York Eye Research Articles

Outcomes and variables that impact pneumatic retinopexies.

To evaluate the efficacy of pneumatic retinopexy (PR) in patients undergoing PR as primary treatment for rhegmatogenous retinal detachment (RRD) and analyze the factors associated with success and failure in the studied population. A retrospective chart review was done of patients with RRD treated with PR as primary management method treated at New York Eye and Ear Infirmary of Mount Sinai between January 2017 and December 2021. Primary outcome measured success or failure of PR. Secondary outcome measured best corrected visual acuity (BCVA) after PR. A separate risk analysis was done to identify and stratify risks associated with success and failure of PR. A total of 179 eyes from 179 patients were included for final analysis. The 83 patients (46.37%) achieved anatomical reattachment of the retina after primary PR with no need for additional surgery. The 96 patients (53.63%) had a failed primary PR and required a PPV and 6 of them required pars plana vitrectomy (PPV) with scleral buckle (SB). In total, 19 cases (10.61%) were done as temporizing pneumatics, 18 (94.74%) underwent PPV, and 1 (5.26%) did not require further intervention. The visual acuities at postoperative month 1 (POM1) for patients who underwent primary PR successfully and for those that underwent PPV after, were 0.58 (20/80) and 1.03 (20/200) respectively. Patients who met Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) criteria had a statistically significant decreased risk of primary PR failing (hazard ratio 0.29, P=0.00). Majority of missed or new breaks were found superotemporally. PR is a good treatment option for treating RRDs in patients that meet PIVOT criteria and can be conducted as a temporizing measure. PIVOT criteria and fovea on status decrease the risk of PR failure.

New AAV tools fail to detect Neurod1-mediated neuronal conversion of Müller glia and astrocytes invivo.

Reprogramming resident glial cells to convert them into neurons invivo represents a potential therapeutic strategy that could replenish lost neurons, repair damaged neural circuits, and restore function. AAV (adeno-associated virus)-based expression systems are powerful tools for invivo gene delivery in glia-to-neuron reprogramming, however, recent studies show that AAV-based gene delivery of Neurod1 into the mouse brain can cause severe leaky expression into endogenous neurons leading to misinterpretation of glia-to-neuron conversion. AAV-based delivery systems were modified for improved invivo delivery of Neurod1, Math5, Ascl1, and Neurog2 in the adult mouse retina and brain. To examine whether bona fide glia-to-neuron conversion occurs, stringent fate mapping experiments were performed to trace the lineage of glial cells. The neuronal leakage is prevalent after AAV-GFAP-mediated delivery of Neurod1, Math5, Ascl1, and Neurog2. The transgene-dependent leakage cannot be corrected after lowering the AAV doses, using alterative AAV serotypes or injection routes. Importantly, we report the development of two new AAV-based tools that can significantly reduce neuronal leakage. Using the new AAV-based tools, we provide evidence that Neurod1 gene transfer fails to convert lineage traced glial cells into neurons. Stringent fate mapping techniques independently of an AAV-based expression system are the golden standard for tracing the fate of glia cells during neuronal reprogramming. The newly developed AAV-based systems are invaluable tools for glia-to-neuron reprogramming invivo. The work in Chen lab was supported by National Institutes of Health (NIH) grants R01 EY024986 and R01 EY028921, an unrestricted challenge grant from Research to Prevent Blindness, the New York Eye and Ear Infirmary Foundation, and The Harold W. McGraw, Jr. Family Foundation for Vision Research. The work in Zhang lab was supported by NIH (R01 NS127375 and R01 NS117065) and The Decherd Foundation.

Choroidal Effusions after Glaucoma Drainage Implant Surgery: Risk Factors and Surgical Management

To report the incidence of patients who developed choroidal effusions after glaucoma drainage implant (GDI) surgery and determine risk factors for and outcomes of surgical intervention. Retrospective case series. Medical records of 605 patients who underwent GDI surgery from January 1, 2017 to June 7, 2021 at New York University Langone Health and New York Eye and Ear Infirmary of Mount Sinai were reviewed. Preoperative, intraoperative, and postoperative clinical data were obtained. Multivariate logistic regression evaluated the factors associated with the need for surgical intervention. Patient records were analyzed for effusion resolution, intraocular pressure (IOP), visual acuity (VA), and complications across treatment modalities. Incidence of choroidal effusion development and need for surgical intervention. Choroidal effusions developed in 110 (18%) patients (110 eyes). Surgical intervention to drain the effusion or ligate the implant tube was performed in 19 (17%) patients. The average time to surgical intervention was 47.6 days. Among patients who developed postoperative effusions, risk factors for requiring surgical intervention included history of selective laser trabeculoplasty (SLT) (P=0.004; odds ratio [OR], 14.4), prior GDI surgery (P=0.04; OR 8.7), 350-mm2 Baerveldt glaucoma implant placement (P=0.05; OR, 4.8), and anterior chamber shallowing (AC; P<0.001; OR, 25.1) in the presence of effusions. The subgroup that required multiple surgeries for effusion resolution had a significantly lower mean IOP at the most recent follow-up compared with those who received medical management only (P<0.001). A higher percentage of patients who required surgical intervention lost VA at the most recent follow-up compared with patients whose effusions resolved with conservative management (i.e., medical management, AC viscoelastic injection). Choroidal effusions after GDI surgery resolved with conservative management in most patients. A history of SLT or GDI placement, implantation of a BGI-350, and the presence of a shallow chamber were risk factors for surgical intervention. Although interventions, such as surgical drainage are at times necessary, a better understanding of their impacts can help guide postoperative decisions. The risks and benefits of these procedures must be carefully considered in these high-risk eyes. Proprietary or commercial disclosure may be found after the references.

Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery.

To investigate whether a history of prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) predisposes to the development of pseudophakic cystoid macular edema (CME). New York Eye and Ear Infirmary of Mount Sinai, New York, New York. Retrospective cohort study. Records of 365 subjects who underwent PPV for RRD and subsequent cataract surgery between 2017 and 2020 were reviewed. Patients with a history of diabetic retinopathy, inflammatory retinal vascular disease, uveitis, advanced age-related macular degeneration, intraocular infection, myopic maculopathy, or significant intraoperative complications precluding posterior chamber intraocular lens placement were excluded. Age-matched subjects who underwent routine cataract surgery served as controls. Clinical data and macular optical coherence tomography (OCT) findings up to 4 years postoperatively were obtained. 54 eyes underwent uneventful cataract surgery by phacoemulsification and had a history of PPV with gas tamponade. 55 eyes underwent uneventful cataract surgery only. The average follow-up time after cataract surgery was 39.1 months. In eyes with a history of PPV, the incidence of OCT-detected CME was 27.8% (15/54) compared with 3.8% (2/55) in the control group ( P < .001) and the incidence of clinically significant CME was 18.5% (10/54) compared with 1.8% (1/55) in the control group ( P = .004). 80% (12/15) of CME cases were treated with topical therapy, and none required intravitreal injection. Prior PPV for RRD is associated with an increased incidence of pseudophakic CME after uneventful cataract surgery. Prophylactic or prolonged postoperative anti-inflammatory topical therapy may be prudent to consider in these patients.

Mitochondrial Dysfunction in Primary Open-Angle Glaucoma Characterized by Flavoprotein Fluorescence at the Optic Nerve Head

To investigate the presence of flavoprotein fluorescence (FPF) at the optic nerve head (ONH) rim as a marker of mitochondrial dysfunction in primary open-angle glaucoma (POAG) and control eyes. Retrospective cross-sectional study of patients recruited from the New York Eye and Ear Infirmary of Mount Sinai. A total of 86 eyes (50 eyes of 30 patients with POAG and 36 eyes of 20 control participants) were enrolled. The presence of POAG was defined by circumpapillary retinal nerve fiber layer thickness (cpRNFLT) of less than the bottom fifth percentile of the normative database, glaucomatous ONH changes, and visual field defects on 24-2 tests. Primary open-angle glaucoma and control eyes were imaged using the OcuMet Beacon. A 23°× 23° infrared scan was obtained, and an FPF scan was performed within a capture field spanning 13° in diameter. The ONH margins on the infrared image were identified by software algorithms. Then, FPF was measured within an elliptical annulus around the ONH rim, with the inner and outer boundaries corresponding to 0.5 to 1.1 times the ONH rim size. Flavoprotein fluorescence at the OHN rim in POAG and control eyes. Differences in FPF between POAG and control eyes were characterized through mixed-effects logistic regression, adjusted for age and interocular pressure. Flavoprotein fluorescence was significantly higher in POAG versus control eyes, with a mean ± SD of 46.4 ± 27.9 versus 28.0 ± 11.7 (P < 0.001), respectively. Among POAG eyes, FPF showed correlation to visual field mean deviation (P < 0.001), visual field pattern standard deviation (P= 0.003), and cpRNFLT (P= 0.001) on linear mixed-effects models. Higher FPF in POAG versus control eyes suggests the presence of mitochondrial dysfunction at the ONH rim in eyes with glaucomatous damage. The degree of FPF corresponds to disease severity, as measured by visual field and nerve fiber layer thickness metrics. Thus, FPF may represent a metabolic indicator of disease status that reveals the extent of injury in glaucoma.

Combined automated screening for age-related macular degeneration and diabetic retinopathy in primary care settings.

Background:Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are among the leading causes of blindness in the United States and other developed countries. Early detection is the key to prevention and effective treatment. We have built an artificial intelligence-based screening system which utilizes a cloud-based platform for combined large scale screening through primary care settings for early diagnosis of these diseases.Methods:iHealthScreen Inc., an independent medical software company, has developed automated AMD and DR screening systems utilizing a telemedicine platform based on deep machine learning techniques. For both diseases, we prospectively imaged both eyes of 340 unselected non-dilated subjects over 50 years of age. For DR specifically, 152 diabetic patients at New York Eye and Ear faculty retina practices, ophthalmic and primary care clinics in New York city with color fundus cameras. Following the initial review of the images, 308 images with other confounding conditions like high myopia and vascular occlusion, and poor quality were excluded, leaving 676 eligible images for AMD and DR evaluation. Three ophthalmologists evaluated each of the images, and after adjudication, the patients were determined referrable or non-referable for AMD DR. Concerning AMD, 172 were labeled referable (intermediate or late), and 504 were non-referable (no or early). Concurrently, regarding DR, 33 were referable (moderate or worse), and 643 were non-referable (none or mild). All images were uploaded to iHealthScreen’s telemedicine platform and analyzed by the automated systems for both diseases. The system performances are tested on per eye basis with sensitivity, specificity, accuracy, and kappa scores with respect to the professional graders.Results:In identifying referable DR, the system achieved a sensitivity of 97.0% and a specificity of 96.3%, and a kappa score of 0.70 on this prospective dataset. For AMD, the sensitivity was 86.6%, the specificity of 92.1%, and a kappa score of 0.76.Conclusions:The AMD and DR screening tools achieved excellent performance operating together to identify two retinal diseases prospectively in mixed datasets, demonstrating the feasibility of such tools in the early diagnosis of eye diseases. These early screening tools will help create an even more comprehensive system capable of being trained on other retinal pathologies, a goal within reach for public health deployment.

In Response to The Challenges of Pharmacotherapy of SARS‐CoV‐2 Infection in Patients with Sudden Sensorineural Hearing Loss Due to COVID‐19

The LaryngoscopeVolume 131, Issue 7 p. E2336-E2336 Otology-Neurotology In Response to The Challenges of Pharmacotherapy of SARS-CoV-2 Infection in Patients with Sudden Sensorineural Hearing Loss Due to COVID-19 Christine Little BA, Christine Little BA Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S.A.Search for more papers by this authorMaura K. Cosetti MD, Corresponding Author Maura K. Cosetti MD maura.cosetti@mountsinai.org orcid.org/0000-0003-1005-4136 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S.A. Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, U.S.A. *Send correspondence to Maura K. Cosetti, MD, Department of Otolaryngology-Head and Neck Surgery, Ear Institute of NYEE of Mount Sinai, 380 Second Ave, 9th Floor, New York, NY 10010. E-mail: maura.cosetti@mountsinai.orgSearch for more papers by this author Christine Little BA, Christine Little BA Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S.A.Search for more papers by this authorMaura K. Cosetti MD, Corresponding Author Maura K. Cosetti MD maura.cosetti@mountsinai.org orcid.org/0000-0003-1005-4136 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S.A. Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, U.S.A. *Send correspondence to Maura K. Cosetti, MD, Department of Otolaryngology-Head and Neck Surgery, Ear Institute of NYEE of Mount Sinai, 380 Second Ave, 9th Floor, New York, NY 10010. E-mail: maura.cosetti@mountsinai.orgSearch for more papers by this author First published: 17 March 2021 https://doi.org/10.1002/lary.29517 The authors have no funding, financial relationships, or conflicts of interest to disclose. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume131, Issue7July 2021Pages E2336-E2336 RelatedInformation

Surgical Transplantation of Human RPE Stem Cell-Derived RPE Monolayers into Non-Human Primates with Immunosuppression.

SummaryRecent trials of retinal pigment epithelium (RPE) transplantation for the treatment of disorders such as age-related macular degeneration have been promising. However, limitations of existing strategies include the uncertain survival of RPE cells delivered by cell suspension and the inherent risk of uncontrolled cell proliferation in the vitreous cavity. Human RPE stem cell-derived RPE (hRPESC-RPE) transplantation can rescue vision in a rat model of retinal dystrophy and survive in the rabbit retina for at least 1 month. The present study placed hRPESC-RPE monolayers under the macula of a non-human primate model for 3 months. The transplant was able to recover in vivo and maintained healthy photoreceptors. Importantly, there was no evidence that subretinally transplanted monolayers underwent an epithelial-mesenchymal transition. Neither gliosis in adjacent retina nor epiretinal membranes were observed. These findings suggest that hRPESC-RPE monolayers are safe and may be a useful source for RPE cell replacement therapy.

Utilization fraction of rhinoplasty instrument sets: Model for efficient use of surgical instruments.

Recognize the avoidable costs incurred due to overpacking of rhinoplasty instrument trays. Reduce rhinoplasty instrument trays by including only instruments used frequently. Establish methods to reduce trays prepared for other otolaryngologic procedures. This is a prospective study. The study evaluates the specific use of instruments opened for rhinoplasty procedures at the New York Eye & Ear Infirmary of Mount Sinai. Instruments were counted in 10 rhinoplasty cases. Usage rate was calculated for each instrument. Additionally, all instruments used in at least 20% of cases were noted. This "20%" threshold was used to create new rhinoplasty tray inventories more reflective of actual instrument usage. Some instruments above the 20% threshold were included in multiples (i.e. two Adson Brown forceps vs. one curved iris scissor). 189 instruments were opened, and 32 instruments were used on average in each rhinoplasty. 55 instruments were used in at least 20% of cases. The 55 "high usage" instruments were used to create new, reduced rhinoplasty tray inventory lists. Based on our analysis, a new rhinoplasty tray inventory was created comprised of 68 instruments, a 64% reduction from 189. Instruments are sterilized and packed in gross excess for rhinoplasty procedures. Previously published figures estimate re-sterilization costs of $0.51 to $0.77 per instrument. Reduction in instruments opened from 189 to 68 is expected to lead to cost savings ranging from $62 to $93 per case, yielding a savings between $6200 and $9300 per 100 cases performed. II-3.

“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?

“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?

Nailfold Capillaroscopy of Resting Peripheral Blood Flow in Exfoliation Glaucoma and Primary Open-Angle Glaucoma

Systemic blood flow alterations have been described using video nailfold capillaroscopy (NFC) in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) variants of primary open-angle glaucoma (POAG). To date, no previous studies have explored alterations in nailfold capillary blood flow in exfoliation glaucoma (XFG). To investigate the measure of peripheral blood flow as a surrogate marker of systemic vascular involvement in patients with XFG, HTG, and NTG, as well as in individuals serving as controls, using NFC. A cross-sectional clinic-based study at the New York Eye and Ear Infirmary of Mount Sinai was conducted from July 6, 2017, to May 18, 2018. A total of 111 participants (30 XFG, 30 NTG, 30 HTG, and 21 controls) received a comprehensive ophthalmic examination to confirm eligibility. Exclusion criteria were the presence of connective tissue disease, uncontrolled diabetes, history of bleeding disorders, and/or history of trauma or surgery to the nondominant hand. Resting capillary blood flow at the nailfold of the fourth digit of the nondominant hand in patients with NTG, HTG, XFG, and controls, using NFC. Two participants were excluded owing to poor nailfold image quality, resulting in 109 participants. Sixty-two participants (57%) were women and 79 (72%) were white. Mean (SD) age of the participants was 67.9 (11.7) years. Mean (SD) resting peripheral capillary blood flow at the nailfold for controls was 70.9 (52.4) picoliters/s (pL/s); HTG, 47.5 (41.9) pL/s; NTG, 40.1 (16.6) pL/s; and XFG, 30.6 (20.0) pL/s. Multivariable analysis of the differences of flow in HTG vs control participants showed values of -18.97 (95% CI, -39.22 to 1.27; P = .07) pL/s, NTG vs controls of -25.17 (95% CI, -45.92 to -4.41; P = .02) pL/s, and XFG vs controls of -28.99 (95% CI, -51.35 to -6.63; P = .01) pL/s. Decreased resting peripheral capillary blood flow may occur in patients with XFG and NTG compared with individuals without glaucoma. These findings may contribute to understanding the possible systemic nature of glaucoma.

Association of Optical Coherence Tomography Angiography of Collaterals in Retinal Vein Occlusion With Major Venous Outflow Through the Deep Vascular Complex

Analysis of collateral vessel formation following retinal vein occlusion may advance our understanding of the venous outflow anatomy in the macula. To determine the location of collateral vessels with optical coherence tomography (OCT) angiography imaging. Observational retrospective cohort study. Collateral vessel formation was studied with OCT angiography (OCTA) in patients with retinal vein occlusion (RVO). The study took place at 2 retinal practices (Vitreous Retina Macula Consultants of New York and Stein Eye Institute, University of California, Los Angeles), with patient records retrieved from March 2015 to August 2017. Data analysis was completed in November 2017. Collaterals identified with fundus photography and/or fluorescein angiography were analyzed with OCTA to determine their course through the superficial vascular plexus (SVP) and the deep vascular complex (DVC). Collateral vessel pathways through the SVP and DVC were analyzed with cross-sectional and en face OCT and OCTA segmentation and color-coded volume renderings prepared from raw OCTA voxel data. From 23 eyes (22 branch and 1 hemispheric retinal vein occlusion ) of 23 patients (mean [SD] age, 73 [11] years), 101 collateral vessels were identified and analyzed (mean [SD], 4.4 [2.0]; range, 2-9 collateral per eye). On OCTA, the collaterals appeared as curvilinear dilated flow signals that connected veins across the horizontal raphe or veins on opposite sides of an occluded venous segment within the same retinal hemisphere. Of the 101 collaterals analyzed, all showed greater flow signal in the DVC, and all had some portion of their course identified within the DVC. No collaterals were found exclusively in the SVP. Volume renderings for 3 cases confirmed qualitatively that retinal collateral vessels course through the retina predominantly at the level of the DVC. Based on a limited number of cases, all collateral vessels associated with retinal vein occlusion were found to course through the DVC. The absence of collaterals isolated to the SVP supports a serial arrangement of the SVP and DVC, with venous drainage predominantly coursing through the DVC.

Noninvasive Detection of Mitochondrial Dysfunction in Ocular Hypertension and Primary Open-angle Glaucoma.

To assess mitochondrial dysfunction in vivo in ocular hypertension (OHT) and primary open-angle glaucoma (POAG) using retinal metabolic analysis. This was an observational, cross-sectional study performed from November 2015 to October 2016 at the New York Eye and Ear Infirmary of Mount Sinai. Thirty-eight eyes with varying stages of POAG, 16 eyes with OHT, and 32 control eyes were imaged on a custom fundus camera modified to measure full retinal thickness fluorescence at a wavelength optimized to detect flavoprotein fluorescence (FPF). Optical coherence tomography was used to measure the retinal ganglion cell-plus layer (RGC+) thickness. Macular FPF and the ratio of macular FPF to RGC+ thickness were the primary outcome variables and were compared among the three groups using an age-adjusted linear regression model. A mixed-effects model was used to assess correlations between FPF variables and clinical characteristics. Both macular FPF and the macular FPF/RGC+ thickness ratio were significantly increased in OHT compared with control eyes (P<0.05 and <0.01, respectively). In POAG eyes, macular FPF was not significantly increased compared with controls (P=0.24). However, the macular FPF/RGC+ thickness ratio in POAG eyes was significantly increased compared with controls (P<0.001). FPF was significantly correlated to age in POAG eyes. Despite lacking clinical evidence of glaucomatous deterioration, OHT eyes displayed significantly elevated macular FPF, suggesting that mitochondrial dysfunction may be detected before structural changes visible on current clinical imaging. Our preliminary results suggest that macular FPF analysis may prove to be a useful tool in assessing and evaluating OHT and POAG eyes.

The Influence of Early Ophthalmic Hospitals on the Journal

To consider the American Journal of Ophthalmology's (AJO's) role not only as a forum to describe clinical and scientific advances but also as a record of institutional histories. We used the New York Eye and Ear Infirmary of Mount Sinai, the Massachusetts Eye and Ear Infirmary, and the Wills Eye Hospital as case studies on the Journal's role in documenting the people and organizations that have moved ophthalmology forward. Perspective. Using the ScienceDirect database, we conducted a literature search to gather all mentions of the 3 eye hospitals in the Journal's archives from 1918 to 2018. We evaluated those search results to identify a few of the individuals and articles that highlight how the history of eye institutions are reflected in the AJO. Searches for the aforementioned 3 hospitals yielded over 3400 results in Journal archives. These included articles on their histories, proceedings from clinical case conferences, profiles of prominent surgeons, and information about educational offerings, among others. Many of those articles were written by physicians from those institutions who also served on the AJO's editorial board or had a long history of publishing in the Journal. The AJO has played a crucial role in the last 100 years as a register of ophthalmic history. The New York Eye and Ear Infirmary of Mount Sinai, Massachusetts Eye and Ear Infirmary, and Wills Eye Hospital provide 3 examples of how that role manifests.

Vision-Related Quality of Life Associated with Unilateral and Bilateral Ocular Conditions

To present ophthalmic patient time-tradeoff vision utilities for quantifying vision-related quality-of-life when the fellow eye still has good vision. These utilities are important for performing reliable cost-utility analyses. Consecutive time-tradeoff vision utilities were obtained from ophthalmic patients with good vision (20/20-20/25) in one eye and vision ranging from 20/20 to no light perception in the fellow eye over a 15-year period from 2000 through2014. Five hundred eighty-six ophthalmic participant interviews from Wills Eye Hospital, New York Eye and Ear Hospital, and ophthalmology office practices in Pennsylvania and New Jersey. Participants underwent a full ophthalmic examination, after which time-tradeoff vision utilities were obtained by personal interview by the authors using a standardized, validated instrument. Time-tradeoff vision utilities. Mean time-tradeoff vision utilities were as follows in participants with good vision (20/20-20/25) in at least one eye and the following visions in the fellow eyes: no light perception, 0.79; counting fingers to light perception, 0.87; 20/200 to 20/400, 0.88; 20/60 to 20/100, 0.88; 20/30 to 20/50, 0.87; and 20/20 to 20/25, 0.94. In people with good vision (20/20-20/25) in one eye, the associated mean time-tradeoff vision utility is a remarkably consistent 0.87 to 0.88 when vision in the fellow eye ranges from 20/30 to light perception. Vision of 20/20 to 20/25 in the fellow eye results in a significantly higher associated utility of 0.94 (P < 0.01), whereas vision of no light perception in the fellow eye results in a significantly lower utility of 0.079 (P < 0.01). These utilities are important for calculating reliable patient value (quality-adjusted life-year) gains in ophthalmic cost-utility analysis populations in which there is unilateral and bilateral disease involvement.

A 12-Year Study of Slotted Palladium-103 Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve

To present our 12-year experience with low-energy-photon, slotted eye plaque radiation therapy. Retrospective interventional case series. Setting: The New York Eye Cancer Center. Fifty-two consecutive patients with uveal melanomas near, touching, or surrounding the optic disc. Slotted eye plaque radiation therapy. Change in visual acuity, local tumor control, radiation side effects, eye salvage, and systemic metastases. Tumors were peripapillary within 1.5mm of the optic disc (n= 8, 15%), juxtapapillary touching ≤180 degrees (n= 23, 44%), or circumpapillary >180 degrees and encircling the disc (n= 21, 41%). Mean follow-up was 47months (median 34months, range 6-146months). Radiation induced a mean 41.2% reduction in tumor thickness. Life table analysis showed that 69% of patients retained their visual acuities ≥ 20/40 and had a vision loss-free survival 84months after treatment. Also, 90% of patients retained their visual acuity between 20/50 and 20/200 and had a vision loss-free survival 36months after treatment. Slotted plaque brachytherapy was associated with 4% secondary cataract, 11% neovascular glaucoma, and no dry eye or eyelash loss. Local tumor control (no recurrence) was achieved in 98.1% of patients. Life table analysis showed an overall enucleation-free survival of 93% and metastasis-free survival of 94%. Slotted plaque radiation therapy provided a normalized plaque-tumor position, such that the entire choroidal melanoma plus a 2- to 3-mm free margin of normal-appearing tissue was included in the targeted zone. At 12 years, slotted plaque radiation therapy resulted in high rates of local tumor control and vision and eye retention.

Abstract 4356: Methylation and expression of androgen receptor in Papillary Thyroid Cancer

Abstract Papillary Thyroid Cancer (PTC) accounts for the vast majority of thyroid cancers and comprises more than 90% of neoplasms in the endocrine system. In the last 30 years, the incidence and prevalence of PTC has dramatically risen in developed countries, with a three-fold higher incidence in women than in men. With an overall five-year survival rate of 98.1%, early stage PTC has a favorable prognosis. However, PTC exhibits increased aggressiveness with poor prognosis in men diagnosed with the disease. These striking observations led us to explore the role of androgen and androgen receptor (AR) in this disease. We found an approximately 70% decrease in median AR RNA expression (p&amp;lt;0.0001) in 24 PTC patient tissue samples (from New York Eye and Ear Infirmary), compared to matched, normal thyroid tissue. A similar trend was also observed in about 500 PTC samples in the TCGA database, compared with 60 normal thyroid samples. Methylation was explored as a cause for the down-regulation of the AR mRNA in disease pathogenesis, using in-silico methods such as Wanderer, a Maplab tool for TCGA RNA data visualization, and MethylPlotter. A methylation pattern of the AR gene, spanning 7 exons, was generated with 30 methylation sites and, AR in PTC was found to be predominantly methylated at ten sites, compared to matched normal thyroid tissue samples, in the TCGA. Patients with ten or more hypermethylated sites on the AR gene in tumor tissue exhibited a significant decrease in the AR RNA expression in the tumor, versus matched normal thyroid tissue. Methylation of AR (10 or more sites) was accompanied by a nine-fold reduction in AR expression in male PTC, and a five-fold decrease in female PTC. This reduction was not observed in hyper- or equally-methylated normal thyroid tissue. We selected eleven methylation sites in the CpG islands that we predict are essential for AR silencing, with four sites in the AR promoter region. Additionally, we found AR gene-specific and global transcription activators to be downregulated, and repressors up-regulated in the PTC samples. The data adds importance to our previous studies showing induction of senescence in AR-transfected PTC cells in culture, when AR is stimulated with 5α-dihydrotestosterone. In conclusion, our study demonstrates a fine regulation and differential expression of AR associated with methylation, and highlights the significance of epigenetic modifications in thyroid cancer progression. Citation Format: Anvita Gupta, Timmy O'Connell, Melanie Jones, Karnika Singh, Monica Schwarcz, JK Rasamny, Dorota Halicka, Jiangwei Li, Codrin Iacob, Nina Suslina, Stimson Schantz, Edward Shin, Zbigniew Darzynkiewicz, Raj Tiwari, Jan Geliebter. Methylation and expression of androgen receptor in Papillary Thyroid Cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4356. doi:10.1158/1538-7445.AM2017-4356

Surgery for Cochlear and Other Auditory Implants: Mario Sanna, Rolien Free, Paul Merkus, and Maurizio Falcioni, eds; Stuttgart: Thieme, 2016

Director, Cochlear Implant Program, New York Eye and Ear of Mount Sinai, New York, NY [email protected] The author discloses no conflicts of interest.

Improving Resident Performance in Oculoplastic Surgery: A New Curriculum Using Surgical Wet Laboratory Videos

To develop a new oculoplastic curriculum that incorporates learning theory of skill acquisition. To develop and evaluate the effectiveness of instructional videos for an oculoplastic surgical wet laboratory. Proof of concept, randomized controlled trial. New York Eye and Ear Infirmary of Mount Sinai-tertiary care academic institution. In total, 16 ophthalmology residents were randomly assigned to 1 of 2 groups and given either video and text or text instructions alone for the following 2 procedures: blepharoplasty and eyelid laceration repair. Operating time and esthetic result were measured, and the groups were statistically compared. A brief survey was administered. We developed a new 6 component oculoplastics curriculum that incorporates concepts of the Fitts and Posner skill acquisition model and mental imagery. In the wet laboratory pilot study, the group that watched the video of the laceration repair showed better esthetic grades than the group that received text alone (p = 0.038). This difference was not found for the blepharoplasty (p = 0.492). There was no difference between groups in operating time for the laceration repair (p = 0.722), but the group that watched the blepharoplasty video required more time to complete the task than those that reviewed text only (p = 0.023). In total, 100% of residents reported the videos augmented their learning. Methods to optimize surgical education are important given limited operating room time in oculoplastics, a subspecialty in which the number of surgeries performed during residency is relatively low. We developed a curriculum based on learning theory and sought to formally test one important aspect, surgical video for wet laboratories. Our pilot study, despite its limitations, showed that wet laboratory surgical videos can be effective tools in improving motor skill acquisition for oculoplastic surgery.

Histopathologic Analysis of the Posterior Segment for Terson's Syndrome: The GioBiopsy Technique.

The purpose of this study was to report on a case of Terson's syndrome (TS) using a novel instrument and technique to harvest posterior pole pathology from a postmortem eye. A modified ocular clamp was used to remove the posterior pole from the postmortem enucleated eye. Gross photographs were taken and an ocular sample of the posterior pole was sent to The New York Eye and Ear Pathology Laboratory. TS was identified from gross pathology and histologic examinations. The case history was consistent with that diagnosis. The authors concluded that high-quality gross and histopathologic examination of the posterior pole can be obtained with this novel instrument and technique. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:170-174.].