To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2026 Annual Meeting registration.
Moderator
Nick Mamalis, MD, ABO
Panelists
Maria S. Romero, MD, ABO; Yvonne Wang, MD, MD, ABO
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
Rushad C. Shroff, MS
Co-Authors
Apoorva Agrawal (DNB)
Purpose
Dry eye disease (DED) is characterized by loss of tear film homeostasis. The purpose of this study is to assess the impact of a novel non-invasive artificial intelligence-based imaging and treatment app on subjective symptoms and objective tear metrics in DED and CVS patients.
Methods
Prospective interventional study of subjects with CVS and evaporative dry eye disease (EDE) defined as subjects with symptoms of dry eye and fluorescein break up time (TBUT) less than 10 seconds. The sample size was 100 subjects. All subjects underwent baseline dry eye evaluation including lipid layer thickness, Non contact TBUT, FBUT, Schirmer's, Meniscus height and variability in ocular surface temperature using the Ocular surface imager. The OSDI questionnaire was administered to all subjects. Our novel smartphone and computer screen app was installed to monitor and remind subjects to blink and follow the 20-20-20 rule. All tests were repeated at 3 months after using the app.
Results
There was a significant change (p=0.03) in TBUT from baseline (7 + 0.87) seconds to one month after the app based intervention (11 +0.78). The lipid layer thickness significantly increased (p=0.002) from (54 + 10)nm to (72 +11)nm after the intervention. There was a significant reduction in OSDI scores (p=0.04) from (24 +4) to (10 +5) after using the app. There was no significant change in the Schirmers values or Meibo score.
Conclusion
The use of this novel and simple app may help patients practice better blink hygiene. This may lead to improvement in tear film metrics and subjective symptoms without pharmacological intervention. Further studies and a larger sample size are required to verify the same
Presenting Author
Berk Onaral, MD
Co-Authors
Ozlem Evren Kemer (MD), Mahmut Asfuroglu (FEBO), Yonca Asfuro?lu (MD, FEBO), Emine Esra Karaca (MD)
Purpose
This study aims to assess ocular surface alterations observed in patients hospitalized in the intensive care unit(ICU) of a tertiary referral hospital.
Methods
We retrospectively analyzed the records of 135 patients admitted to the ICU of our hospital between November 2023 and May 2025 who were consulted to our clinic due to suspected ocular surface pathology. The evaluation parameters included demographic characteristics, requirement for respiratory support, duration between hospitalization and onset of ocular findings, eyelid position, blinking reflex, presence of corneal involvement, adequacy of eyelid closure, clinical course, blood culture findings, and application of an amniotic membrane ring (AMR).
Results
Punctate epithelial erosions were seen in 14% of patients,corneal epithelial defects of variable severity in 54%,corneal stromal melting in 14% and microbial keratitis in 17% of cases.Corneal perforation occurred in only 1 of 135 patients. Strong correlation was found between lagophtalmos and the extent of corneal involvement (p=0.001).Absence of blink reflex correlated with a higher rate of corneal involvement (p=0.003).Patients who died of systemic causes during follow-up demonstrated progressive ocular involvement (p=0.004).Adequate eyelid closure was achieved in only 29 of 135 patients (21.5%). Progression of ocular surface pathology was observed in merely 0.7% of the treated cohort.
Conclusion
Lagophthalmos,absent blink reflex and insufficient eyelid closure are major causes for ocular surface disorders in ICU patients. Implementation of preventive strategies;encompassing timely recognition, effective eyelid closure, lubrication and when indicated, AMR application is essential to reduce the risk of severe sight-threatening complications.
Presenting Author
Preeya K. Gupta, MD
Co-Authors
Christopher Rapuano (MD), Sam Garg (MD), Alice Epitropoulos (MD, FACS), Bonnie An Henderson (MD), Anat Galor (MD, MPH)
Purpose
To assess short-term (8-week) clinical safety and efficacy outcomes in eyes with chronic ocular surface pain (COSP) that have been treated with a novel topical ocular cooling device targeting the long ciliary nerves of the eye.
Methods
Unilateral treatments with the cooling device were administered to the ocular surface of 31 subjects. Twenty eyes received the interventional treatment and eleven eyes received a sham treatment. Patient reported outcomes were collected weekly (either in person at week 2 and 8 visits or via virtual visit) using the visual analogue scale (VAS), ocular pain assessment survey (OPAS) and chronic ocular pain questionnaire (COP-Q). Clinical exam, evaluation of Adverse events (AEs), and Cochet-Bonnet corneal sensitivity testing were conducted at baseline, week 2, and week 8. All subjects were followed for eight weeks.
Results
The VAS, OPAS, and COP-Q all trended towards a mean reduction in eye pain from baseline that was greater in the interventional arm vs sham arm. The COP-Q demonstrated a statistically significant reduction in eye pain severity from baseline relative to the sham group at Week 8 in patients screened for peripheral-dominant COSP via an anesthetic challenge (p=0.042). Corneal sensitivity testing statistically significantly improved in the treatment arm by week 8 (45.6mm to 50.0mm, p=0.042) and did not improve in the sham arm. No serious AEs were reported. The most common AEs were transient mild to moderate conjunctival hyperemia, eye pain, and foreign body sensation immediately post-treatment.
Conclusion
These results suggest that ocular surface treatment using a novel ocular surface cooling device is well tolerated, improves corneal sensation, and provides relief from COSP through 8-weeks post-treatment.
Presenting Author
Gautam Ramanathan, BA
Co-Authors
Siddharth Nath (MD, PhD), Albert Cheung (MD)
Purpose
The objective of this study was to review systemic immunosuppression regimens used for patients undergoing ocular surface transplants to further inform clinical practice.
Methods
We conducted a systematic review and meta-analysis. Our literature search encompassed studies included in PubMed, Cochrane, OVID Medline, CINAHL, and Web of Science between 2015 and 2025 reporting use of systemic immunosuppression in postoperative management of ocular stem cell transplantation procedures. Analyses were summarized by weighted pooled means of post-operative measures and t-testing. Our primary outcomes were improvement in best-corrected visual acuity (BCVA) ? 2 lines, stable ocular surface and rates of complications of systemic immunosuppression protocols at final follow up.
Results
14 studies comprising 598 eyes were included, with a mean follow-up of 43.2 ± 26.7 months. Among those reporting visual outcomes, 63% (143/227) of eyes improved ?2 lines in BCVA, ranging from 85% in KLAL to 33% in allo-CLET. For ocular surface outcomes, 71% (389/548) of eyes were stable at last follow-up, ranging from 83% in KLAL/Lr-CLAL to 56% in allo-CLET. Across studies, 21% used a single agent, 29% two, 43% three, and 7% four, with triple therapy most common. KLAL regimens typically included tacrolimus, while allo-SLET/CLET relied on MMF. The most frequent adverse events were rejection and neovascularization.
Conclusion
Systemic immunosuppression is a valuable adjunct to ocular surface stem cell transplantation and is associated with both ocular surface graft survival and improvements in BCVA.
Presenting Author
Taylor Crook, BSc
Co-Authors
Jose Giraldo (MD), Olivia Lee (MD), Amber Kwon (BA), Moonjung Choi (MD)
Purpose
The purpose of this study is to evaluate the clinical significance of tear Matrix Metalloproteinase-9 (MMP-9) concentration in conjunction with clinical signs and symptoms of meibomian gland dysfunction (MGD) and determine the correlation of the MMP-9 immunoassay with other ocular surface diagnostic modalities.
Methods
59 MGD patients (118 eyes) and 17 control patients (34 eyes) were examined prospectively for the assessment of the clinical signs and symptoms of dry eye. Each patient was examined for their tear breakup time (TBUT), meibum quality (MQ), anesthetized Schirmer's test, MMP-9 antigen test, and infrared meibography. The MMP-9 immunoassay was graded on a 0-8 scale, with band color intensity referenced against previously reported concentration ranges (Lee J, et al. 2021). Patient symptoms were self-reported using the Ocular Surface Disease Index (OSDI) survey. Statistical analysis included Kendall's tau rank tests and independent t-tests.
Results
MMP-9 was positive in 95.1% of MGD eyes (mean of 3.05 ± 2.16) compared to 32% of controls (mean of 1.12 ± 1.92) which was significant for both mean score (p<0.01, CI 1.00-2.96) and incidence (p<0.01, CI 5.05-91.42) with a sensitivity of 90.5% and specificity of 67.6%. MMP-9 concentration showed a positive correlation with Schirmer's scores (?=0.245, p=0.0082) and meibomian gland dropout (?=0.255, p=0.0033). The MMP-9 concentration was not significantly correlated with the other clinical assessments such as TBUT (p=0.3624), meibum quality (p=0.8079), and OSDI (p=0.9749).
Conclusion
Elevated tear MMP-9 concentration is associated with more severe meibomian gland dropout, increased aqueous tear production and serves as a sensitive and specific marker for MGD. These results demonstrate that elevated MMP-9 levels in human tears may serve as a clinically useful biomarker of the chronic ocular surface inflammation linked to MGD.
Presenting Author
Pooja Khamar, MD, PhD
Co-Authors
Rohit Shetty (FRCS)
Purpose
Dry eye disease (DED) shows diverse manifestations, making diagnosis and management challenging, especially sub-clinical DED. We used an AI-based classifier of tear film biomarkers to identify subclinical risk groups, aiming to improve early detection, patient stratification, and treatment planning.
Methods
Tear samples (n=8,000) were collected using Schirmer's strips from subjects undergoing ocular surface evaluation. Eight biomarkers relevant to various inflammatory markers were quantified using immunoassays. Based on Schirmer's test, tear breakup time (TBUT), and Ocular Surface Disease Index (OSDI) scores, subjects were clinically categorized as controls or DED. A decision tree classifier (DTC) identified MMP-9 as the key discriminator, stratifying eyes into Controls (n=3,960), SC-1 (n=960), SC-2 (n=1,320), and DED (n=1,760). A Random Forest (RF) model was then trained excluding MMP-9, with and without clinical parameters, and evaluated using AUC, sensitivity, and specificity.
Results
The DTC model achieved an AUC of 0.86, correctly classifying 68% of SC-1 and 71% of SC-2 eyes. Controls and DED correlated significantly with Schirmer's, TBUT, and OSDI (p<0.001), whereas SC groups showed no significant correlation (p>0.05), indicating early disease. The RF model based on MMP-9 stratification reached an AUC of 0.79, with 94.8% sensitivity and 88.6% specificity. When clinical parameters were integrated, overall model accuracy increased to 0.91, with specificity for DED detection improving to 91%. These findings confirm that biomarker-driven stratification enhances classification and exposes hidden disease segments.
Conclusion
AI-guided stratification of 8,000 tear samples defined MMP-9 cutoffs that subdivided healthy eyes into subclinical risk groups. This biomarker-based classification complements clinical testing, providing a robust framework for early detection, risk prediction, and personalized management of DED in clinical and surgical practice.
Presenting Author
Abdullah Ahmed, MBBS
Co-Authors
Eshani Ragam (BSc), Abdelrahman Elhusseiny (MD), Hajirah Saeed (MD, MPH), Asmaa Zidan (MBBS), Mahrukh Chaudhry (MBBS), Hamza Ibrahim (MBBS), Mohammadali Ashraf (MD), Hasan Khan (MD)
Purpose
As lamotrigine is increasingly prescribed, related adverse drug reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are on the rise. We sought to evaluate the worldwide prevalence of lamotrigine-associated SJS/TEN, which has mortality rates up to 50% and ocular morbidity approaching 80% of survivors.
Methods
In this meta-analysis, PubMed, Ovid, Scopus, and Web of Science databases were searched from inception to August 31, 2025. Observational studies with ?30 patients, a confirmed SJS/TEN diagnosis that identified lamotrigine as the causative agent, and that employed standardized diagnostic criteria were included. Two reviewers independently selected studies and extracted data. Meta-analysis using random-effects models with Freeman-Tukey double arcsine transformation. Subgroup analyses by geographic region, population type, and time period were conducted. Quality was assessed using Newcastle-Ottawa Scale.
Results
Forty-five studies with 4,616 patients were included. Of these, 232 cases (5.0%) were lamotrigine-associated. Pooled proportion of lamotrigine-associated SJS/TEN was 3.4% (95% CI, 2.2%-4.8%) with substantial heterogeneity (I� = 76.9%). In terms of geographic variation, North America was highest (5.8%; 95% CI, 2.8%-9.6%), followed by Europe (3.2%; 95% CI, 1.7%-5.2%), and Asia (2.0%; 95% CI, 1.0%-3.1%). Pediatric populations showed significantly higher prevalence (7.3%; 95% CI, 3.5%-12.1%) versus adults (1.7%; 95% CI, 0.5%-3.5%; P = 0.010). There was a temporal increase in lamotrigine-associated SJS/TEN observed (P < 0.001).
Conclusion
Lamotrigine was associated with approximately 1 in 30 cases of SJS/TEN worldwide, having significant implications for long-term ocular morbidity. Findings emphasize the importance of careful risk-benefit assessment when prescribing lamotrigine, particularly in pediatric populations, and highlight the need for enhanced pharmacovigilance.
Presenting Author
Jainam Shah, BSc
Co-Authors
Sachin Pathuri (BSc), Joshua Ong (MD), John Berdahl (MD), Andrew Lee (MD), Rahul Pandit (MD), Anurag Shrivastava (MD), Karl Golnik (MD)
Purpose
Evidence on ocular surface effects of electronic smoking (e-cigarette/vape) is limited. We sought to examine whether electronic smoking is associated with ocular surface diseases (OSDs), and whether more frequent vaping corresponds to higher prevalence and greater odds of OSDs, using a large, diverse U.S. national patient cohort.
Methods
Retrospective analysis of 371,398 adults in the All of Us Research Program with EHR data (2018-2023), of whom 92,246 completed surveys on electronic smoking. OSD was defined by ICD-10 codes for dry eye disease (DED), tear-film insufficiency (TFI), meibomian gland dysfunction (MGD), blepharitis, conjunctivitis, keratitis, and corneal scars/opacities. Propensity matching on demographics, tobacco smoking frequency, and diabetes yielded 17,513 matched pairs of electronic smokers and controls. Chi-square tests evaluated differences in OSD prevalence; multivariable regression estimated adjusted odds ratios of OSD (aORs); ordinal models assessed frequency-dependent effects of electronic smoking.
Results
In our matched cohort (n = 35,026), electronic smokers had higher prevalences of MGD (22.4% vs 15.1%), TFI (18.7% vs 12.0%), and DED (29.8% vs 20.3%); all statistically significant (P<0.05). Multivariable regression showed greater odds of MGD (aOR: 1.28), TFI (aOR: 2.23), and DED (aOR: 1.67) in electronic smokers; all significant (P<0.05). Relative to controls, "Some Days" vape/e-cigarette users had higher odds of MGD (aOR: 1.21), TFI (aOR: 2.16), and DED (aOR: 1.28), while "Every Day" users had the highest odds (MGD aOR: 1.82; TFI aOR: 2.55; DED aOR: 1.92). All associations were significant (P<0.05), with a clear frequency-related trend (P-trend<0.05).
Conclusion
Electronic smoking was associated with greater odds of MGD, TFI, and DED, with daily users at greatest risk, suggesting progressive ocular surface damage. Clinicians should routinely ask about electronic smoking habits in social history, screen electronic smokers for OSD proactively, and counsel reduction or cessation to mitigate ocular morbidity.
Presenting Author
Zeenal G. Dabre, MBBS
Co-Authors
Christine Mun (MS), Sandeep Jain (MD), Kiera Byrne (None), Christian Kim (BSc)
Purpose
Ocular graft-versus-host disease (oGVHD) remains a significant complication following hematopoietic stem cell transplantation (HSCT), with current incidence ranging from 40% to 60%. The study aimed to determine whether initiating treatment during the window of opportunity, prior to a formal diagnosis of oGVHD, could preempt disease progression.
Methods
This retrospective study included 26 post-HSCT patients who presented to the UIC Dry Eye and oGVHD Clinic prior to meeting the ICCGVHD classification criteria for definite oGVHD. Treatment was initiated during "window of opportunity," defined by at least two of the following: (1) new-onset corneal staining, (2) conversion of MMP-9 from negative/faint positive to positive, (3) corneal epithelial thinning on anterior segment OCT, (4) inflammatory cell detected on in vivo confocal microscopy, (5) increased ocular symptoms. Patients were followed at 3-month intervals to assess for reversal or progression of ocular findings. Relevant clinical data were extracted from medical records.
Results
The median time of onset of ocular findings post-HSCT was 6 months. The earliest ocular manifestation was observed 2 months post-HSCT. Two additional early features of oGVHD were identified: (1) concurrent development of systemic GVHD (18/26, 69%), and (2) conjunctival involvement (8/26, 31%). Following initiation of therapy during the "window of opportunity", 69% (18/26) of patients showed reversal of ocular findings, and 27% (7/26) progressed to definite oGVHD, while 4% (1/26) showed neither progression nor improvement. Of the seven patients who progressed, five missed follow-up visits, one discontinued topical therapy, and one progressed despite regular follow-ups.
Conclusion
A short "window of opportunity" exists before the patient's progress to definite oGVHD. Initiating treatment during this period may prevent or even reverse ocular changes before they advance to irreversible ocular surface damage. However, a large-scale prospective trial is needed to confirm these findings.
Presenting Author
Matthew B. Weiss, BSc
Co-Authors
Jungah Huh (MD), Christopher Starr (MD), Jaffer Shah (None), Steven Abijmil (BA)
Purpose
To investigate clinical factors associated with abnormally increased corneal sensitivity measured by non-contact corneal esthesiometry (NCE) in patients with ocular surface discomfort by comparing those with hypersensitive corneas to patients with normal corneal sensitivity.
Methods
A retrospective chart review of patients with ocular surface symptoms who underwent NCE was conducted. Patients were grouped by corneal sensitivity status (high vs normal sensitivity) based on NCE thresholds. The dataset was tested for normality and homogeneity of variance. Clinical factors (age, sex, tear film metrics, comorbidities, etc.) were compared between groups using Wilcoxon t-tests for continuous variables, and Fisher's exact or Chi-square testing for categorical variables. Multivariable logistic regression determined independent predictors of increased corneal sensitivity, controlling for age, sex, and obesity status. A p-value < 0.05 was considered statistically significant.
Results
Out of 162 patients (342 eyes), 32.7% had corneal hypersensitivity as measured by NCE. In a multivariable regression analysis, younger age was significantly associated with corneal hypersensitivity (?=-0.024, p<0.001). Several ocular comorbidities were independent risk factors for hypersensitivity: patients with ocular rosacea (?=1.39, p<0.001), conjunctivochalasis (?=1.03, p=0.042), allergic conjunctivitis (?=0.65, p=0.015), or a history of eyelid surgery (?=0.83, p=0.025). Additionally, the presence of peripheral neuropathy was associated with increased corneal sensitivity (?=1.42, p=0.033), suggesting a possible neuropathic corneal pain component.
Conclusion
Corneal hypersensitivity was common in dry eye patients and strongly associated with younger age, ocular rosacea, conjunctivochalasis, allergic conjunctivitis, eyelid surgery, and peripheral neuropathy. This highlights the multifactorial nature of corneal hypersensitivity, and these factors can aid in early recognition of neuropathic corneal pain.
Presenting Author
Hannah Cho, BA
Co-Authors
Moonjung Choi (MD), Olivia Lee (MD)
Purpose
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions with high rates of ocular morbidity. Identifying predictors of acute severity, chronic complications, and poor visual outcomes may help guide earlier ophthalmology intervention.
Methods
Retrospective review of all acute SJS/TEN patients hospitalized at our institution's burn unit between 2016 to May 2025 and diagnosed with ocular involvement was performed. Demographics, time to ophthalmology consultation and treatment, culprit drug class, outside hospital (OSH) presentation, total body surface area (TBSA) involvement, and ocular history were collected. Ocular involvement was graded using the grading system proposed by Gregory et al (Ophthalmology 2016;123:1653- 1658). Outcomes included acute ocular severity and final vision. Associations were assessed using chi-square tests and t-tests.
Results
A total of 35 patients with ocular SJS/TEN were included. Of these, 26 had follow-up beyond the acute episode, and 92.3% developed chronic ocular involvement. At hospitalization, mean age was 38.2 years (SD 20.1), mean TBSA 26.2% (SD 26.3), and mean time to ophthalmology evaluation 5.3 days (SD 3.2). Severe acute ocular involvement occurred in 68.6% but was not associated with sex, age, culprit drug, OSH presentation, TBSA, or ocular history (all p > 0.05). Poor final vision occurred in 20.6%. Those with poor vision had greater TBSA involvement (42.9% vs. 19.5%, p ? 0.05) and trended toward longer delay to first amniotic membrane transplantation (24.0 vs. 6.8 days, p ? 0.07).
Conclusion
In this cohort, severe acute ocular involvement in SJS/TEN was not predicted by demographics, culprit drug, or TBSA involvement. Poor final vision was associated with higher TBSA and a trend toward delayed amniotic membrane intervention, highlighting the importance of the ophthalmologist's involvement and early intervention with membrane placement.
Presenting Author
Namrata Sharma, MD, FRCSEd, FRCOphth
Co-Authors
Aafreen Bari (MD), Tushar Agarwal (MD), Rajesh Sinha (MD, FRCS), Tanuj Dada (MD)
Purpose
To study the outcomes of minor salivary gland transplantation for severe dry eye disease secondary to chronic Steven Johnson Syndrome
Methods
An ambispective interventional case series was conducted at the Rajendra Prasad Centre for Ophthalmic Sciences, Delhi, India, between 2022 and 2023 to evaluate the outcomes of minor salivary gland transplantation, wherein the glands were anchored to the superior rectus muscle, in twenty patients with severe dry eye disease secondary to chronic Stevens-Johnson Syndrome. Preoperative clinical parameters were assessed and compared with findings at the 1-year postoperative follow-up.
Results
At the 1-year follow-up, significant improvements were observed in mean Schirmer-1 values (p = 0.0004), hyperemia scores (p = 0.0004), keratinization scores (p = 0.04), corneal epithelial defect scores (p = 0.0004), corneal opacification scores (p = 0.001), corneal neovascularization scores (p = 0.001), and palisades of Vogt scores (p = 0.007). Improvements were also noted in corneal keratinization (p = 0.04) and conjunctivalization scores (p = 0.08).
Conclusion
Minor salivary gland transplantation represents a viable therapeutic option for severe dry eye disease secondary to chronic Stevens-Johnson Syndrome, demonstrating clinical improvement in both corneal and conjunctival surface parameters.
