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Moderator
Naveen K. Rao, MD, ABO
Panelists
Ken D. Novak, MD, ABO; Magda B. Rau, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Naren Shetty, MS, PhD
Co-Authors
Swaminathan Sethu (PhD)
Purpose
To investigate the relationship between inflammatory tear film biomarkers and postoperative discomfort, specifically pricking sensation, in patients undergoing cataract surgery, and to explore the potential of preoperative biomarker profiling in predicting and managing such symptoms.
Methods
This prospective observational study was conducted on 100 eyes of 100 patients undergoing cataract surgery. Pre-operatively steroids and NSAIDs were deferred. Tear samples were collected at two time points: pre-operatively on the day of surgery and postoperatively on day 1 using Whatman Filter Paper 41 strips and inflammatory biomarkers, including IL-17A and TNF?, were analyzed. On postoperative day 1, patients were divided into two groups based on symptoms: Group 1 (n = 50): no pricking sensation and Group 2 (n = 50): pricking sensation present. Patients with ocular surface disease, uveitis and systemic conditions affecting tear production, or surgical complications were excluded.
Results
Patients with postoperative pricking sensation demonstrated elevated levels of IL-17A and TNF? compared to asymptomatic patients indicating an underlying inflammatory state of the ocular surface. The findings suggest that these biomarkers may serve as predictors for postoperative discomfort
Conclusion
IL-17A and TNF? are potential inflammatory markers linked to postoperative discomfort following cataract surgery. Preoperative biomarker screening could identify at-risk patients, enabling targeted anti-inflammatory therapy to improve postoperative comfort. This biomarker-driven approach may enhance personalized care in cataract surgery
Presenting Author
Ayesha Musthafa, MBBS, MS
Co-Authors
Rohitha Nayak (MBBS, DOMS, DNB), Harsha Rao (MD, PhD), Naren Shetty (MS, PhD)
Purpose
To characterize the clinical presentation, imaging features, risk factors, and treatment outcomes of capsular bag distension syndrome (CBDS) following cataract surgery using AS-OCT and Nd:YAG capsulotomy.
Methods
In this prospective observational study at a tertiary care eye hospital, patients presenting with CBDS after uneventful phacoemulsification and in-the-bag IOL implantation were enrolled. Diagnosis was confirmed by slit-lamp biomicroscopy and anterior segment OCT (CASIA-2). Patients underwent Nd:YAG laser posterior capsulotomy (multiple ~2 mJ shots to achieve ?4 mm opening) and received topical prednisolone acetate 1% 4� daily for 1 week. Outcomes included refractive shift, IOL/PC distance by CASIA-2, anterior chamber depth, complications, and fluid characteristics.
Results
Fifty-one eyes were included. Pre-capsulotomy, 80% exhibited myopic shift (mean ?2.35 D), 20% hyperopic shift. AS-OCT showed IOL-posterior capsule separations ranging from ~181 to 2412 µm. Post-YAG, visual axis cleared in all cases; refraction normalized in most, with hyperopic shifts up to +5.1 D in few. CASIA-2 demonstrated significant reduction in IOL displacement. No significant intraocular inflammation occurred. The laser energy required inversely correlated with IOL-PC distance (~3.6 mJ/mm� per 100 µm increase).
Conclusion
CBDS exhibits characteristic refractive shifts and imaging findings. Nd:YAG laser capsulotomy is an effective, safe intervention leading to visual axis clearance and refractive stabilization, with treatment parameters influenced by IOL-posterior capsule separation. CASIA-2 imaging aids precise diagnosis and outcome assessment.
Presenting Author
Zhaoxing Dai, MD
Purpose
To evaluate the safety and efficacy of a novel non-invasive cataract therapy combining Active Crystallin Quantitative Analysis (ACQA) and Crystallin Reactivation and Self-reassembly (CRSR) technologies. The approach aims to detect and treat cataracts at early or subclinical stages, offering an alternative to surgical intervention.
Methods
ACQA technology uses fluorescence spectroscopy to quantitatively assess lens transparency changes due to protein denaturation. CRSR employs targeted light energy to disrupt hydrogen bonds in denatured crystallins, triggering structural repair and reassembly. Preclinical studies were conducted on UV-induced cataract pig models and galactose rat models, followed by pilot clinical studies (NCT04569318, NCT05396547) involving multi-session treatments (15–20 minutes/session) with follow-up periods up to 3 months. Effectiveness was evaluated using LOCS III grading, LogMAR visual acuity, and VF-14 questionnaires. Safety was assessed via ocular toxicity screening and patient-reported outcomes.
Results
In animal models, CRSR significantly improved lens transparency without tissue damage. In early-phase clinical trials (n=11, FIM study; n=100 planned), CRSR demonstrated an average improvement of LogMAR -0.205 (p=0.013), with 100% of subjects showing improvement in cataract severity. There were no adverse events, and subjects reported stable vision up to 12 months post-treatment. Some patients noted improvement in near vision, suggesting potential benefit for presbyopia. Fluorescence profiles and slit-lamp imaging supported molecular and structural lens recovery.
Conclusion
The ACQA-CRSR combined platform offers a promising non-invasive alternative for cataract management, enabling early detection and treatment without surgery. It demonstrates safety, vision improvement, and functional lens restoration, suitable for patients not indicated for surgery or in early-stage cataract.
Presenting Author
Sumitha Muthu, MS
Co-Authors
Rohit Shetty (FRCS)
Purpose
To evaluate binocular vision status among ophthalmic surgeons using clinical evaluation and to detect any Non- strabismic binocular vision anomalies (NSBVA) if present. We also assessed symptoms related to NSBVA using Modified CISS (Convergence insufficiency symptom survey) questionnaire and correlated this with binocular vision parameters.
Methods
: We conducted a prospective study on 31 ophthalmic residents who were asked to fill a Modified CISS questionnaire (CISS questionnaire modified to assess symptoms possibly related to binocular vision status, hand-eye coordination while performing ocular surgeries under operating microscope). A score was assigned for the answers to each of the question and final score calculated. All subjects were subjected to complete ophthalmic evaluation including vision, refraction, anterior and posterior segment and detailed orthoptics assessment to look for NSBVA. Those diagnosed with NSBVA were treated with appropriate vision therapy.
Results
: 52% (n=16) had normal BSV parameters, 35 % (n=11) had deranged orthoptic parameters and also were symptomatic for NSBVAs, 13 % (n=4) had mildly deranged accommodative parameters only but experienced no symptoms during performance of surgeries. All except 1 surgeon with NSBVA had a score more than 11 on the modified CISS questionnaire. Subjects with a score of less than 10 on the questionnaire had no binocular vision anomaly. All surgeons reported subjective improvement in symptoms after 6 weeks of vision therapy.
Conclusion
Modified CISS questionnaire is a sensitive tool to screen for NSBVAs among eye surgeons. NSBVA is highly prevalent among ophthalmic surgeons. Hence, screening for NSBVAs in this cohort can help detect NSBVAs and possibly improve their surgical performance as well as reduce eyestrain and other symptoms related to peformance of surgeries.
Presenting Author
Shreya Saraogi, MS
Co-Authors
Naren Shetty (MS, PhD), Lubna Zameer (DNB), Swaminathan Sethu (PhD), Arka subhra Ghosh (PhD), Archana Nair (MSc)
Purpose
Emerging evidence highlights the contribution of immuno-inflammatory mechanisms to cataractogenesis. In light of this, we conducted a comprehensive analysis of intraocular inflammatory mediators and characterized immune cell profiles across distinct cataract subtypes
Methods
Subjects undergoing cataract surgery (n=78) were recruited following ethics committee approval and informed consent. Study includes subjects with nuclear sclerotic cataract (NS 1-5, n=38), posterior subcapsular cataract (PSC, n=34), mature cataract (n=4) and cortical cataract (CC, n=2). Aqueous humor (AH) collected by anterior chamber paracentesis were used to measure the levels over 25 inflammatory factors and 8 immune cell types by flow cytometry.
Results
A significantly higher AH levels of IL-17F and VEGF-A were observed in subjects with PSC and NS cataract compared to those with NS without PSC cataract. The proportions of neutrophils, monocytes, NK cells, and T cells were significantly different between the types of cataracts studied. Neutrophils were higher in subjects with PSC cataract compared to those with NS and PSC cataracts. However, monocytes, NK cells and T cells were higher subjects with NS and PSC cataracts compared to those with PSC cataracts.
Conclusion
Immuno-inflammatory profile is distinct in PSC. Our findings demonstrate cataract type-specific immune cell, molecular diversity has profound implication in understanding of cellular, molecular basis of cataractogenesis.it has clinical applicability in prognostication, prevention, management of post-cataract surgery outcomes,co-morbidities.
Presenting Author
Aisling Higham, FRCOphth, MBBS, MSc
Co-Authors
Hannah Chiu (MD, FRCSC), Amin Hatamnejad (BSc), Ernest Lim (MBBS, BSc), Madison Putman (BSc), Eric Tam (MD, FRCSC), Sohel Somani (MD, FRCSC), Yajie He (MSc), Nick De Pennington (BM BCh, MBA, FRCS)
Purpose
This study evaluates whether large language models (LLMs) can support an automated conversational system for post-operative cataract follow-up. Building on prior deterministic artificial intelligence (AI) trials, this trial of generative AI explores patient experience, safety, and quality of symptom reporting and clinical question answering.
Methods
A prospective single-center trial was conducted from September 2024-May 2025. Adults undergoing uncomplicated cataract surgery were recruited. Dora-CA2, a voice-based LLM assistant, conducted telephone consultations prior to the post-operative week 1 (POW1) visit. Symptom assessment (redness, pain, vision, floaters, flashing lights) was performed using an LLM with prompting alone, without clinical fine-tuning. Outcomes included agreement between Dora-CA2 and masked review of symptom significance, patient acceptability (Net Promoter Score, NPS), and handling of patient-initiated questions. Agreement was measured using Cohen's Kappa (?).
Results
Of 244 patients, 187 answered the post-op call and 116 completed the telephone consultation (completion rate 62%). Agreement with clinicians on symptom significance was 92.2% (?=0.675), with sensitivity 79.4% and specificity 94.0%. Symptom-level agreement ranged from ?=0.50 for pain to ?=0.80 for flashing lights, with sensitivities 50-100% and specificities above 90%. Mean NPS was 8.6/10. Patients asked 69 questions across 27 calls, and Dora-CA2 fully addressed 54 (78.3%) using retrieval augmented generation (RAG) from existing patient information sources. Reviewers judged 93 of 116 conversations (80%) as providing sufficient information to assess symptoms.
Conclusion
LLM-based conversations had high patient acceptability and were sufficient for symptom assessment in 80% of cases in a clinical decision support role. This work reinforces that general-purpose LLMs are not yet ready for standalone clinical use. More specialised models will be required to meet levels required for fully autonomous clinical use.
Presenting Author
Minoo Tohidi Kaloorazi, MD
Co-Authors
Fargol Mostofian (MD), Iqbal Ike Ahmed (MD, FRCSC), Matthew Schlenker (MD, FRCSC)
Purpose
To evaluate the effectiveness of a tailored educational video, delivered on the day of consultation, in improving patient understanding, reducing preoperative anxiety, and enhancing perceived quality of care in a Canadian cataract surgery population.
Methods
This ongoing prospective, randomized two-arm trial is being conducted at Prism Eye Institute to enroll patients referred for cataract surgery. Participants will view a tailored educational video prior to their consultation. Knowledge (cataract questionnaire) and anxiety (STAI-Y1) will be assessed before and after the video, with an additional survey on perceived quality of care. Demographics and visual acuity will be extracted from records. Primary outcomes are changes in knowledge and anxiety; secondary outcomes include perceived quality of care and exploratory correlations with visual acuity and demographics.
Results
In the first iteration, the educational video was tested on 10 patients (mean age 66.1 years; 50% male). Based on their feedback, a revised second edition was developed and evaluated in 11 new patients (mean age 67.4 years; 6 male). In the first cohort, mean improvement in questionnaire scores was 2.9 points, with 70% achieving a score ?8 after viewing the video. In the second cohort, mean improvement was 3.7 points, and 81.8% achieved a score ?8, meeting the predefined goal of ?80%. The refined video and questionnaire are now prepared for evaluation in the full study sample.
Conclusion
A tailored video-based educational tool shows promise in improving patient comprehension and reducing anxiety before cataract surgery, warranting further evaluation in larger cohorts.
Presenting Author
Iman M. Qureshi, BM BCh
Co-Authors
Toshit Varshney (MD), Dominique Tynan (MD), Ella Preston (BSc), Gus Gazzard (MD, FRCOphth, MA, MBBS), Robin Hamilton (FRCOphth, MBBS, MD)
Purpose
To determine whether refractive status influences immediate intraocular pressure (IOP) spike risk following intravitreal injection (IVIs), comparing pre- and post-cataract surgery (CS) outcomes across refractive groups.
Methods
Retrospective audit of IVIs at Moorfields Eye Hospital from 29/01/10 to 28/01/25. Only eyes receiving IVI in time period before and after CS—and a valid IOL power recorded in the electronic medical record- were included. Eyes were stratified by refractive status using IOL power: high hypermetrope (?30D), moderate hypermetrope (24.5-29.5D), emmetropia (20-24D), moderate myopia (11.5-19.5D), and high myopia (?11D). Primary outcomes were defined as IOP spike ?10 mmHg (IOP+10) and a post-injection value >40 mmHg (IOP>40) at approximately 20 minutes post-injection. Paired and combined pre- versus post-cataract spike rates were compared using chi-square and Fisher's exact tests.
Results
In paired analysis (1,853 IVIs pre- and post-CS), moderate hypermetropes (n=400) had had largest reduction in IOP+10 spike rates(31.0%?13.5%; ?17.5 percentage points; p<0.001; number needed to treat [NNT]=5.7) followed by emmetropia (n=2,392) (31.2%?24.5%; ?6.7pp; p<0.001; NNT=14.9); other groups had non-significant changes with moderate myopes showing least improvement. In combined analysis of all IVIs (n = 23,398) pre- vs post-CS, moderate hypermetrope uniquely maintained lower post-CS IOP+10 spike rate (26.5%?22.2%; p=0.016), while emmetropic eyes showed an increase in spikes (28.8%?31.9%; p<0.0001); changes in other groups were not significant. Severe IOP>40 spikes were rare.
Conclusion
CS provides a refractive status-dependent decrease in post-IVI IOP+10 spike rates, with moderate hypermetropic eyes benefiting most significantly and moderate myopes showing the least reduction. These findings suggest that biometry and CS affect post IVI pressure responses, which can guide planning and post-injection monitoring protocols.
Presenting Author
Purendra Bhasin, MS
Purpose
To evaluate the demographics, types, and outcomes of ocular trauma sustained due to firecracker injuries during Diwali 2023–2024 at a tertiary ophthalmic centre.
Methods
A retrospective observational study was conducted on 47 eyes of 42 patients with firecracker injuries. Data were assessed for patient demographics, time lapsed, type and extent of trauma, visual disability score, and follow-up over 2–12 months. Pareto charting was used to analyze frequency and cumulative percentages.
Results
Firecracker injuries were 50 times more common during Diwali week compared to the rest of the year. Of the patients, 88% were male, 66.67% were under 20 years, and 36.70% were bystanders. Closed globe injuries accounted for 88%, with surgical intervention required in 39%. Ocular adnexal involvement occurred in 33.33%, and anterior segment injuries in 69.73%. At final follow-up, 60% of eyes achieved visual acuity >6/9, while 15% had severe visual loss (<3/60) and one eye required evisceration.
Conclusion
Firecracker injuries during Diwali pose a significant risk, particularly to young males and bystanders. Most injuries are preventable. Public awareness, stricter safety regulations, and protective measures are essential to reduce the incidence and severity of such ocular trauma during festivals.
Presenting Author
Ari H August, BA
Co-Authors
Danijel Pericic (MD, MS)
Purpose
Demodex mites may be commensal organisms, but ocular infestation is associated with various conditions like blepharitis. Spread by direct contact, the incidence of infestation has been found to increase with age and following ocular surgery. We aim to identify the incidence of Demodex infestation among ophthalmologists and ophthalmic technicians.
Methods
This prospective study used convenience sampling to invite ophthalmologists and ophthalmic technicians. Participants completed a survey including demographics (age, sex, race/ethnicity, role, time in direct ophthalmic patient care), health history (diabetes, rosacea, dry eye disease, blepharitis, Demodex infestation, contact lens use), and the blepharitis symptom questionnaire (BSQ). A single comprehensive ophthalmologist, blinded to survey responses, scored slit lamp examinations for collarettes, erythema, Meibomian gland expressibility, meibum quality, ocular surface staining, and tear breakup time; collarettes ? +2 in either eye defined "Demodex infestation."
Results
Data collection is ongoing, current results: Of 19 participants, 15 were female (79%), and 13 (68%) were ophthalmic technicians; the average age was 30 (years [y], SD12; median 26) with a mean time in ophthalmic care of 1.5y (SD8; median 1.5). The mean BSQ score was 9 (SD8; median 7) and examination score was 9 (SD5; median 9). Nine of 19 participants (47%) had Demodex infestation. Infestation was associated with male sex (p=0.03), erythema (p=0.03) and poor meibum quality (p=0.02). Additionally, increased time in ophthalmic care was associated with age (p=0.04) collarette severity (p=0.03), erythema (p=0.005), poor gland expressibility (p<0.001), and poor meibum quality (p<0.001).
Conclusion
Almost half of ophthalmologists and ophthalmic technicians had Demodex infestation, with severity increasing with time in ophthalmic care. Ophthalmic care providers should be aware of personal infestation with and potential transmission of Demodex. Further collection to achieve a representative sample is ongoing.
Presenting Author
Zahra Javdani Sanatgar Mog, MD
Purpose
This review evaluates the biological mechanisms by which alcohol contributes to cataract formation and synthesizes epidemiological evidence on its association with cataract risk.
Methods
A narrative review of meta-analyses, cohort studies, and experimental research was conducted, focusing on alcohol-related oxidative stress, lens metabolism, and the incidence of cataract surgery.
Results
Heavy alcohol consumption increases the risk of nuclear and posterior subcapsular cataracts through oxidative stress, depletion of antioxidants, protein cross-linking, sorbitol accumulation, and dehydration. In contrast, several studies report that moderate intake, particularly of wine, may modestly reduce the risk of cataract formation, possibly due to the antioxidant properties of polyphenols.
Conclusion
Alcohol shows a dose-dependent effect on cataractogenesis: heavy intake is harmful, whereas moderate intake may be neutral or mildly protective. Reducing excessive alcohol use should be emphasized, especially in those with additional risk factors such as diabetes, smoking, or UV exposure.
Presenting Author
M�lanie H�bert, MD, MSc
Co-Authors
Emily Chew (MD), Alisa Thavikulwat (MD), Susan Susan Vitale (PhD, MS)
Purpose
Cataract and age-related macular degeneration (AMD) are processes presumed to be due to aging. The primary goal was to find metabolites associated with cataract, and the secondary outcome was to evaluate overlaps between those metabolites and metabolites that have been identified to be associated with AMD.
Methods
A post hoc analysis was performed using AREDS dataset. A total of 1784 eyes of 908 participants and 892 endogenous metabolites were analyzed. We assessed association of metabolites to cataract surgery and incident moderate cataract by subtypes (i.e., nuclear sclerosis grade ?4, cortical grade ?10%, and posterior subcapsular (PSC) grade ?5%). Eyes with the outcome at baseline were excluded. A repeated measures multivariate proportional hazards model adjusting for age, sex, and other significant variables from AREDS report 32 was used with the Wei-Lin-Weissfeld method to account for the correlation between both eyes. False discovery rate accounted for multiple comparisons using p<0.05.
Results
There were 76 metabolites that were associated with at least one cataract outcome (FDR p<0.05). All except one were associated with increased risk with higher metabolite levels. The lipids pathway was the main pathway involved for cataract surgery (n=5/12, 42%), nuclear cataracts (n=23/35, 66%), and cortical cataracts (n=17/28, 61%); the carbohydrates pathway was the main pathway for PSC cataracts (n=4/13, 31%). Of the 278 metabolites significantly associated with age (FDR p<0.05), 19 were associated with at least one cataract outcome. Of the 16 baseline metabolites significantly associated with incident late AMD (FDR p<0.05), none of these were significant for a cataract outcome.
Conclusion
Though both cataracts and AMD are understood to be aging processes, cataract development seems to be associated with distinct endogenous metabolites, suggesting that other pathways could be involved beyond those conventionally found with aging.
Presenting Author
Mohammadali Ashraf, MD
Co-Authors
Eshani Ragam (BSc), Abdullah Ahmed (MBBS), Raja Danyal Abbas (BSc), Jousef Bakir (BSc), Nicholas Tomaras (BSc), Ahmad Alzein (BA), Mohamad Alzein (BSc), Andre Stone (MD), Belal Asfour (BSc), Hajirah Saeed (MD, MPH)
Purpose
White cataract often signals preventable delays in care rooted in socioeconomic determinants of health. This study examines associations between socioeconomic factors and demographic disparities using a large cohort from a single tertiary care center.
Methods
We retrospectively reviewed all patients with history of cataract encounters at the University of Illinois Chicago from September 2017-August 2024. White cataract cases (Group A) were compared with two cataract groups based on visual acuity: Group B (VA <20/200) and Group C (VA ?20/200). To create balanced comparators, 718 patients were randomly chosen from Groups B and C. Data included demographics, insurance, primary care provider (PCP) access, ZIP code-level median household income, ocular and systemic history, substance use, and documented social drivers of health (SDoH). Group differences were assessed and associations with white cataract were estimated using logistic regression.
Results
Among 26,122 cataract encounters, a total of 2154 cases were analyzed (718 cases in each group). White cataract comprised 2.73% of encounters with cases having a mean age of 61.31 years, 49.7% were male, and race/ethnicity was 54.2% Black, 18.7% Hispanic, and 15.3% white. Mean age differed across groups (61.3, 64.1, 67.0 years for groups A-C; P<0.001). Prior ocular trauma and glaucoma were more prevalent in A and B versus C (both P<0.001). SDoH risks including transportation barriers (P<0.001), housing instability (P<0.05), and limited health literacy (P<0.05) were also higher in A and B than C. Ocular trauma (OR 5.27) and glaucoma history (OR 4.07) were the main predictors of white cataract
Conclusion
White cataract disproportionately affects people with unmet social and economic needs. Addressing key SDoH risks, particularly transportation barriers, housing instability, and limited health literacy, while integrating social care into ophthalmology practice could curb late-stage vision loss and improve equity.
Presenting Author
Qais A Dihan, MD
Co-Authors
Muhammad Chauhan (MD, MS), Ahmed Shakarchi (MD, MPH), Abdelrahman Elhusseiny (MD), Ahmed Sallam (MD, PhD, FRCOphth), Dane Jester (BSc)
Purpose
To determine whether sensorineural hearing loss (HL) serves as a predictor for increased risk of developing degenerative myopia, as well as requiring cataract surgery, in patients with Alport syndrome.
Methods
We conducted a retrospective US-based population study. Following PSM, we compared a patient cohort with Alport syndrome + bilateral sensorineural HL (2543 pts) to a patient cohort with Alport syndrome and no hearing loss (NHL; 2543 pts). We compared their risks for developing subjective visual disturbances, degenerative myopia, and requiring and undergoing cataract surgery at 3, 5, and 10 years.
Results
HL patients had nearly twice the risk for visual disturbances as their NHL counterparts at 3 (HR: 1.95; 95% CI: 1.5-2.6), 5 (HR:1.73; 1.4-2.2), and 10 years (HR: 1.86; 1.5-2.3). Additionally, HL were at increased risk for cataract surgery at 5 (HR:1.74; 95% CI: 1.03-2.9) and 10 years (HR: 1.75; 1.1-2.7). HL was also associated with increased 10-year risk of degenerative myopia (HR:2.66; 1.3-5.6).
Conclusion
HL in Alport syndrome was associated with an increased risk of visual disturbances, cataract surgery, and degenerative myopia at 10 years. HL may serve as a clinical marker to prompt timely ophthalmic screening and optimize vision outcomes in patients with Alport Syndrome.
