM; n=24). OCT parameters were correlated with spherical equivalent (SE) and evaluated with area under the receiver operating char-acteristic curves (AUROC).

Results: In MM and HM, SE was positively correlated with thinning of average, min-imum, and non-temporal GCIPL (p<0.05 for all) except for inferior in MM (p=0.15). In HM, the correlation was shown for average and non-temporal RNFL (p<0.05 for all) except for inferior (p=0.06). SE was not correlated with ONH parameters in MM or HM (p>0.05). The highest AUROCs for RNFL and GCIPL parameters were for superior (0.82) and superonasal (0.80) regions respectively, with comparable diagnostic ability (p=0.74).

Conclusion: Myopia is associated with thinning of average RNFL, average and minimum GCIPL, and non-temporal parameters of both GCIPL and RNFL, warranting consider-ation of refractive status in glaucoma suspects.

References: Akcay, B.I.S., Gunay, B.O., Kardes, E., Unlu, C., & Ergin, A. (2017). Evalu-ation of the ganglion cell complex and retinal nerve fiber layer in low, moderate, and high myopia: A study by RTVue spectral domain optical coherence tomography. Seminars in Ophthalmology, 32(6), 682-688. Aref, A.A., Sayyad, F.E., Mwanza, J., Feuer, W.J., & Budenz, D.L. (2014). Diagnostic specificities of retinal nerve fiver layer, optic nerve head, and macular ganglion cell-inner plexiform layer measurements in myopic eyes. J Glau-coma, 23, 487-493. Shin, J.W., Sung, K.R., & Song, M.K. (2020). Ganglion cell-inner plexiform layer and retinal nerve fiber layer changes in glaucoma suspects enable predic-tion of glaucoma development. Am J Ophthalmol, 210, 26-34.

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POSTER #9

EPIDEMIOLOGY OF UNITED STATES INPATIENT OPEN GLOBE INJURYFROM 2009-2013

Vivian Paraskevi Douglas 1; Neha Siddiqui 2, Evan Chen 3; Ravi Parikh 4;

Konstantinos Douglas 1; Paula Feng 5; Grayson Armstrong 1

MASSACHUSETTS EYE AND EAR INFIRMARY 1; UNIVERSITY OF ILLINOIS HOSPITAL AND HEALTH SCIENCES SYSTEM, CARLE ILLINOIS COLLEGE OF MEDICINE 2; YALE UNIVERSITY 3; NYU LANGONE HEALTH DEPARTMENT OF OPHTHAL-MOLOGY, NYU SCHOOL OF MEDICINE 4; DEPARTMENT OF OPHTHALMOLOGY AND VISUAL SCIENCE, YALE SCHOOL

OF MEDICINE 5;

Objective: To study the epidemiology and socioeconomic burden of inpatient open globe injuries (OGI) in the United States (US).

Design: A retrospective cohort study using the National Inpatient Sample (NIS) from 2009-2013.

Methods: Patients with a primary diagnosis of OGI using ICD codes were assessed in the NIS dataset, a nationally representative sample of inpatient stays. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance status/type, and income quartile were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi square tests, ANCOVA, and Tukey HSD tests.

Results: A total of 4,935 US inpatient hospital discharge records met inclusion/exclusion criteria. The estimated national prevalence of OGI during the 5 year period from 2009-2013 was 24,671 (95% confidence interval [CI] 21,056-28,286). The overall annual prevalence rate was 1.60 per 100,000 per year (CI 1.55-1.64). Overall, average annual prevalence rates were highest among patients 85+ (9.12, CI 8.33-9.98), on Medicare (3.88, CI 3.67-4.09), males (2.32, CI 2.21-2.38), African Americans (2.26, CI 2.16-2.47), and Native Americans (1.88, CI 1.43-2.46). Overall OGI rates were lowest among Caucasians (1.20, CI 1.16-1.25), females (0.92, CI 0.87-0.96), those with private insur-ance (0.87, CI 0.83-0.92), and Asians (0.69, CI 0.58-0.85). Being in the lowest income quartile was a risk factor for OGI (p<0.05).

Conclusions: Open globe injuries (OGI) are one of the most preventable eye injury types which can limit the quality of life and also have significant economic burden on patients and the health care system.1,2 Several countries have characterized OGI incidence in hopes to guide public health measures.2,3 This study demonstrates that OGIs dispro-portionately affect those 85+, young males, elderly females, patients of African American descent, on Medicare, and in the lowest income quartile. Further studies should delineate causes for socioeconomic differences in OGI to guide future public health measures.


References: 1Kanoff, J.M., et al., Characteristics and outcomes of work-related open globe injuries. Am J Ophthalmol, 2010. 150(2): p. 265-269 e2. 2Batur, M., et al., Ep-idemiology of Adult Open Globe Injury. J Craniofac Surg, 2016. 27(7): p. 1636-1641. 3Pieramici, D.J., et al., Open-globe injury. Update on types of injuries and visual results. Ophthalmology, 1996. 103(11): p. 1798-803.

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POSTER #10

GENOMIC-METABOLOMIC ASSOCIATIONS IN AGE-RELATEDMACULAR DEGENERATION (AMD)

Ines Lains1, Shujian Zhu2, Wonil Chung2, Rachel S. Kelly3, Archana Nigalye1, Raviv Katz1, John B. Miller1, Demetrios G. Vavvas1, Ivana K. Kim1, Rufino Silva4, Joan W. Miller1,

Jessica Lasky-Su3, Liming Liang2, Deeba Husain1

MASSACHUSETTS EYE AND EAR, HARVARD MEDICAL SCHOOL, BOSTON, UNITED STATES1. HARVARD SCHOOL OF PUBLIC HEALTH2; SYSTEMS GENETICS AND GENOMICS UNIT, CHANNING DIVISION OF NETWORK MEDICINE

BRIGHAM AND WOMEN’S HOSPITAL AND HARVARD MEDICAL SCHOOL, BOSTON, MA, UNITED STATES3; FACULTY OF MEDICINE, UNIVERSITY OF COIMBRA, COIMBRA, PORTUGAL4

Objective:

Purpose: Age-related macular degeneration (AMD) is a multifactorial disease compris-ing environmental and genetic risk factors. Thirty-four loci with more than 7,000 single nucleotide polymorphisms (SNPs) have been linked with AMD risk, but the functional consequences of most of them remains to be established. The assessment of genetic-me-tabolite associations (i.e. metabolite quantitative trait loci, mQTL) can provide unique insights into causal mechanisms of AMD. This study aimed to analyze associations be-tween established AMD risk SNPs and plasma metabolites (mQTL) in a cohort of AMD patients and controls.

Methods: Prospective, cross-sectional, multicenter study (Boston, United States and Co-imbra, Portugal). We included subjects with AMD and controls without any vitreoretinal disease (> 50 years old); AMD grading was performed according to the AREDS classifi-cation scheme. Fasting blood samples were collected and analyzed by ultra-performance liquid chromatography and high-resolution mass spectrometry for metabolomic profil-ing, and by an Illumina Omni express platform for SNPs profiling. Analyses of mQTL of endogenous metabolites were conducted using linear regression models adjusted for age, sex, smoking, 10 metabolites principal components (PCs) and 10 SNP PCs. These mod-els were first performed for each cohort and then combined by meta-analysis.

Results: We included 388 patients with AMD and 98 controls; after quality control, data on 544 plasma metabolites was considered. Meta-analysis identified 66 significant mQTL (p<10-5), correspondent to 9 metabolites and 7 genes. The most significant associations (false discovery rate < 0.05) were seen between SNPs in the LIPC gene and phosphatidy-lethanolamine metabolites, and SNPs in the ASPM gene and the branched-chain amino acids leucine, isoleucine and valine. Pathway analysis integrating all the metabolites and genes of interest mapped to the glycerophospholipid, as well as to the alanine, aspartate and glutamate metabolite pathways. No common mQTL were found between AMD cases and controls.


Conclusion: To our knowledge, this is the first study on metabolomic-genomic associa-tions in AMD. Our results suggest that AMD risk loci are associated with levels of specific lipid and amino acids plasma metabolites, furthering our understanding of their biologi-cal effect. This increases our understanding on the biological relevance of AMD-risk SNPs and offers new potential therapeutic targets, as we strive for precise treatment options for this blinding disease.

References: N/A

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POSTER #11

TOPOGRAPHIC VARIATION OF RETINAL AND CHOROIDAL VASCULARDENSITY IN NORMAL EYES USING OPTICAL COHERENCE

TOMOGRAPHY ANGIOGRAPHY

Michael Park MD, Benjamin Young MD, Linus Shen MS, Ron Adelman MD, MPH, MBA, Lucian Del Priore MD, PhD

DEPARTMENT OF OPHTHALMOLOGY AND VISUAL SCIENCE, YALE UNIVERSITY SCHOOL OF MEDICINE,NEW HAVEN, CONNECTICUT, USA

Objective: To establish a topographic map of the vessel density in the superficial and deep vascular plexus and choriocapillaris layer in normal eyes using optical coherence tomogra-phy (OCT) angiography.

Purpose: Optical coherence tomography angiography has become widely used by clini-cians and researchers to qualitatively and quantitatively describe the retinal vasculature in normal eyes and eyes with chorioretinal pathology, including diabetic retinopathy, mac-ular degeneration, and retinal artery and vein occlusions. A detailed study establishing a normative vascular topography map for each of the vascular layers has not yet been done. This study was performed to establish a normative, continuous vessel density topography map of the superficial and deep vascular plexus, as well as the choriocapillaris layer in normal eyes using OCT angiography imaging.

Design: Retrospective cohort study

Methods: 8x8 mm OCT angiography images centered on the fovea from 14 normal eyes (13 patients) were analyzed. A continuous vessel density curve as a function of distance from foveal center was generated for the superficial and deep retinal vasculature, and the choriocapillaris layers. The transition point, defined as the point of greatest slope change, was determined for each of the density curves. We determined the vascular density along different meridians and used this data to determine the vessel density in the nasal, superi-or, temporal, inferior quadrants in all 3 layers.

Results: The transition point occurred at different distances from the foveal center for each layer, at 587.9 microns, 881.8 microns, and 1986.5 microns from foveal center for the superficial, deep, and choriocapillaris layers, respectively. For the superficial plexus, the nasal quadrant had the greatest vessel density (p<0.0008). For the deep plexus, the nasal, superior, and temporal quadrants had greater vessel density compared to the inferi-or quadrant (p<0.0091). For the choriocapillaris layer, the temporal quadrant had greater vessel density compared to the nasal and superior quadrants (p<0.0073) but was not significantly different than the inferior quadrant (p=0.2738).


Conclusion: Our study provides a normative, continuous vessel density topography map using OCT angiography of normal eyes. This vascular density map may be a valuable tool to determine baseline values for these parameters, and to determine the changes in these parameters in different chorioretinal diseases.

References: 1. Coscas, Florence, et al. “Normative data for vascular density in superficial and deep capillary plexuses of healthy adults assessed by optical coherence tomography angiography.” Investigative ophthalmology & visual science 57.9 (2016): OCT211-OCT223. 2. Nassisi, Marco, et al. “Topographic distribution of choriocapillaris flow deficits in healthy eyes.” PloS one 13.11 (2018). 3. Takayama, Kei, et al. “Novel classi-fication of early-stage systemic hypertensive changes in human retina based on OCTA measurement of choriocapillaris.” Scientific reports 8.1 (2018): 1-13.

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POSTER #12

SHORT-TERM SURGICAL OUTCOMES OF GLAUCOMA DRAINAGE DEVICEIMPLANT AFTER FAILED TRABECTOME SURGERY

Marez Megalla, Yale Ophthalmology; Yapei Zhang, Yale Eye Center;

Ji Liu, Yale Eye Center

Objective: To assess the effectiveness of glaucoma drainage device (GDD) implant after failed trabectome.

Methods: Retrospective chart review of GDD implantation after failed trabectome during 2013-2019. Outcome measures were intraocular pressure (IOP), number of IOP-lower-ing medications and surgical complications at 12 months after GDD. Unpaired t-test was used for statistical analysis.

Results: Fifteen eyes were included. The interval time between trabectome and GDD ranged from 1 to 32 months (15.4±10.1). The average IOP was 26.7±8.5mmHg with 2.9±0.7 medications prior to trabectome, and 28.9±8.8 with 3.3±0.80 medications prior to GDD (pre-GDD). After GDD surgery, average IOP was reduced to 14.1±5.0mmHg (p=<0.00001) with 2.1±1.6 medications (p=0.0069 vs pre-GDD) at the 12-month visit. No major surgical complications were documented for either trabectome or GDD sur-gery.

Discussion: Trabectome surgery has been found effective in treating open angle glauco-ma,1 Studies assessing the effectiveness of trabectome during GDD and after failed GDD have also shown significant reductions in IOP.2,3 However, some eyes may fail to respond to the primary trabectome surgery. It is unclear if these eyes would respond to sequential GDD. Our data indicated placement of a GDD after failed trabectome still resulted in significantly reduced IOP and medication usage without major surgical complications.

Conclusion: Trabectome failure did not affect surgical outcomes of sequential GDD sur-gery, which can serve as a rescue for further IOP control.

References: Avar, M., Jordan, J., Neuburger, M., et al. Long-term follow-up of intraocu-lar pressure and pressure-lowering medication in patients after ab-interno trabeculectomy with the trabectome. Graefes Arch Clin Exp Ophthalmol. 2019; 257: 997-1003. Esfan-diari, H., Shazly, T., Shah, P., et al. Impact of same-session trabectome surgery on Ahmed glaucoma value outcomes. Graefes Arch Clin Exp Ophthalmol. 2018; 256: 1509-1515. Mosaed, S., Chak, G., Haider, A., et al. Results of Trabectome Surgery Following Failed Glaucoma Tube Shunt Implantation: Cohort Study. Medicine (Baltimore). 2015; 94: e1045.


POSTER #13

ASSOCIATION OF POSTERIOR POLAR CATARACT ON THE FORMATION OF POSTERIOR CAPSULAR OPACIFICATION

Marez Megalla, Yale Ophthalmology;

Ninani Kombo, Yale Department of Ophthalmology and Visual Science

Objective: To determine the rate of posterior capsular opacification (PCO) after successful surgical removal of posterior polar cataract (PPC). Given posterior capsular dehiscence pres-ent with PPC, the rate of PCO post cataract surgery is hypothesized to be reduced.

Methods: A retrospective chart review done at a tertiary care center from 2011-2019 was conducted. Patients who had PPC and subsequent cataract extraction without surgical disruption of the posterior capsule were included. Visual acuity prior to and post cataract extraction, type of intraocular lens placed, the development of PCO, time to formation, and severity of PCO were assessed. Unpaired t-test was used for statistical analysis.

Results: Of 179 patients identified, 80 patients met inclusion criteria. There was equal prevalence of PPC among males and females. Time to follow up ranged from 1 month to 60 months. All lenses placed were acrylic. There was a low rate of PCO formation among our patient population, the vast majority of which were not visually significant.

Conclusions: The rate of formation of visually significant PCO after successful surgical extraction of PPC is very low.

References: N/A

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POSTER #14

NEURO-OPHTHALMIC MANIFESTATIONS OF CHECKPOINT INHIBITORSMarez Megalla, Yale Ophthalmology; Anita Kohli, Yale Ophthalmology;

Adeniyi Fisayo, Yale Ophthalmology

Objective: To determine the neuro-ophthalmic manifestations of checkpoint inhibitors ad-verse events.

Introduction: Checkpoint inhibitors, such as ipilimumab, nivolimumab, and pembroli-zumab, have been reported to cause ophthalmic adverse events. While myasthenia gravis induced by these medications has been previously documented, other neuro-ophthalmic manifestations have been rarely reported. This study aims to identify those rarer mani-festations.

Methods: A retrospective chart review of patients on checkpoint inhibitors who devel-oped neuro-ophthalmic adverse events was undertaken. Visual acuity, color vision, pupil-lary reactivity, slit lamp and fundus examination, as well as ophthalmic imaging modali-ties (visual fields, optical coherence tomography, etc) were analyzed.

Results: Five patients were identified with neuro-ophthalmic manifestations, three of which carried a melanoma diagnosis. Four patients were treated with combination ther-apy of ipilimumab and nivolimumab. Optic neuritis was present in 3 patients, ocular myasthenia in 2 patients, and giant cell like vasculitis in 1 patient. One optic neuritis pa-tient and one ocular myasthenia gravis patient had been previously reported.1 Treatment modalities included intravenous immunoglobulins, topical and oral steroids and resulted in resolution in all patients.

Conclusions: Neuro-ophthalmic manifestations including optic neuritis and giant cell like vasculitis can occur following use of checkpoint inhibitors.

References: N/A


POSTER #15

NOVEL SURGICAL DEVICE TO ALLOW PRECISE LOCALIZATION AND SAFEDRAINAGE OF SUBRETINAL FLUID DURING SCLERAL BUCKLING SURGERY

Kevin Ma, Wen Hu 1, Jan Kylstra

MASSACHUSETTS EYE AND EAR INFIRMARY, BOSTON, MA 1

Objective: We present a novel surgical device to allow for safer and faster drainage of subret-inal fluid during scleral buckling surgery.

Purpose: Drainage of subretinal fluid is an important step of scleral buckling surgery in the repair of rhegmatogenous retinal detachments. External needle drainage under indirect ophthalmoscopy is a useful technique to achieve drainage of subretinal fluid. However, this method can be challenging due to the difficulty in determining the exact needle position and entry site.

Methods: We present a novel surgical device to allow for safer and faster drainage of sub-retinal fluid during scleral buckling surgery.

Results: The novel device features a blunt scleral depressor tip from which a drainage needle can be manually advanced. While the operator is directly examining the retina, the blunt tip is first used to perform scleral depression externally, allowing for precise localiza-tion of the desired drainage site. Once the desired location is identified, the spring-loaded needle can be advanced in a controlled fashion, which then pierces the wall of the globe and allows the subretinal fluid to passively egress. The rate of fluid egress can be titrated via the occlusion of a connecting channel from the lumen of the syringe using the index finger.

Conclusion: The device allows for precise identification and placement of the needle in-sertion site under direct visualization of the retina, controlled drainage of fluid while the intraocular pressure is maintained, and assessment of the adequacy of drainage in real time.

References: N/A

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The ACCME defines a commercial interest as any entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on, patients. Relevant financial relationships are financial relationships in any amount, which occurred in the twelve-month period preceding the time that the individual was asked to assume a role controlling content of the CME activity, and which relate to the content of the educa-tional activity.

Financial relationships are those relationships in which the individual benefits by receiv-ing a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as independent contractor (including contracted research), consulting, pro-motional speaking and teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. The MMS/ACCME considers relationships of the person involved in the CME activity to also include financial relationships of a spouse or partner.

Arroyo, Jorge:Ownership Interest: Envision Diagnostics

Barshak, Miriam:Ownership Interest - Name of Relevant Commercial Entity(ies):Pfizer; Boston Scientific Corp, St. Jude Medical, Inc.

Bradbury, Michael:Ownership Interest: Regeneron, Chase and Associates, Inc (Iviews imaging system)

Dagianis, John:Fees for Non-CME Services Received Directly from Commercial Interest or their Agents: Lumenis, Speaker Bureau

Duker, Jay:Consulting Fees - Name of Relevant Commercial Entity(ies): EyePoint Pharma - Director

Contracted Research - Name of Relevant Commercial Entity(ies): Zeiss, OptoVue


Heier, Jeffrey:Consulting Fees - Name of Relevant Commercial Entity(ies):4D Molecular Technologies, Adverum, Aerie, Aerpio, Akros, Aldeyra, Alkahest, Allegro, Apellis,Array, Asclepix, Bayer, BVI, BioMarin, Daiichi-Sankyo, Eloxx, Galecto, Galimedix, Genentech/Roche, Generation Bio, Helio, Interface, iRenix, Janssen R&D, jCyte, Kala, Kanghong,Kodiak, Notal Vision, Novartis, Ocular Therapeutix, Omeicos, Orbit Biomedical, Oxurion, Regeneron, Regenxbio, Ret-rotope, Scifluor, Shire, Stealth Biotherapeutics, Voyant, ZeissContracted Research - Name of Relevant Commercial Entity(ies):Aerpio, Apellis, Clearside, Daiichi Sankyo, Genentech/Roche, Genzyme, Hem-era, Janssen R&D, Kalvista, Kanghong, Novartis, Ocudyne, Ophthotech, Optos, Optovue, Oxurion, Regeneron, Regenxbio, ScifluorOwnership Interest - Name of Relevant Commercial Entity(ies):Adverum, Aldeyra, Allegro, Digital Surgery Systems, jCyte, Ocular Therapeutix

Migliori, Michael E.:Consulting Fees - Name of Relevant Commercial Entity(ies): Horizon Therapeutics

Rizzo, Joseph:Receipt of Intellectual Property Rights/Patent Holder: Bionic Eye TechnologiesConsulting Fees: GenSightOwnership Interest: Bionic Eye Technologies

Shah, Ankoor:Salary - Name of Relevant Commercial Entity(ies): Innovation and Digital Health Accelerator, Boston Children's Hospital

Receipt of Intellectual Property Rights / Patent Holder - Name of Relevant Com-mercial Entity(ies): Rebion

Ownership Interest - Name of Relevant Commercial Entity(ies): Rebion

Yoo, Sylvia:Consulting Fees - Name of Relevant Commercial Entity(ies): Horizon Therapeutics

NO FINANCIAL INTERESTNone of the other individuals in a position to control the content of this activity, in-cluding planners, CME Review Committee members, faculty presenters, moderators, panelists and reviewers have any relevant financial relationship with an ACCME-defined commercial interest to disclose.

780th Meeting | 39

HOTEL COMMONWEALTH500 Commonwealth Avenue, Boston, MA

DATE TOPIC MODERATOR

October 30, 2020Retina-Diabetes Nauman Chaudhry, MD

Plastics – Trauma Daniel Lefebvre, MD

December 4, 2020Infectious Uveitis Pryja Janardhana, MD

Cataract Lauren Shatz, MDTWO DAY MEETING (Friday/Saturday)

March 12, 2021

Glaucoma Manishi Desai, MD

Neuro-ophthalmology Emergencies Marc Bouffard, MD

March 13, 2021Ethics and Risk Management Mary Daly, MDPractice Management John Mandeville, MD

May 14, 2021Excimer Based Refractive Surgery Jason Brenner, MD

Corneal Surgery Peggy Chang, MD

FUTURE NEOS MEETINGS


THE BOARD AND COMMITTEES 2019-2020

The Board Mary Daly, MD, PresidentJorge Arroyo, MD, President-electJay Duker, MD, Vice-President, Chair Admissions CommitteeDonna Siracuse-Lee, MD, SecretaryLaura Fine, MD, Immediate Past President, Chair Nominations CommitteeJohn Dagianis, MD, Past President, Chair Policies CommitteeJeffrey Heier, MD, Past PresidentJoseph Rizzo, MD, Treasurer, Chair Finance CommitteeJoel Geffin, MD, Chair Program CommitteeMichael Price, MD, Chair Educational Endowment Fund CommitteePhil Aitken MD, Chair Ophthalmic Services CommitteeBrendan McCarthy, MD, Chair Public Health and Education CommitteeAngela Turalba, MD, Director of Continuing EducationAnita Shukla, MD, Chair Young Ophthalmologists CommitteeMichelle Liang, MD, Chair, I.T. CommitteeMichael Bradbury, MD, Executive Director

COMMITTEES:

Executive CommitteeMary Daly, PresidentJorge Arroyo, MD, President-electJoseph Rizzo MD, TreasurerMichael Bradbury, MD, Executive Direc-tor (ex officio)

Admissions CommitteeJay Duker, MD, ChairMary Daly, MD

Finance CommitteeJoseph Rizzo, MD, ChairMary Daly, MD Jorge Arroyo, MD (ex officio)Michael Bradbury, MD (ex officio)

Nominations CommitteeLaura Fine, MD, ChairAnn Bajart, MD (MA)Mitchell Gilbert, MD (CT)Elliot Perlman, MD (RI)Christopher Soares, MD (VT)David Weinberg, MD (NH)

ex officio members:Drs. Bradbury, Siracuse-Lee, Fine, Heier, Levy)

Program CommitteeJoel Geffin, MD, ChairFina Barouch, MDEdward Feinberg, MDGena Heidary, MDJeremy Kieval, MDJohn Papale, MDShlomit Schaal, MDLucia Sobrin, MDAngela Turalba, MDMichael Yoon, MDLaura Fine, MD (ex officio)Mary Daly, MD (ex officio)Michael Bradbury, MD (ex officio)

780th Meeting | 41

Public Health and Education Committee

Brendan McCarthy, MD, ChairSherleen Chen, MDRobert Daly, MDMacie Finkelstein, MDMagdalena Krzystolik, MDVasiliki Poulaki, MDChristopher Soares, MDCathryn Welch, MDMary Daly, MD (ex officio)John Dagianis, MD (ex officio)

Society Policies Committee

John Dagianis, MD, ChairMichael Bradbury, MD

Ophthalmic Services Committee

Phil Aitken, MD, ChairHusam Ansari, MDTimothy Blake, MDJohn Dagianis, MDNicoletta Fynn-Thompson, MDKathryn Hatch, MDMarc Leibole, MDDavid Vazan, MDRobert Westcot, MDPeter Zacharia, MDJorge Arroyo, MD (ex officio)Laura Fine, MD (ex officio)

Committee for Educational Endowment Fund

Michael Price, MD, ChairThomas Coghlin, MDJohn Dagianis, MDFrancis D’Ambrosio, MDRichard Dornfeld, MDMatthew Gardiner, MDGrace Lee, MDDavid Lawlor, MDJoseph Rizzo, MD

Information Technology Committee

Michelle Liang, MD, ChairDavid Ramsey, MDNaveen Rao, MDAnkoor Shah, MDJohanna Seddon, MD

Jorge Arroyo, MDElliot Perlman, MD, (emeritus)Mary Daly, MD (ex officio)

Young Ophthalmologists Committee

Anita Shukla, MD, ChairJoanne Chang, MDJeffrey Heier, MDStephen Anesi, MDNicole Siegal, MDJennifer Cartwright Garvey, MDElizabeth Houle, MDHyunjoo Lee, MDMichelle Liang, MDDan Lefebvre, MDJoshua Ney, MDArchana Seethala, MDJorge Arroyo MD (ex officio)Michael Bradbury (ex officio)Michael Price, MD (ex officio)

Miguel G. Ocque, Administrative Director


TODAY’S EXHIBITORS

SPONSOR LEVEL

Alcon817.293.0450

www.alconlabs.com

Takeda - Shire781.869.7620www.shire.com

EXHIBITOR LEVEL

Aerie Pharmaceuticals203.901.8851

www.aeripharma.com

Allergan774.991.1187

www.allergan.com

Bio-Tissue508.808.3017

www.biotissue.com

J&J Surgical Vision800.843.2020

www.jnjvisionpro.com

Microsurgical Technology800.979.2020

www.microsurgical.com

Novartis862.778.8300

www.novartis.com

877.628.8998www.dextenza.com

Ophthalmic Instrument Company800.272.2070

www.oic2020.com

Optovue Inc.510.623.8868

www.optovue.com

ScienceBased Health281.885.7727www.sbh.com

609.720.5629www.sunophthalmics.com

Zeiss Meditec, Inc925.856.2574

www.zeiss.com/med

Ocular Therapeutix

Sun Ophthalmics

780th Meeting | 43

NEW ENGLAND OPHTHALMOLOGICAL SOCIETY EDUCATIONAL ENDOWMENT FUND DONORS

Diamond Patrons $100,000 or more

Dr. Michael J. BradburyIn memory of Dr. C. Davis BelcherIn memory of Dr. Hal M. Freeman

Dr. C. Stephen FosterMassachusetts Eye and Ear Infirmary

In honor of Dr. Joan MillerDr. and Mrs. Paul M. Pender

In Memory of Paul D. Pender and Har-ry V. Carey

Dr. and Mrs. Richard J. SimmonsIn memory of Dr. Ruthanne Simmons

Ophthalmic Consultants of BostonPhysicians and Patients

In honor of Dr. B. Thomas Hutchinson

Platinum Patrons $10,000 to $99,999

Boston Eye ResearchIn memory of Dr. Sanford Hecht

Dr. John DagianisIn memory of Dr. Hal M. Freeman, In honor of James and Eleanor Da-gianis, and Paul and Verna Dobbins

Dr. and Mrs. Stuart DuBoffIn memory of Dr. Ruthanne SimmonsIn honor of Samuel and Gloria DuBoff and William and Diane Brown

Dr. Hal M. FreemanDr. Albert R. Frederick, Jr.

In honor of B. Thomas HutchinsonDr. and Mrs. Joseph J. GrecoThe Health Foundation of Central Mas-sachusetts

In honor of Dr. Michael J. BradburyHOYA Optical LaboratoriesDr. B. Thomas HutchinsonNew Hampshire Society of Eye Physicians and Surgeons

Dr. Delia Sang and Dr. Mark HughesIn memory of Dr. Charles L. Schepens

Dr. Gerald SpindelIn honor of Israel and Rose Spindel and

Benjamin Burch

Gold Patrons $3,000-$9,999

Dr. Jorge ArroyoDr. William AtleeDr. Ann Bajart

In honor of Judy Cerone KeenanDrs. A. Robert and Jean Bellows

In memory of Dr. W. Morton GrantDr. Thomas Coghlin

In honor of Dr. Mary Daly, Dr. Ira Asher,Dr. Kevin O’Brien, and Dr. Reid Appleby, Jr.

Dr. and Mrs. Paul P. DunnIn memory of Dr. C. Davis Belcher and in honor of Dr. A. Robert Bellows

Dr. Joel GeffinDr. C. Mitchell Gilbert

In honor of Drs. Claes Dohlman, Ken-neth Kenyon, and Martin Wand

Dr. and Mrs. Donald KaplanIn memory of Dr. Robert Vernlund

Jean Keamy for the Keamy Family Foun-dation

In memory of Donald and Yvonne KeamyMaine Society of Eye Physicians and Sur-geonsNew England Lens Implant Society

In memory of Dr. Sanford HechtDr. and Mrs. Elliot Perlman

In memory of Drs. C. Davis Belcher and Kathleen Maguire

Dr. Michael RaizmanDr. Shiyoung Roh and Mrs. Myung Ja RohDrs. Helen and Jack Schinazi


In memory of Dr. C. Davis BelcherDr. and Mrs. John Sebestyen

In memory of Dr. Taylor R SmithDr. Bradford J. Shingleton

In honor of Drs. Albert R. Frederick,B. Thomas Hutchinson, Silvio Von Pirquet and A. Robert Bellows

Drs. Richard and Ruthanne SimmonsIn memory of Dr. W. Morton Grant

Dr. and Mrs. Richard J. SimmonsIn memory of Drs. Paul A. Chandler, W. Morton Grant, Ruthanne Simmons, and C. Davis Belcher

Dr. and Mrs. Paul WassonIn memory of Dr. Paul WassonIn memory of Dr. Oscar Hollander

Dr. and Mrs. Hal WoodcomeIn memory of Dr. Harold Woodcome, Sr.

Estate of Dr. Leon Zimmerman

Silver Patrons $1,000-$2,999

Dr. Reid S. Appleby, Jr.In honor of Dr. Harold Woodcome, Jr., and Associates in Honor of Dr. Robert Bahr

Dr. and Mrs. Lloyd M. AielloDr. Robert BahrDr. C. Davis Belcher

In honor of Dr. Richard SimmonsDr. Harry Braconier

In memory of Drs Taylor Smith, Karl Riemer, Carl C. Johnson.

In memory of Dr. Hal M. FreemanDr. and Mrs. Sheldon M. BuzneyChildren’s Hospital Ophthalmology FoundationDr. and Mrs. William E. Clark, Jr.Dr. Mary Daly

In memory of Dr. and Mrs. William J. DalyDr. Joseph L. Dowling, Jr.Dr. Jay S. DukerEye Health Services

In memory of Dr. C. Davis BelcherDr. Laura FineDr. and Mrs. David GreenseidDr. Bernard Heersink

Dr. Jeffrey Heier Dr. Ralph HinckleyDr. William S. Holt Dr. Robert T. LacyDr. Joseph Levy

In honor of Dr. Thomas Hedges IIIDr. Byron S. LingemanDr. Richard LowDr. Kathleen Maguire and Stephen Burke

In memory of Dr. Hal M. FreemanDr. Lisa McHamDr. Clifford Michaelson

In memory of Dr. Jesse and Mrs. Ruth Lee MichaelsonDr. Stanislaw Milewski

In memory of Dr. Taylor R. Smith Dr. Peter B. Mooney

In memory of Dr. Henry F. AllenDr. Paul MoultonDr. Dale OatesDr. Stephen J. PhippsDr. and Mrs. Michael PriceDrs. Shiyoung Roh and John WeiterDr. and Mrs. George Santos Dr. Delia Sang

In honor of Dr. Lloyd M. AeilloDrs. Jack and Helen Schinazi

In memory of Mrs. Mary SantosIn honor of Dr. Irving L. Pavlo

Dr. Roger F. SteinertIn honor of Drs. A. Robert Bellows, S. Arthur Boruchoff, Albert R. Frederick, and B. Thomas Hutchinson

Dr. J. Elliott TaylorDr. Felipe I. Tolentino

In honor of Drs. Hal M. Freeman and Roland Houle

In memory of Dr. Charles L. SchepensDr. Trexler R. ToppingVermont Ophthalmological SocietyDr. Martin Wand

In memory of Dr. W. Morton GrantDrs. Peter Wassermann, T. Gordon Hand, Christie Morse and Bradford Hall,

In memory of Dr. John DetwillerIn honor of Dr. Lewis Stieglitz

Master William Weiter

780th Meeting | 45

In honor of Ann Bajart and Tony Schemmer, and Deborah and Elliot Perlman

Dr. Kenneth WolfDr. Allen Zieker

Benefactors $500-$999

Dr. Phil AitkenIn memory of Drs. Robert Guiduli and Simmons Lessell

Maria CaponeIn Memory of Dr. Y. Jacob Schinazi

Dr. Michael CooperIn honor of Dr. Brendan McCarthyIn memory of Dr. Robert HaimoviciDr. Behrooz Koleini and Dr. S. Arthur

BoruchoffDrs. Elliot and Macie FinkelsteinDr. David Fleishman

In memory of Dr. Gary B. Fleishman Dr. George GarciaDr. Timothy Goslee

In honor of Dr. Mary DalyDr. Robert Guiduli

In memory of Dr. Kathleen J. MaguireDr. Lynne KaplinskyDr. Robert LytleMaine Eye CenterDr. Brendan McCarthy

In Memory of Dr. Behrooz KoleiniDr. and Mrs. Howard MartonDr. Christopher NewtonOphthalmic Consultants of BostonRetina Center of MaineRhode Island Society of Physicians and Surgeons Dr. Joel SchumanDr. Lewis StieglitzDr. Dennis StolerDr. Barry WepmanDr. Charles Wingate

Sponsors $250-$499

Dr. Caroline BaumalIn memory of Dr. Jose Berrocal

Dr. Francis Y. Falck, Jr.Dr. Ralph A. Goodwin, Jr.Dr. Dana GraichenDr. Payson B. Jacobson

In memory of Dr. Abraham Pollen Dr. Glenn P. KimballDr. Peter LouDr. Carmen PuliafitoDr. Sarkis Soukiasian

In Honor of Dr. Roger SteinertDr. Caldwell W. SmithDr. Neal G. SneboldDr. Jonathan TalamoDr. Yvonne Tsai

In memory of Helena ToksozDr. Andrew Wong

In memory Dr. Charles L. Schepens Worcester Ophthalmology Associates Dr. Charles Zacks

Friends Up to $250

In Memory of Dr. Y. Jacob SchinaziNancy Asbedian Lois FainMarion J. GoldsmithRobert & Lorraine KingsburyDiane KlaiberWilliam & Ingrid MercerMichael MiglioriDr. & Mrs. Samir MoubayedBeth OrsonDr. Virginia Schmidt ParkerKarl StephensJanice Solomon

In Memory of C. Davis Belcher Accent EyewearJames BernsonDr. Charles Beyer-MachulePhilip Cacciatore Eye Health ServicesMilton Feinson Dr. Richard GetnickEvelyn JohnDr. Ernest KornmehlDon Lesieur


Joyce MarshallRebecca MurphyTherese O’KeefeDr. Stephen Poor, IIIEileen Raffferty Elizabeth Reece Dr. Richard SimmonsMarian Spilner Dr. Ann StrombergElizabeth SullivanAndrienne TashjianThe Rivers School

In Memory of Dr. Peter Gudas:Naomi LitrowinikMercedes SaylerNeedham Psychotherapy AssociatesNew England Carpenters Health FundNorfolk Lodge A.F. and A.M. James and Jean TwyningJacqueline PepperJeanne Smith

Dr. Peter BatsonDr. Richard BrownDr. David CorbitDr. Paul Cotran

In memory of Dr. Mariana Mead Dr. Peter DonshikDr. Stuart Fay

In honor of Dr. Michael Bradbury and Dr. Tuck

Melvyn and Eleanor Galin FoundationIn honor of B. Thomas Hutchinson

Dr. Andrew GilliesIn memory of Dr. Moshe Lahav

Dr. Timber GormanDr. Jay Gooze

In memory of Kirstyn SmithDr. Amy GregoryDr. Walter GriggsDr. Robert HermDr. Ted HouleDr. Glenn P. KimballDr. David LawlorDr. Howard M. Leibowitz

In memory of Dr. Behrooz KoleiniDr. Clifford Michaelson

In memory of Dr. Behrooz KoleiniDr. Lawrence PiazzaDr. Theodore RennaMolly-Jane Isaacson Rubinger

In honor of Trexler ToppingDr. Donna Siracuse-LeeAlice Sarno

In memory of B. Thomas HutchinsonDr. Domenic M. StrazzullaDr. Carter TallmanDr. Michael Wiedman

In honor of Dr. Claes Dohlman

www.neos-eyes.org

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