The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study has identified high levels of in vitro antibiotic resistance among ocular staphylococcal and pneumococcal pathogens, resistance that may affect treatment success, according to Penny Asbell, MD, FACS, MBA, director of the Hamilton Eye Institute at the University of Tennessee Health Science Center.

The ARMOR study is an ongoing nationwide study examining in vitro antibiotic resistance among isolates that have been collected from ocular infections. 

Between 2009 and 2018, 6091 ocular isolates were collected; specifically, 

 (n = 2189), coagulase-negative staphylococci (n = 1745), 

VA and visual function go the way of ocular inflammation

The ocular isolates were obtained at the participating study sites nationwide and sent to a central laboratory for confirmation of bacterial identity and susceptibility testing. 

The investigators also carried out a literature search for susceptibility data on the bacteria from ocular infections reported in other studies for comparison with 10-year ARMOR findings, according to Asbell.

According to investigators, the key findings from ARMOR include the following:

	Staphylococci were resistant to azithromycin (60%-61%), methicillin (35%-51%), and ciprofloxacin (33%-34%).

 isolates were resistant to azithromycin and penicillin (32% and 36%, respectively). 

	Multidrug resistance, defined as resistance to at least 1 antimicrobial drug in 3 or more drug classes, was especially prevalent among methicillin-resistant staphylococci.

A bright spot is that the prevalence of methicillin-resistant 

 may be declining after reaching a peak from 2005 to 2015.

Research: Similar endophthalmitis rates for generic, branded topical antibiotics

Based on their findings, the investigators concluded that “the ARMOR study showed high levels of in vitro antibiotic resistance among ocular staphylococcal and pneumococcal pathogens and were largely representative of those reported in smaller US surveillance studies.”

The investigators also suggest that surveillance data are relevant in that resistance to antibiotics may foretell treatment failure.


This article is adapted from Asbell’s presentation at the Women in Ophthalmology 2021 Summer Symposium. The ARMOR study is sponsored by Bausch + Lomb. Asbell was a consultant for Bausch Health US, LLC, for Grand Rounds presentation to Bausch & Lomb but has received no compensation for participation in this study.

Articles

Ongoing nationwide study looks at in vitro antibiotic resistance among isolates.

ARMOR study: Keeping pace with microbial resistance to antibiotics

The administration of dexamethasone intraocular suspension 9% (Dexycu, EyePoint Pharmaceuticals) has undergone a change. 

Previously, it was injected into the posterior chamber after ocular surgery to manage postoperative inflammation. 

Surgeons are injecting the bioerodible, sustained-release drug depot directly into the lenticular capsule after phacoemulsification and IOL implantation.


Evaluating efficacy, safety of intracameral dexamethasone 9% vs topical regimen for cataract surgery

Lisa Nijm, MD, JD, medical director of Warrenville Eye Care in Illinois, shared her pearls for successful capsular bag administration of the suspension, which was approved in 2018 to manage inflammation after ocular surgery.

Once positioned intraocularly, the drug tapers over time as would be done with conventional topical drops, but the new route of administration reduces or eliminates patients’ treatment burden and adherence issues, she explained.

Nijm’s experience with this anti-inflammatory approach has been positive, as patients are comfortable and have no or minimal inflammation a day after surgery.

The original technique was for the dexamethasone suspension to be placed in the ciliary sulcus. 

Evaluating dexamethasone intraocular suspension 9% post-cataract surgery

The challenge with this, Nijm said, was the surgeon’s inability to visualize the placement of the droplet and its size. 

Because this was a blind technique, there was potential for trauma to the iris and for drug migration to the anterior chamber or for the drug to be deposited on the optic of the intraocular lens, Nijm pointed out.

The capsular bag technique is an improvement on the previous method because the surgeon can visualize the placement and size of the dexamethasone delivered. 

The iris is not in contact with the drug, the risk of drug migration decreases, and the procedure is performed more naturally by surgeons.

Nijm said she accidentally performed this technique while injecting dexamethasone in a patient with a large capsulorhexis. 

Novel ophthalmic pharmaceuticals drive innovation, improve outcomes

In this case, the Verisome sustained-delivery platform (EyePoint Pharmaceuticals) accidentally landed in and remained in the capsular bag and the outcome of the case was good. 

This experience coincided with the work of Robert Osher, MD, and Robert Weinstock, MD, who had been working on placing dexamethasone intraocular suspension in the capsular bag.

The drug is prepared with a vortex mixing device that distributes the drug into suspension, which is then drawn into a syringe and a cannula attached. This step can be performed in advance and the suspension will remain uniform for up to 10 minutes.

According to Nijm, it is important for the surgeon to prepare the eye to ensure ease of injection of the dexamethasone suspension.

Presbyopia-correcting IOL improves vision for patients

“The IOL should be well positioned and all other medications, such as antibiotics, should be administered before the dexamethasone is injected,” she said. “The primary injection site and the paracentesis should be well-sealed. Intraocular dexamethasone is the final step of the surgery.”

These steps will result in an anterior chamber that is deep and stable. The IOP should be in the normal range or slightly higher. 

Nijm said she prefers to use a superior paracentesis to deliver the dexamethasone. She enters the anterior chamber through the paracentesis and goes inferiorly to the 6 o’clock or 8 o’clock position and places the cannula under the capsular bag distal to the IOL optic. 

The size of the spherule should be approximately 2 mm. She then rubs the cannula tip lightly against the superior lip to dislodge the drug; if the spherule is too large, some drug can be aspirated out of the eye. 

The cannula is removed in 1 rapid motion to minimize any leakage. The wound can be hydrated without dislodging the spherule. Wounds should be well sealed and the IOP optimal.

Depth-of-focus enhancement makes target easier to hit

Nijm advised not performing this technique if the capsular bag is torn or if there is positive posterior pressure.


This article is adapted from Nijm’s presentation at the Women in Ophthalmology 2021 Summer Symposium. Nijm is a consultant to EyePoint Pharmaceuticals.

Sustained-release option is deposited directly into the lenticular capsule.

Surgeons are changing delivery method

The feasibility of Home OCT monitoring (Notal Vision, Inc) with a patient self-operated device, automated data transmission, and analysis for disease surveillance was demonstrated in a longitudinal at-home pilot study

Such daily monitoring can result in fewer office visits, earlier detection of reoccurrence of fluid resulting in faster retreatment, and elimination of unnecessary routine injections of antivascular endothelial growth factor (VEGF) therapy, according to senior author Anat Loewenstein, MD, from the Division of Ophthalmology at Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine at Tel Aviv University in Tel Aviv, Israel.

Dry AMD treatment facilitated by swept-source OCT imaging

Loewenstein and her colleagues evaluated the performance of the home-monitoring technology that includes a spectral-domain 

device by which patients perform self-imaging, automated uploading of data, and a deep learning algorithm for automated OCT analysis. 

The goals of the study, she explained, were to evaluate the technology’s performance in daily image acquisition and automated analysis and to characterize the dynamics of retinal fluid exudation in patients with neovascular AMD.


This prospective, observational longitudinal study included 4 patients (mean age, 73.8 years) with unilateral or bilateral neovascular AMD who were being treated with anti-VEGF therapy.

Home monitoring patients for AMD: Targeting CNV

The participants monitored themselves at home using the Home OCT device for up to 3 months. 

Each time they completed the self-imaging, the macular cube scans were uploaded automatically to the Notal Health Cloud. The Notal OCT Analyzer and human graders evaluated the scans for fluid, segmentation, and volume.

The main outcomes of the study were determination of the completion of the daily self-imaging, image quality and acquisition time, agreement between the automated and human grading of retinal fluid, and the temporal dynamics of fluid volume, Loewenstein described.

The 4 patients initiated a total of 240 self-imaging attempts. Of these, 211 (87.9%) were completed successfully. Of the completed attempts, 97.6% had satisfactory image quality.

Study targets intravitreal injections for AMD, PCR risks

Regarding the presence of retinal fluid, the automated analysis and human graders agreed in 94.7% of cases.

When the investigators looked at a subset of 24 scans in which fluid was present, the correlation coefficient between the measurements of the fluid volume between the automated and human graders was 0.996 and mean absolute difference 1.5 nanoliters. The respective interhuman agreements were 0.995 and 1.2 nanoliters.

The scans demonstrated wide variations in the dynamics of fluid exudation and treatment responses, according to Loewenstein.

Based on the results, the investigators concluded that the study patients were able to perform daily self-imaging at home and generate macular cube scans that were of satisfactory quality. 

The agreement between the automated analysis and the human graders was high.

AI: Capturing more information from OCT in wet AMD

In addition, the technology facilitated characterization of the dynamics of fluid exudation and showed wide variation between eyes, which may lead to relevant disease biomarkers.

“Home OCT telemedicine systems offer an alternative for physicians to monitor disease and may allow highly personalized retreatment decisions, with fewer unnecessary injections and clinic visits,” Loewenstein concluded. “The review of remote OCT data will offer billing opportunities for ophthalmologists who utilize the service of a remote monitoring center that provides Home OCT service to patients.”


Loewenstein has no financial disclosures related to this content.


1. Keenan TDL, Goldstein M, Goldenberg D, Zur D, Shulman S, Loewenstein A. Prospective longitudinal pilot study: daily self-imaging with patient-operated home OCT in neovascular age-related macular degeneration. 

. Published online June 25, 2021. doi:10.1016/j.xops.2021.100034

Patients can get real-time disease monitoring with self-operated device.

Home monitoring of wet AMD offers high-quality scans

Patients treated with gene therapy for severe inherited retinal diseases may eventually have access to a virtual reality (VR) system that can measure their functional vision and their improved visually guided navigation in the clinic and real-world settings, according to Tomas Aleman, MD, from the Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia.

Aleman is one of the coauthors on intellectual property describing the VR mobility test (PCT/US2019/029173). 

He pointed to the success achieved in phase 3 clinical trials of gene therapy treatments for patients with visual loss resulting from the 

 gene mutation in Leber congenital amaurosis (LCA); that success was then extended to other inherited retinal disorders. 

Virtual reality simulator will boost retinal surgery training 


According to the team, the hope is that these advances will result in clinically available therapies.

However, the investigators emphasized, an interim step is “a need for testing paradigms that can quickly, accurately, and reproducibly define the level of visual function” in settings such as clinical trials and clinic settings and determine patients’ functional vision.

According to Aleman, the investigators maintain that there is great promise for use of such a system in vision research and visual rehabilitation considering the commercial availability of consumer headsets. They reported their results recently in 


The investigators from the United States and Belgium developed a VR orientation and mobility testing protocol and algorithm using commercially available VR hardware and evaluated the protocol’s usefulness in patients with LCA and controls with normal vision.

Seven controls ranging in age from 10 to 35 years and 3 patients with LCA ranging in age from 7 to 18 years were included in the study. 

Two of the patients with LCA were tested before and after having undergone gene therapy. 

Perimetry and full-field sensitivity testing were performed for the patients and the VR orientation and mobility parameters were correlated with the patients’ visual dysfunction, according to Aleman.

During the study, the subjects negotiated mobility and VR courses and were graded based on their performances. 

The visual acuities in the patients with LCA were below 20/200, the dark-adapted sensitivity losses exceeded 5 log units, and the visual fields were constricted from 20 to 40 degrees.

Gene therapy sparks foveal morphologic changes in LCA

Aleman explained that before undergoing gene therapy, patients required about a 1000-fold brighter environment to navigate, had at least 4 times more collisions, and were slower in orienting and navigating compared with the control subjects.

After treatment, patients experienced improvements in cone-mediated (by 1 to 2 log units) and rod-mediated (by > 4 log units) sensitivities that resulted in fewer collisions by at least half at about 100-fold dimmer luminance levels, and 4 times faster navigation times.

This type of testing, the authors wrote, will provide much needed flexibility in its deployment and in the possibility to test various visual attributes that may be affected by gene therapy in the setting of translational studies.

“Our preliminary work justifies the investment in time and resource needed to validate the reliability and variability of results,” Aleman said. “These were obtained in the [VR orientation and mobility] protocol as an end point of functional vision in larger populations of normally sighted subjects and patients with [inherited retinal diseases] both prior to and concurrent with implementing this test in a clinical trial.”

Ocular findings reported in case of siblings with LCA

The investigators concluded that the study “provides proof-of-concept data in support for the use of a [VR] orientation and mobility test to quantify the impact of the disease and of treatments thereof on functional vision in inherited retinal degenerations.”

---

Aleman has no financial disclosures related to the content.


1. Aleman TS, Miller AJ, Maguire KH, et al. A virtual reality orientation and mobility test for inherited retinal degenerations: testing a proof-of-concept after gene therapy. 

 2021;15:939-952. doi:10.2147/OPTH.S292527

Improvements are seen after gene therapy for Leber congenital amaurosis.

Study examines VR orientation, mobility testing


The early and late stages of uveal melanoma differ markedly, according to findings detailed by scientists from Bascom Palmer Eye Institute, University of Miami Miller School of Medicine in Florida.

An analysis of the tumors from 2 patients with metastatic uveal melanoma identified temporal and anatomic complexities in the genetic evolution of the disease that had not been recognized previously,

 according to first author Daniel Rodriguez, BS, who is pursuing a doctorate of medicine and of philosophy at the J. William Harbour laboratory at Bascom Palmer Eye Institute.

Liquid biopsies: Not yet ready for prime time in uveal melanoma

A great deal is known about the early stages of uveal melanoma but not the later metastatic stage. 

A number of genes involved in the disease have been identified, including initiating mutations in genes in the Gaq/11 signaling pathway. 

 (or “BSE” progression) associated with high, intermediate, and low metastatic risk, Mr Rodriguez explained. 

The genetic evolution of uveal melanoma has remained largely a mystery until now.


In the study, investigators conducted multiregional genomic sequencing of 22 tumors from 2 patients with widely metastatic uveal melanoma.

Patient 1 was a 51-year-old Caucasian man who received a diagnosis of uveal melanoma involving the choroid of the left eye. He was treated first with plaque brachytherapy. 



Pearls for managing care of high-risk uveal melanoma patients

Metastasis to the liver 3 years later was treated with ipilimumab and cyclophosphamide. 

Four months later, therapy was switched to vorinostat due to disease progression.

With new lesions discovered in the man’s liver and lung and around the spleen, therapy was changed to pembrolizumab. 

The disease progressed relentlessly in his liver, peritoneum, and left 12th rib. 

Treatment was changed over time with a series of drugs that included everolimus, pasireotide, binimetinib, sotrastaurin, sunitinib, sirolimus, and temozolomide.

 Ultimately subcutaneous metastasis occurred, and the patient died 21 months after the initial metastasis was discovered.

Patient 2 was a 69-year-old woman with a stage T3b uveal melanoma involving the ciliary body and choroid in her right eye. 

Conjunctival melanoma: Unlocking mysteries of disease

The eye was enucleated and 21 months later, small nodules were seen in the lungs. 

Initially, she was observed. Liver metastasis was confirmed 1 year later and she was treated with ipilimumab. 

The disease progressed to the liver and she underwent therapy with temozolomide and Yttrium-90 hepatic radioembolization. 

Rapid extrahepatic progression occurred and she died 1 year after the initial metastasis had begun.

Based on 22 tumors from the 2 patients, the investigators performed multiregional genomic sequencing. 

 Investigators identify an eye cancer culprit

They reported observing “multiple seeding events from the primary tumors, metastasis-to-metastasis seeding, polyclonal seeding, and late driver variants in 

, and other genes previously unreported” in association with uveal melanoma.

Identification of the late drivers of the disease is the key distinction in uveal melanoma. 

The authors defined them as “rare or even one-off events that may provide a selective advantage in specific cases but are not generally necessary for UM [uveal melanoma] development or progression.” 

In patient 2, the emergence of the late driver was the 

 variant concurrent with rapid disease progression.

Options give 1-2 punch to metastatic uveal melanoma 

“These findings revealed previously unrecognized temporal and anatomic complexity in the genetic evolution of metastatic uveal melanoma, and they highlighted the distinction between early and late phases of uveal melanoma genetic evolution with implications for novel therapeutic approaches,” the investigators concluded.

--


1. Rodriguez DA, Yang J, Durante MA, et al. Multiregional genetic evolution of metastatic uveal melanoma. 

.2021;6(1):70. doi:10.1038/s41525-021-00233-5

Investigators have found that the early and late stages of uveal melanoma differ markedly.

Study reveals temporal, anatomic complexity in genetic evolution of uveal melanoma 

 is already a mature and well-refined procedure, I have been delighted to find that new technologies continue to make surgery easier on me and my staff, with better outcomes for patients. 

Here, I will discuss 3 recent cases that illustrate the value of new technology in cataract surgery.

Case 1: Cataract patient with severe untreated glaucoma


The patient was a 73-year-old, non–English-speaking woman referred by a local retina specialist. She had non–insulin-dependent diabetes, as well as high cholesterol and hypertension. 

Her ocular history was significant for diabetic retinopathy and macular cysts in both eyes. She was not on any topical eye drops.

Upon examination, I found that her best-corrected visual acuity (BCVA) was 20/50 OD and 20/40 OS. She had 3+ nuclear sclerosis and 1+ cortical cataracts in both eyes. 

Cataract surgery pearls for cases with poor mydriasis, zonules

The IOP was not high (17 to 18 mm Hg), but she had severe visual field constriction in both eyes, as well as loss of retinal nerve fiber layer and retinal ganglion cells, worse in the left eye than the right. 

The cup to disc ratios were 0.76 oculus dextrus (OD) and 0.72 oculus sinister (OS). 

Pachymetry was slightly thinner than average OU; the angles were narrow but open. I diagnosed the patient with normal-tension 

To address the already-severe glaucoma, we needed to get her pressure significantly lower. 

Given that, along with the patient’s language barrier and financial challenges expressed by her family interpreter, I determined that drops alone might not be successful. 

Fortunately, we have several options to perform minimally invasive glaucoma surgery (MIGS). I particularly like the combination of the microstent (Hydrus Microstent; Ivantis, Inc) and viscocanalostomy with a surgical system (Omni Surgical System; Sight Sciences).

Not only do the 2 together significantly reduce IOP by improving outflow, but performing a 180° canaloplasty gives me the flexibility to come back later and treat the remaining 180°, with or without goniotomy, if I need greater pressure reduction in the future. 

The path to faster visual recovery following glaucoma surgery

Additionally, performing the Omni procedure first opens the channel and makes insertion of the microstent 

The MIGS procedure added only a few minutes to the case, and this patient ended up with an excellent result: 20/20 visual acuity OU and a reduction of her IOP into the 12 to 13 mm Hg range without drops. 

I do not have a nearby glaucoma specialist to refer patients to and would prefer to avoid trabeculectomy for my patients, so being able to use these new technologies to titrate MIGS to disease severity at the time of 


Case 2: Cataract and ocular surface disease


A 68-year-old retired, female patient presented for a cataract evaluation, complaining of decreased vision over the past year (worse in the left eye) and difficulty driving at night due to glare. 

She had previously received a diagnosis of dry eye, MGD and mild age-related macular degeneration. Systemic conditions included arthritis and seasonal allergies.

Upon examination, her BCVA was 20/25 OU, decreasing to 20/50 with glare. She had visually significant regular astigmatism and desired spectacle independence. 

 exam showed just a few drusen and very mild disruption of the retinal pigment epithelium, with normal macular thickness and contour. 

Analyzing macula dystrophy classifications

Her IOP was in the 18 to 20 mm Hg range, with a cup to disc ratio of 0.5 OD and 0.45 OS. There was no history of glaucoma.

and use an intraoperative extended-release formulation of dexamethasone injectable suspension 9% (Dexycu; EyePoint Pharmaceuticals Inc) to deliver a tapering dose of steroid for the first few weeks after surgery. 

In my experience, this intracameral steroid very effectively controls inflammation with little impact on IOP and is an excellent choice for most patients undergoing cataract surgery. 

The ability to reduce or eliminate postoperative drops greatly improves the surgical experience for patients—of particular importance for those receiving premium IOLs and for anyone with 

 because it reduces the amount of toxic preservatives on the eye.

Because this patient had OSD, I wanted to be as kind as possible to the ocular surface and minimize any discomfort after surgery. She was 20/20 uncorrected, and the toric lens was in perfect position after surgery.

On postoperative day 1, the patient had 1-2+ anterior chamber cells, with almost no cells by the 1-week visit and none at the 1-month visit.

Although dexamethasone 9% is a great option for most cataract patients, I recommend initially using it for patients with social, physical, or cognitive limitations that prevent them from administering drops reliably or for patients with severe OSD. 

Once you are comfortable with the injection technique, you can expand your use of dexamethasone 9% more broadly.

Additionally, rather than injecting the spherule behind the iris, as we were initially taught, I prefer to inject it 

 into the capsular bag, where the capsulorhexis overlap of the lens optic and the inferior edge of the lens haptic can hold the spherule in position 

With this approach, the medication stays 
in place nicely rather than popping out, especially in a patient with larger pupils.


Case 3: Presbyopia-correcting IOL candidate


A 56-year-old pastor presented for a cataract evaluation with complaints of decreased vision interfering with daily activities and night driving. 

He wore contact lenses to correct for moderate myopia and had previously received a diagnosis of MGD.

Upon exam, BCVA in the left eye was 20/40, worsening to 20/80 with glare. The macula, optic nerve, and IOP were all normal. 

He had 1+ nuclear sclerosis, with a 2+ posterior subcapsular cataract (PSC) OS and 1+ PSC OD. 

He wanted spectacle independence, with a strong need for good intermediate vision for computer work and the ability to see his notes on the lectern in church. I planned femtosecond laser-assisted cataract surgery on the left eye with a PanOptix (Alcon) trifocal lens. 

We discussed that he would wear a multifocal contact lens OD until that eye could be treated and that he would need to stop wearing contact lenses for 2 to 4 weeks prior to biometry.

and potential contact-lens warpage, it is important to look closely at the keratometry and make sure multiple measurements are in agreement before proceeding with a premium IOL. 

Posterior corneal elevation: Is there a role for premium IOLs?

In the past, this would have involved having multiple screens open on my computer and flipping back and forth between screens and printouts.

Since I started using the Veracity Surgical preoperative planning software (Carl Zeiss Meditec), I have been able to quickly see all the patient’s preoperative data from multiple diagnostic devices in our office and compare refractions and keratometry across different devices 


I can run multiple IOL power calculation formulas (including toric and postrefractive formulas, when needed) to ensure the correct IOL choice.

Veracity is so much more efficient than the “old” way of doing things. I can tell right away, while the patient is still in the lane, if I will need to bring them back for more biometry after a period of intensive ocular-surface management.

The system also pulls information from our electronic health record system and alerts me to any medical or ocular issues 

 that might affect the outcome, providing an extra measure of safety.

This patient’s Ks were in good agreement at the start. He ended up with a nearly 20/20 uncorrected visual acuity outcome and is looking forward to surgery with the same IOL in the fellow eye.

These just a few of the cutting-edge advancements in the field of cataract surgery.


Feulner is the founder of Advanced Eye Care & Aesthetics in Bel Air, Maryland. She is a paid consultant for EyePoint Pharmaceuticals, Inc.

Three cases demonstrate value of new tools, technology for surgeons.

Advances in cataract surgery show value in tools, tech for surgeons

Bilateral retinoblastoma (RB) tumors have separate genomic alterations, which can affect both the tumorigenesis and the prognosis for saving the eyes.

Being able to identify the differences between the eyes without the need for enucleated tumor tissue may help direct active management of RB, with usefulness in bilateral cases,

 reported senior author Jesse Berry, MD. 

Berry is based at The Vision Center at Children’s Hospital Los Angeles and USC Roski Eye Institute at Keck School of Medicine of USC in Los Angeles, California.

Great progress has been made in the treatment of this cancer because of discoveries about RB, and mortality rates have decreased; however, patient morbidity remains high. 

AAV gene therapy targets autoimmune uveitis

These patients often have vision loss or may have to lose the eye itself to prevent extraocular disease spread.

“This morbidity is even more impactful in children who have a hereditary disease with both eyes affected,” Berry commented.

Treatment in patients with bilateral RB is further complicated by variable responses in both eyes, despite the same germline mutation in the 

tumor suppressor gene and similar treatments. 

That is likely due to differences in the tumors at the molecular level, Berry explained.

Despite treatment advances, this patient population has not benefited because RB tumors cannot be biopsied directly. 

According to investigators, aqueous humor analysis differentiated the tumors in patients.


Ophthalmology Times: October 1, 2021

ARMOR study: Keeping pace with microbial resistance to antibiotics

Surgeons are changing delivery method

Home monitoring of wet AMD offers high-quality scans

Study examines VR orientation, mobility testing

Study reveals temporal, anatomic complexity in genetic evolution of uveal melanoma

Advances in cataract surgery show value in tools, tech for surgeons

Bilateral retinoblastoma tumors: The same but different

Should we always trust the OCT?

Dexamethasone ophthalmic insert matches drops for inflammation control

The relationship between myopia and conjunctival-scleral geometry

Depth-of-focus enhancement makes target easier to hit

Grail Study shows refractive stability of Juvene IOL