Alice Yang Zhang

The purpose of this study was to assess the impact of Stargardt disease (STGD) on activities of daily living and mental health, correlating patient-reported outcome (PRO) measures from the Michigan Retinal Degeneration (MRDQ) and Vision-Related Anxiety Questionnaires (MVAQs) with clinical data. Patients with STGD with biallelic pathogenic ABCA4 mutations were recruited from the University of North Carolina (UNC) at Chapel Hill and Foundation Fighting Blindness (FFB) databases. Participants completed MRDQ and MVAQ testing. Best-corrected visual acuity (BCVA), electroretinogram (ERG), and fundus autofluorescence (FAF) were retrospectively analyzed for UNC patients. Fifty participants (mean age = 48.8 ± 18.5) were included. Median θ for MRDQ: central vision (0.138), color vision (0.143), contrast sensitivity (0.122), and photosensitivity (0.185). Median MVAQ θ scores for cone- and rod-related anxiety were 0.005 and -0.055, respectively. The following additional analyses were performed using the UNC subset of participants (n = 12): BCVA correlated with contrast sensitivity (P = 0.027). Rod ERG response correlated with scotopic vision (P = 0.044). Central FAF lesion extent correlated with central vision (P = 0.039) and contrast sensitivity (P = 0.032). Rod-related anxiety correlated with rod ERG response (P = 0.048), color vision (P < 0.001), contrast sensitivity (P < 0.001), photopic peripheral vision (P < 0.001), cone-related anxiety (P < 0.001), photosensitivity (P = 0.014), mesopic peripheral vision (P < 0.001), and scotopic vision (P < 0.001). Cone-related anxiety correlated with color vision (P = 0.026), contrast sensitivity (P = 0.013), photopic peripheral vision (P < 0.001), mesopic peripheral vision (P < 0.001), and scotopic vision (P < 0.001). In patients with STGD, structural and functional measures correlated with reduced functional vision and increased vision-related anxiety per PRO criteria. These findings provide insight into patient-perceived disease burden and may help inform future STGD interventions.

This report describes the case of a school-aged male child with T-cell acute lymphoblastic leukemia who developed cytomegalovirus retinitis despite systemic antiviral therapy. The patient had a history of cytomegalovirus viremia that improved with intravenous foscarnet and oral maribavir; however, routine ophthalmic screening revealed new retinal whitening and hemorrhages in the right eye. Anterior chamber paracentesis confirmed intraocular cytomegalovirus DNA. Although systemic viral loads declined, the retinal lesions progressed toward the macula, prompting initiation of intravitreal foscarnet. Treatment was initiated with a 1.2 mg/0.05 mL injection under anesthesia, followed by 2.4 mg/0.1 mL injections administered twice weekly at the clinic. The regimen was well tolerated and resulted in stabilization and regression of retinitis without central involvement, with fundus photography demonstrating fading whitening and vascular sclerosis. This case highlights the importance of close ophthalmic monitoring in immunosuppressed pediatric patients with cytomegalovirus viremia and emphasizes intravitreal foscarnet as an effective adjunct when systemic therapy fails. Furthermore, it demonstrates the feasibility of administering multiple intravitreal injections in the pediatric population, underscoring the role of local antiviral delivery in preserving vision in cases of antiviral-resistant cytomegalovirus retinitis.

Purpose: To evaluate the diagnostic accuracy of GPT-4.o, Claude 3.7 Sonnet, and Gemini 2.5 Pro for real-world retinal cases. Methods: Forty retina cases from the University of Iowa’s EyeRounds repository were assessed under 2 conditions: (1) full clinical context (textual history, examination, and image descriptions); and (2) image-only (raw clinical images). Outputs were evaluated for diagnostic accuracy, symptom/sign recognition, differential diagnosis, and treatment recommendations. Cochran Q, McNemar test, analysis of variance, and Cohen kappa were used to make statistical comparisons. Results: In full-context cases, GPT-4.o achieved the highest diagnostic accuracy (78.4%), followed by Claude (73.0%) and Gemini (29.7%) ( P < .001). In image-only cases, Claude was superior (73.7%), outperforming GPT-4.o (63.2%) and Gemini (31.6%) ( P < .001). GPT-4.o was best at identifying signs/symptoms in full-context cases (64.0%), while Claude excelled in image-only cases (63.3%). GPT-4.o (42.9%) and Claude (37.0%) outperformed Gemini (25.9%) on differential diagnosis ( P ≤ .011). Claude showed superior treatment accuracy in image-only cases (61.1%), while GPT-4.o was superior in full-context cases (57.3%), and both outperformed Gemini (35.8%). GPT-4.o and Claude showed substantial agreement in image-based diagnoses (κ=0.658), while Gemini showed minimal agreement (κ≤0.196). Conclusions: GPT-4.o and Claude demonstrated strong diagnostic and clinical reasoning in retinal cases, with Claude excelling in image-based analysis and GPT-4.o in text-rich contexts. Gemini’s lower performance underscores the importance of careful model selection in clinical applications.

Background: This study aims to determine the prevalence of perceived unfairness in authorship inclusion and byline ordering, two common concerns in the literature on authorship, among a sample of the physician population at the University of North Carolina School of Medicine. Methods: We developed and distributed a survey among eight different departments at a large U.S. academic medical center, with questions pertaining to basic demographics, contributions to research, and perceptions of authorship inclusion and ordering on their publications. Responses were analyzed using chi-squared test for predictors of perceived author order misplacement or exclusion from authorship. Results: Out of 83 respondents (9.2% response rate) from eight clinical departments, 52% perceived unfair authorship ordering and 34% perceived unwarranted exclusion from a project. Perceived lower positioning of the author byline was reported to occur more commonly in the earlier stages of training (medical student and resident levels). The most common reasons for these occurrences were related to issues with communication. Conclusions: Difficulties around communication and the hierarchical nature of medical training contribute to the perceived unfairness of author ordering and authorship inclusion. Structured authorship agreements and education in publication ethics may reduce these perceived inequities.

Purpose: To provide a conceptual understanding of the continuous and discrete wavelet transforms (CWT, DWT) for clinical electroretinography (ERG) analysis, and how these methods uncover time–frequency features that complement traditional time-domain analysis. Methods: A technical overview without the use of mathematical formula describing the basics of CWT and DWT and implementation considerations. We also review an example of four standard ISCEV full-field ERG (ffERG) recordings from a healthy 32-year-old male. Results: Wavelet analysis uncovered time–frequency signatures absent in raw traces. In DA 0.01 cd s/m ² DWT scalogram, energy localized in the 2–5 Hz range, with CWT scalograms corroborating these findings. In DA 3.0 cd s/m ² , a broader frequency response is seen across 10, 20 and 40 Hz center frequencies. A similar progression was found in the LA 3.0 cd s/m ² , with additional low energy indices at 80 and 160 Hz. For the LA 30 Hz flicker, all frequency and time–frequency profiles effectively replicated the 30 Hz response of the cone system. Conclusions: CWT and DWT provide complementary and objective insight into ERG responses. Open-source MATLAB toolkit and step-by-step tutorial provided herein lower technical barriers and enable use by the broader community.

This case report presents a rare instance of neovascular glaucoma secondary to central retinal vein occlusion in a previously healthy man in his early 30s who exhibited acute unilateral vision loss, ocular pain, and elevated intraocular pressure. Ophthalmic imaging, including ultra-widefield fundus photography and optical coherence tomography, revealed retinal hemorrhages, intraretinal fluid, and iris neovascularization consistent with ischemic central retinal vein occlusion and secondary neovascular glaucoma. Notably, systemic evaluation revealed severe hyperlipidemia associated with the patient’s strict nonvegetarian diet, with no other identifiable risk factors. Treatment included intravitreal antivascular endothelial growth factor injections, Ahmed glaucoma valve implantation, and panretinal photocoagulation followed by pars plana vitrectomy. The patient experienced partial visual recovery after the initiation of lipid-lowering therapy and dietary counseling. This case underscores the importance of considering modifiable metabolic factors, particularly extreme dietary patterns, in young patients presenting with central retinal vein occlusion. It supports the incorporation of systemic lipid screening and dietary assessment into the diagnostic workup of atypical retinal vascular events. Although causality cannot be established, this case advocates the need for further investigation into the systemic implications of diet-related hyperlipidemia in ocular vascular disease.