SIGs are 90-minute informal, discussion-based meetings that focus on a specific question or issue (e.g., understanding a technique, new technological advances, exploring controversial issues, etc.). Session proposals were submitted through the abstract process and selected by the Annual Meeting Program Committee.
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Thursday, May 11 - recordings available
Reaching consensus on clinical and histological nomenclature for the specific lesions of early age-related macular degeneration
Tuesday, June 13 - recordings available
PRPH2-related retinal disease: A discussion of current clinical observations and basic science towards the development of effective therapies
Thursday, June 29 - recordings available
Current progress and future of human stem cell derived retinal ganglion cells for studying neurodegeneration mechanisms, developing neuroprotection and cell replacement therapy for optic neuropathies
Exploring the contribution of ARMS2 and HTRA1 genetic risk factors in age-related macular degeneration
Tuesday, Sept. 12 - recordings available
Aging, the eye, and the brain: Considerations on the pathophysiology of major conditions and the development of neuroprotective therapies
Thursday, Sept. 28 - recordings available
Challenges in developing FDA recognized standards for gene validity and variant interpretation for inherited eye diseases
Corneal endothelial cells and microenvironment in aqueous humor: the connection in Fuchs endothelial corneal dystrophy and bullous keratopathy
- Reaching consensus on clinical and histological nomenclature for the specific lesions of early age-related macular degeneration
Mitchell Lee, Svetlana Cherepanoff (Moderator), Christine Curcio, Cheryl Au, Jennifer Arnold
The fields of AMD histopathology and AMD clinical research are progressing rapidly. The advent of retinal multimodal imaging has allowed identification of a wide range of AMD-associated lesions not previously described clinically or histologically. A less fortunate result of this progress has been the decoupling of nomenclature between the disciplines of clinical ophthalmology and ocular histopathology. In general terms the clinical definitions of drusen and other AMD lesions are size and appearance based, while the histological definitions are content and context based. There is significant overlap and divergence in the use of terminology between the disciplines, breeding confusion, and making clinicopathological correlation more challenging.
The introduction of consensus nomenclature for clinical and histopathological lesions in AMD is critical to optimising epidemiological studies, clinical trials, translational research, and basic research. This panel aims to develop this consensus, with the goal of achieving shared terminology where there is clinical and histological agreement, as well as distinct terminology for clinically-defined lesions and histologically-defined lesions.
- Secondary glaucoma: Molecular mechanisms of disease
Richard Lee (Moderator), Ursula Schlötzer-Schrehardt, Louis Pasquale, Tin Aung and Fiona McDonnell
Pseudoexfoliative (PEXG) and pigmentary glaucoma (PG) are relatively common causes of secondary glaucoma. With a growing working-age population, patients' livelihood and quality of life depend on optimal disease management and vision preservation. Currently, PEXG and PG are treated similarly to primary open angle glaucoma, with no disease-specific therapies available. The emerging molecular landscape of PEXG and PG is complex. From metabolomics in PEXG to melanocyte biology in PG, this program will explore the key players driving these two unique conditions with the goal of painting a clear picture of their pathogenesis. Our broad question is whether there's a possible interplay between secondary glaucoma and other conditions and/or common pharmacological agents. We hope that a better understanding of these processes will guide the development of future therapeutics. Our distinguished panelists include Dr. Richard Lee of the Bascom Palmer Eye Institute, Dr. Ursula Schlötzer-Schrehardt of the University of Erlangen-Nürnberg, Dr. Louis Pasquale of the New York Eye and Ear Infirmary, Dr. Tin Aung of the Singapore National Eye Centre, and Dr. Fiona McDonnell of the University of Utah.
- Uveitis registries: A digital tool for patient care, education, research and collaboration
Rupesh Agrawal (Moderator) — OASIS registry: A web-based platform
Robert Finger — TOFU-registry: Involving patients into data collection – the TOFU patient module
Vishali Gupta (Moderator) — Application of registry in real life settings: 10-year follow up and outcome data for patients with uveitis
Development of registries as a prototype model: Registries offer several promising strategies to address challenges in the field of uveitis ( and similar other entities). Most significantly, by achieving large sample sizes of rare uveitis subsets, we can advance our knowledge of these conditions through observational epidemiological research (of outcomes, risk factors, etc.), AI research, and involving patients (via PROMs) in the generation of evidence and treatment decisions.
Application of registry in real-world settings: Application of the registry as a tool that enhances and possibly simplifies uveitis management, like a medical record system for uveitis that uses AI- and literature-derived feedback to add value to uveitis clinicians, motivating them to use the system for the value added. That would be a way of making it a big study without funding since the system would have value itself.
Art of Collaboration: Through this SIG, the roadmap to collaboration among the researchers would be discussed. Collaboration would further amplify the value of the method to enhance the clinical management of this heterogeneous group of rare disease entities.
- Clinical applications of ultrawide-field OCT
David Huang (Moderator), Yifan Jian (Moderator), Benjamin Vakoc, Min Wang, Paulo-Eduardo Stanga
The speed of OCT has been increasing steadily since its invention and is now sufficient to support explorations of ultrawide-field fundus imaging applications in retinal diseases. Swept-source OCT is particularly suitable for ultrawide-field imaging because of its deep range. Technologies that are capable of high speed and deep range include Fourier-domain mode-locking (including frequency-comb), short-cavity, vertical cavity, and akinetic tuning. Potential applications include retinal vascular diseases (e.g. diabetic retinopathy, retinopathy of prematurity, vein occlusions), tumors (choroidal melanoma, retinoblastoma), and peripheral retinal pathologies (nonperfusion, neovascularization, holes, tears, retinoschisis). This panel will discuss the state of the technology and the results of early clinical studies.
- Making Ocular Biomarkers Count: Validity and Standardization
Marlies Gijs, Sarah Hamm-Alvarez, Ashok Sharma, Swati Gupta, Virginia Calder
Rachel Redfern, Penny Asbell, Katherine Held
Ocular biomarkers may provide the pathway to improved understanding of mechanisms, classification, determination of disease severity, response to treatment and/or new targets for treatment, but the small volume samples (tears, aqueous, vitreous, cells etc.) present difficulties in analysis methodologies.Ways to validate, harmonize all aspects of processing small volume eye samples and maximize information generated are needed so that results can be interpreted from research done all over the world. Key questions for discussion include: challenges to tear analysis, ways to standardize ocular fluid analysis, ocular markers for systemic diseases, proteomic methods for small volume samples, and key issues in sensitivity and reproducibility in biomarker discovery. The purpose of the SIG is to have a methods-focused panel discussion, with the goal of identifying potential standardized methods for small-volume sample processing. Minimally invasive objective analysis of ocular samples may provide key metrics for research and patient care. With careful attention to analysis methods of potential ocular biomarkers, vision researchers will add to precision medicine going forward
- Suprachoroidal drug delivery for uveitis and retinal diseases–Clinical Practice and Future Directions
Thomas Ciulla, Parisa Emami-Naeini, Marc de Smet
Suprachoroidal drug space delivery, which represents an alternative to intravitreal therapy, offers the potential for efficacy, safety, and durability, given the favorable pharmacokinetics of medication delivered in this unique potential space. This ARVO SIG offering will provide a comprehensive perspective on this burgeoning technique and will include basic / translational sciences perspectives of the pharmacokinetics of SCS drug delivery, phase 2 and phase 3 study on SCS drug delivery for macular degeneration, diabetes, and uveitis. This SIG will also include a panel discussion of how SCS drug delivery may play a role in our therapeutic armamentarium for medications to improve the lives of patients with uveitis, retinal disease, and posterior segment diseases in the future.
— Pharmacokinetics of suprachoroidal drug delivery: Translation from the lab to the clinic
— Efficacy and safety of suprachoroidal triamcinolone acetonide for macular edema due to noninfectious uveitis
— Suprachoroidal drug delivery technology: Future directions in technology and disease indication
— Point-Counterpoint: SCS drug delivery is the wave of the future vs. Boutique drug delivery technique.
- Big data in retina research: Data standards, interoperability, analytics, and applications
Durga Borkar (Moderator), Cindy Cai (Moderator), Thomas Hwang, Aaron Lee, Zhongdi Chu
Big data research in the field of retina has exploded in recent years due to the digitization of healthcare and advancements in analytic methodologies. The Data, Information, Knowledge, and Wisdom (DIKW) Model provides a theoretical framework for defining the steps important for retina informatics. However, many challenges still exist in big data research in each of these domains. Data standards and the use of common data models to aggregate data are underdeveloped for retina research. In the realm of analytics, artificial intelligence models lack transparency. Finally, challenges still exist in how big data are converted to wisdom and implemented to provide value to a health care system.
This SIG will convene a panel of experts from across the spectrum of big data research in retina, from data standards, data interoperability, algorithm development, and application. Specifically, the panel will discuss the current state in each of these realms and engage in a conversation with the broader audience on the biggest needs and areas for development. The SIG will also provide an open forum for interdisciplinary discussion on future directions and most pressing research priorities.
- Leveraging single cell data to improve ocular therapy outcomes
Karthik Shekhar — The conservation of human retinal cell types in animal models
Revathi Balasubramanian — Single cell RNA seq of aqueous humor outflow tissues and congenital glaucoma
Milica Margeta — Microglial transcriptional signatures in retinal development and disease
Xin Duan — Translating single-cell RNA-Seq Profiling to a retina neuron connectivity map
Moderator: Petr Baranov — Leveraging single cell data to improve the outcome of stem-cell-derived retinal ganglion cell transplantation
The development of the single-cell RNA sequencing methods together with multi-omics, electrophysiological, imaging and computational approaches have created unprecedented opportunities to understand the molecular heterogeneity of ocular and extraocular tissues. We are now able to reconstruct development, disease pathogenesis and aging in the eye at a remarkable spatial and temporal resolution. In this SIG the speakers present cases on how scRNA seq led to an improved understanding of ocular tissues and their development and pathophysiology, and how this information could be leveraged to identify novel targets, better therapies or co-treatments. We also discuss novel tools, databases, techniques and resources available to address specific research questions.
- Teleophthalmology: Real-world experiences and challenges
Glenn Yiu, Sally Baxter, Yao Liu, Bobeck Modjtahedi, Adrienne Scott
Use of teleophthalmology for eye care delivery and screening has surged in recent years due to advances in imaging devices, clinical informatics, artificial intelligence, and remote work technologies. Ocular telehealth can reduce health disparities by expanding eye care access to underserved communities, and reduce blindness by enabling earlier detection of sight-threatening ocular diseases. The COVID19 pandemic has further increased awareness and need for remote eye care. Yet, wide adoption of teleophthalmology has been limited by logistic, technical, and financial barriers.
This SIG will discuss new advances and challenges in teleophthalmology. Our experts have successfully implemented teleophthalmology programs across different healthcare systems and practice settings, with focus on different diseases including glaucoma, diabetic, and sickle-cell retinopathy. Each panelist has unique real-world insights on health access, workflow logistics, clinical informatics, predictive models, and financial sustainability. We hope to share our experiences, provide guidance on overcoming barriers, and encourage participants to exchange insights to make teleophthalmology more widely accessible.
Tuesday, June 13
- Intraocular immune response in human uveitis: New perspectives and future directions
Soumyava Basu (Moderator), Lynn Hassman (Moderator), James Walsh, Shilpa Kodati, Colin Chu
Our understanding of the pathomechanisms of human uveitis is primarily derived from studies in animal models of uveitis. While providing significant mechanistic insights, these models do not replicate some of the fundamental characteristics of human uveitis. Immunological data from human uveitis has largely been constrained by the limited access to ocular tissue samples from uveitis patients and the relative lack of tools to meaningfully analyze the available samples.
We propose a panel discussion on the intraocular immune response in human uveitis covering the following points:
1. Fundamental differences between human uveitis and animal models
2. Value of historical data from histopathological studies in uveitis
3. Challenges (real and perceived) in sample collection in human uveitis
4. Differences between blood and ocular fluid samples from uveitis patients
5. Recent approaches to analysis of human uveitis samples – flow cytometry and single cell RNA sequencing
6. Combining human and animal data to generate new perspectives
The discussion will be curated to cover these points sequentially for the benefit of the general audience.
- Leveraging high-throughput screening advances for therapeutic breakthroughs in vision research
Keith Luhrs — HTS in ophthalmology: Concepts, design, and considerations
John Hulleman — New HTS-enabling technologies using protein complementation
Ruchi Sharma — High-throughput screening in iPSC-derived RPE to identify new AMD drugs
The identification of new small molecule or gene-based therapeutics for diseases such as age-related macular degeneration (AMD) is a top priority in vision science. To accomplish this goal, high-throughput screening (HTS) can be employed to unbiasedly survey thousands (or millions) of compounds at the biochemical, cellular, or organismal level. However, due to the scale of HTS and its financial investment, screening requires careful planning, assay identification, development, optimization, and interpretation.
In this session, experts from academia (Hulleman), government (Sharma), and industry (Luhrs) will cover:
1. Conceptual design to generate models with disease relevance (appropriate cells, insults/stimuli, endpoints). How to balance model complexity with practicality. Challenges and opportunities in small molecule, siRNA, and CRISPR screens.
2. New advances in targeted HTS by endogenously labeling proteins of interest using luciferase and fluorophore-based protein complementation.
3. Application of induced pluripotent stem cell-derived RPE cells as AMD HTS models. Use of machine learning models and artificial intelligence to perform next-generation screening.
- Role of the glycocalyx in ocular health and disease
Hannes Buelow — Glycans in neural patterning
Patricia D'Amore — The endothelial glycocalyx
Pablo Argueso — Glycans in corneal biology
Vivien Coulson-Thomas, Norman Harris
The surfaces of eukaryotic cells are covered with a dense layer of glycoproteins, glycolipids and proteoglycans that make up the glycocalyx. The overall goal of this SIG is to bring the cutting-edge research that has been done in glycobiology to the field of ophthalmology. This SIG will include basic and translational research with focus on ocular pathologies and therapeutic approaches. The SIG will feature cross-sectional talks and discussion on the structure and function of the glycocalyx in different compartments of the eye and their relevance to infection, wound healing, vascular disease, and regenerative medicine.
Overall, we aim to discuss the following topics:
1. New trends in glycobiology.
2. Cutting edge developments in the structure and function of the glycocalyx.
3. Relevance of the glycocalyx to ocular pathology and identification of potential areas where research is warranted.
4. Discussion of emerging therapies targeting the glycocalyx for treating ocular disease.
- Oculomics and cardiovascular disease
Carol Cheung — A deep learning system for retinal vessel caliber measurement in cardiovascular disease risk assessment
Charles Guenancia — Actual clinical workflow: Do we need new cardiovascular assessment tool, the cardiologist point of view
Pearse Keane — The AlzEye study: Going from the eye to the body in the age of oculomics
Daniel Clauw — Neuroimaging as a tool to understand visual discomfort and ocular pain in fibromyalgia
The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple, noninvasive, and can provide in vivo information of the microstructure and vascular health. For more than 10 years, research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT-angiography) and to provide a description of the geometric characteristics of its vessels components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called “oculomics” using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. This SIG is intended to summarize the state of the art in oculomics and cardiovascular disease research.
- PRPH2-related retinal disease: A discussion of current clinical observations and basic science towards the development of effective therapies
Andrew Webster, David Birch, Muna Naash, Andrew Goldberg, Jose Sahel
Radha Ayyagari, Stephen Daiger
The PRPH2 gene (previously retinal degeneration slow-RDS) was the second gene found to be causative of inherited retinal degeneration in humans (Dryja, Humphries Nature 1991; PMIDs:1684223,1749427). It segregates, almost exclusively, as a dominant form of blindness and is one of the most prevalent causes of inherited blindness in most clinics. Disappointingly, there are no proven preventative measures. The gene expresses a transmembrane protein component of the photoreceptor outer-segment discs in vertebrates, and mutation, or haploinsufficiency in humans, causes a spectrum of retinal degeneration. The variability of disease between families correlates to a degree with the specific mutation, but variability exists in those with identical genotypes suggesting cis-acting and/or trans-acting, genetic and/or environmental modifying factors. Recent advances in the understanding of the molecular and cellular biology of the PRPH2-protein, and of technologies in the generation of pertinent animal models and gene-editing, brings closer the hope of translation into therapies. Here we combine clinical and basic-science expertise to discuss the best strategies for effective future treatments.
- Viral tools for studying visual circuit connectivity and functions across animal models
Martin Bohlen (Moderator) — Illuminating the structure and function of the retinotectal circuit in rodents and primates
Karl Farrow — Transsynaptic viral tracing strategies and the collicular circuits mediating innate behaviors
Mike Hasse — An opto-tagging approach to studying cortical projections from macaque V1
Studies over the last several decades have provided enormous insights about our vision and its pathologies. This was made possible by breakthroughs in virus engineering and technologies for measuring neural activity, which have allowed precise targeting of cell types for studying their connectivity and functions in the context of natural vision. These techniques have also allowed identifying genes and metabolic factors associated with onset and progression of diseases impacting vision. However, many of these tools have traditionally been developed in rodents, and are unavailable for other animals higher up the evolutionary tree, especially primates. Understanding the similarities and differences between different animal models, pertaining to their brain structures, genetic makeup, and immune responses, is key for refining these tools for both empirical research and developing gene therapies for eye diseases. This SIG is aimed at initiating a conversation about the latest developments in viral tools for studying visual circuits, and generalizability across rodents and non-human primates.
- Advancing ocular data standards within the OMOP Common Data Model
Sally Baxter (Moderator), Kerry Goetz, Michelle Hribar, Clair Blacketer
Observational data collected in the electronic health record (EHR) during clinical care has potential for reuse in research, quality measure calculation and patient and population level predictive models and artificial intelligence algorithms. This reuse has been limited in vision research, however, by a lack of standardization of ocular data collected during clinical care. During the past year, there have been multiple efforts to address the gaps in ocular data standards; this SIG will be focused on standardizing ocular data for the Observation Health Data Sciences and Informatics (OHDSI) Observational Medical Outcomes Partnership (OMOP) Common Data Model.
This SIG will convene a panel of experts in the OMOP Common Data Model in vision science. Panelists will describe OMOP, the current state of standardization of ophthalmic data within OMOP, solicit feedback about newly developed standards and use cases, and encourage participation and engagement from the community in ongoing standardization efforts.
- Novel retinal findings in mitochondria health and disease
Vera Bonilha — Overview
Deborah Ferrington — Proteomics findings of the mitochondria of RPE in AMD donors
Baerbel Rohrer — Anaphylatoxin receptor signaling (intracellular and extracellular) in mitochondrial metabolism and dynamics under AMD-associated stress condition
Cristina Kenney — The retrograde signaling system (mitochondria to nuclei) using the transmitochondrial cybrid model
James Hurley — Metabolic activities between mitochondria in the retina and RPE
The selected panel of experts will provide a brief review and oral presentation of novel data on the pivotal function of mitochondria in retinal health and disease. The SIG will start with a review of the retinal cell-specific metabolic differences and how the metabolic interdependence of each retinal cell type creates a unique ecosystem. Next, the proteomic profiling of the mitochondria of RPE cells from donors with AMD will be provided to discuss novel insights into the pathology of the disease. We will continue by discussing the role of the extracellular C5aR signaling on mitochondrial fission/fusion and the role of intracellular C3aR in mitochondrial calcium handling and respiration. Lastly, the mitochondrial retrograde signaling system in regulating the expression of nuclear genes using the transmitochondrial cybrid model will be discussed. We expect the presented data and review to provide the basis for an exciting discussion to further our understanding of the role of mitochondria in the retina in health and disease.
- Single cell atlas of the human eye
Rui Chen — Single cell atlas of the human retina
Joshua Sanes — The cell types of the human eye
Ayellet Segre — Integrative analysis of single-cell genomics and application for disease
Single cell genomic technologies are revolutionizing basic and translational research in many medical fields, including ophthalmology. In this SIG, we will discuss advances in the use of single cell and single nuclei RNAseq, ATACseq, and spatial technologies to construct the first single cell atlas of the human eye as part of the human cell atlas (HCA) effort. Topics covered will include identification and characterization of cell types from all parts of the human eye, including cornea, trabecular meshwork/Schlemm’s canal, iris, ciliary body, lens, retina, RPE/choroid, sclera, optic nerve head, and optic nerve. Progress in generating a single cell spatial atlas will also be presented. To facilitate the access of the data source by the community, information of the database and interactive cell atlas browsers will be discussed. Discussion topics will also include the roadmap of further developing the next version of single cell reference atlas for the human eye.
Thursday, June 29
- Fibrosis in neovascular AMD: Current knowledge, imaging, diagnosis, clinical impact and therapy
Eric Souied — Imaging fibrosis
Usha Chakravarthy — Clinical impact of fibrosis
Marion Munk — Optimizing current treatment regimens and potential treatments on the horizon
Christine Curcio, Alexandra Miere
Currently available anti VEGF treatment in neovascular AMD (nAMD) act anti-permeable, but does not prevent complications such as fibrosis, EMT and atrophy. After initial improvement, well treated patients are therefore confronted with vision decline, despite optimized treatment. Early identification of fibrosis is of uppermost importance. Nowadays, OCT is the main image modality in nAMD, but no standardized definition of fibrosis is available. Also, no homogenous characterization of predictive biomarkers such as SHRM are available and identification is often challenging. New advancements such as multispectral imaging, PS-OCT aid to the OCT and facilitate to identify fibrosis and precursor lesions. With this rapid advancement comes the need of a common understanding and a standardized assessment of fibrosis and predictive morphological markers.
This SIG will discuss assessment of fibrosis and morphological biomarkers on different image modalities, based on the newest insights.
It will explore the pathological pathway and the clinical impact of fibrosis in nAMD. The optimization of treatment with current available therapy and new potential treatment options will be discussed too.
- Ophthalmic trauma: Principles, challenges and enhancing outcomes
Sundaram Natarajan (Moderator) — Gaps in the ophthalmic trauma literature and lack of guidelines
Rupesh Agrawal (Moderator) — Ophthalmic trauma registry: IGATES
Gangadhara Sundar — Why Ophthalmic trauma and not ocular trauma: Role of lid, adnexa and orbit in ophthalmic trauma
Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The epidemiology of ophthalmic trauma varies depending on geographic location, socio-economic status, age, occupation, and cultural practices. Ophthalmic trauma is ubiquitous and often managed by emergency room physicians, on-call residents in training, and only complex and residual morbidity managed by the experienced subspecialist. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. The development of an international data repository for ophthalmic trauma will help facilitate a succinct view of epidemiology and outcomes internationally, with specific value to developing countries for whom less published data is available. While individual institutions and research collaborations have evaluated different therapeutic modalities for these injuries, controversies around practice patterns and standards of care persist. This course, which brings together international experts will highlight the value of an ophthalmic trauma registry and variations in principles for the management of ophthalmic trauma.
- Viral strategies for retinal circuit mapping and visual restoration
Greg Field, Maureen Neitz, Florentina Soto, Keisuke Yonehara
Yongling Zhu, Xin Duan (Speaker)
Over the last decade, viral vectors have emerged as highly promising tools for the delivery of genetic material in basic and translational research. Advances in viral vector design and use have placed them at the frontier for both gene therapy and basic vision research. In this session, five panelists will guide the discussion of the development and use of viral approaches for visual restoration and circuit mapping.
Dr. Soto will discuss the use of AAVs to modify in vivo expression of cell adhesion molecules for synapse formation and retinal degeneration, and Dr. Neitz will address the challenges in treating vision disorders with genes targeted to the cones. Dr. Field will discuss the use of viruses to identify where and how RGC signals converge in the brain. AAV and glycoprotein-deleted rabies virus have been used in the CNS for circuit mapping. Dr. Duan will discuss a newly engineered virus-based anterograde transsynaptic tracer for studying retina circuit wiring during development and rewiring subject to neuronal repair. Dr. Yonehara will talk about using genetically modified rabies virus to link the structure and activity of direction-selective circuits in the retina.
- Current progress and future of human stem cell derived retinal ganglion cells for studying neurodegeneration mechanisms, developing neuroprotection and cell replacement therapy for optic neuropathies
Arupratan Das, Jason Meyer, Iqbal Ahmad, Thomas Reh, Petr Baranov
Retinal ganglion cell (RGC) degeneration is the root cause for optic neuropathies with very little therapy options. This SIG will present an overview of latest advancements and path forward in the areas of neuroprotection and cell replacement therapies for optic neuropathies using RGCs derived from human pluripotent stem cells. Areas of emphasis will include the use of these RGCs for investigating mechanisms of cell death in glaucoma and for in vitro modeling of retinal development. Additionally, discussions will center around their translational use for disease modeling and pharmacological screening, including those cells derived from patient samples as well as the use of CRISPR/Cas9 gene editing strategies to develop disease models or isogenic controls. Further conversations will discuss the use of these retinal ganglion cells for cellular replacement, including current obstacles to the successful implementation of pluripotent stem cell-derived retinal ganglion cells for this application.
- Lipids in retinal health
Dorota Skowronska-Krawczyk — PUFA homeostasis in aging eye
Jean-Sébastien Joyal — Metabolic reprogramming of the neovascular niche governs the transition from pathological to physiological angiogenesis in proliferative retinopathy
Julia Busik — Cholesterol crystal formation and diabetic retinopathys
Lois Smith — Essential fatty acids in the retina-preclinical and clinical studiess
Timothy Hla — Sphingosine 1-phosphate (S1P) signaling in retinal vasculature
Photoreceptor outer segment membranes are highly enriched in lipids, especially in docosahexaenoic acid (DHA 22:6n3, 15.3%), arachidonic acid (AA 20:4n6, 11%), palmitic acid (16:0, 20.8%), stearic acid (18:0, 20.1%), and oleic acid (18:1n9, 13.8%). However, the role of lipids in retinal health is not well understood. Diets rich in DHA delay progression of geographic atrophy and may exert neurovascular protective impacts on the retina in patients from premature infants to the senior adults. Recently, lipids are also found to serve as energy fuel for photoreceptors. Disturbance of lipid uptake into the retina causes fuel deficiency and induce pathological subretinal neovascularization. In this panel, we will discuss the current understanding of retinal lipid biology including lipid alteration with aging, lipid catabolism and metabolic consumption, as well as clinical intervention.
- New technologies and challenges in EV research: Isolation, characterization, and development of stem cell-derived EV therapeutics
Mikael Klingeborn — New technologies for isolating EV, quantification, and analysis of EV therapeutics
Jennifer Jones — Multiplex and multidimensional EV analyses
Miguel Flores-Bellver — Stem cell-derived EV: biological properties and potentials for ocular biomarkers and therapeutics
Sun Young Lee, Fiona McDonnell
Extracellular vesicles (EVs) are small cargo-bearing vesicles released by cells in the extracellular space. Since the conceptual changes in the role of EV from the cellular disposal system to cell-to-cell communication mechanism, EV research has rapidly grown within mechanistic studies in healthy and diseased eyes and translational vision research developing novel diagnostics and therapeutics. EV isolation and characterization are imperative in EV research. However, they remain key challenges lacking standardization. Specific topics that three speakers will present are as follows: 1) new technologies for isolating EV, quantification, and analysis of EV therapeutics, 2) multiplex and multidimensional EV analyses, and 3) biological properties and potentials for ocular therapeutics of stem cell-derived EV. The SIG includes a diverse range of speakers and panels from institutions and organizations, focusing on the latest developments in the field fostering active discussion followed by each speakers presentations.
- Exploring the contribution of ARMS2 and HTRA1 genetic risk factors in age-related macular degeneration
Takeshi Iwata (Moderator), Radha Ayyagari (Moderator), Yingbin Fu, Paul Baird, Margaret DeAngelis, Brandi Williams
Age-related macular degeneration (AMD) is the leading cause of severe irreversible central vision loss in individuals over 65 years old. Genome-wide association studies have shown that the region at chromosome 10q26, where ARMS2/LOC387715 and HTRA1 genes are located, represents one of the strongest associated loci for AMD. However, the mechanism underlying the contribution of this locus to AMD pathology has remained elusive and, in some case, controversial.
In this SIG, we will extensively discuss based on the literature published by panelists and others regarding the ARMS2/HTRA1 risk alleles and their functional significance.
We will discuss the presumed function of ARMS2 mRNA/protein and the molecular processes of the HTRA1 protein in AMD pathogenesis in vitro and in vivo, including those of mice models of HtrA1/HTRA1, which developed Bruch’s membrane damage, choroidal neovascularization, and polypoidal choroidal vasculopathy, similar to human AMD patients.
The elucidation of the molecular mechanisms of the ARMS2 and HTRA1 susceptibility loci has begun to untangle the complex biological pathways underlying AMD pathophysiology.
- Glaucoma informatics and artificial intelligence: Data, development, and deployment
Sophia Wang, Michael Boland, Felipe Medeiros, Brian Stagg, Nicolas Jaccard
Advances in informatics and artificial intelligence (AI) coupled with the rise of electronic health records (EHRs) has enabled an explosion in glaucoma informatics and AI research for predicting glaucoma outcomes, improving risk stratification, and enhancing patient care. Challenges of this research can be broadly categorized across the three main “life stages” of predictive algorithms: 1) data inputs and standards, 2) developing algorithms with data from multiple modalities (structured EHR, imaging, and text), and 3) deployment into clinical decision support tools. These represent critical areas around which the community of glaucoma informatics and AI researchers can coalesce, discuss future directions and priorities, and share their experiences and solutions.
The SIG will convene glaucoma, informatics, and AI experts to engage the vision research comunity in discussing the current state of data standards for glaucoma informatics research, algorithm development using EHR structured data, free-text data, and imaging data, and deployment of glaucoma decision support tools. Panelists will also engage the audience to discuss areas of opportunity for improvement and future research.
Tuesday, Sept. 12 - recordings available
- Adaptive optics imaging of inherited retinal diseases: opportunities and challenges
Kiyoko Gocho, Danial Roshandel, Jessica Morgan, Katarina Stingl, Jacque Duncan
Inherited retinal diseases (IRDs) comprise a heterogeneous group of genetic disorders affecting the retina. Caused by mutations in over 280 genes, IRDs result in visual impairment due to dysfunction and degeneration of photoreceptors, retinal pigment epithelium, or the choroid. IRDs have an estimated incidence of 1:3500 in the global population, and they are the leading cause of blindness at young age.
Advances in retinal imaging include the introduction of adaptive optics (AO), a high-resolution imaging technique derived from astrophysics, which, for the first time, enables the in-vivo visualisation of individual cells in the patients’ retinas. Given that the primary cell types affected in IRD patients are photoreceptors, AO-based retinal imaging provides a vital tool for shedding light on cellular pathogenesis, disease progression, and its clinical correlation. However, its translation from the research environment to the clinical practice is under progress. The objective of this SIG is to discuss the current opportunities and challenges for early diagnosis, detection of subclinical changes, patient stratification for treatment, and assessment of IRDs progression using AO imaging.
- Mathematical and computational ophthalmology
Philip Luthert — The limits of experimental & clinical approaches to ophthalmology
David Crabb — Computational ophthalmology (AI)
Paul Roberts — Mathematical ophthalmology (Mechanistic Modelling)
This SIG will serve three purposes: 1) to bring together quantitative/biomedical scientists & clinicians using quantitative methods in ophthalmology; 2) to summarise the current state of affairs; 3) to clarify future directions & foster new collaborations.
— Discussion Topic 1: Problems in ophthalmology that can be addressed by Mathematical & Computational approaches (Moderator: Luthert)
— Discussion Topic 2: Availability of experimental, biomedical & clinical data for use in modelling (Moderator: Crabb)
— Discussion Topic 3: Combining mathematical (mechanistic) & computational (AI) approaches (Moderator: Roberts)
Future Directions & Close (Roberts, Crabb & Luthert)
- The role of the microbiome in ocular diseases
Martin Zinkernagel (Moderator), Denise Zysset, Dimitra Skondra (Moderator), Stephanie Ganal-Vonarburg, Elio Herzog
Our body is home to trillions of microorganisms that have direct and indirect impact on health and disease. The gut harbors the largest community of microbes but there are many more niches including the ocular surface. The gut microbiome has been shown to be integral to digestion of food and contribute to a substantial portion of the variation in metabolites such as blood lipids. Alterations in the gut microbiome have been associated with cardiovascular disease, atherosclerosis, age related macular degeneration, retinal artery occlusion and inflammatory eye disease. Furthermore, recent data has shown that the ocular surface microbiome is implicated in various diseases ranging from dry eye disease to keratitis. This special interest group will discuss various aspects of the human microbiome and the impact on ocular health and disease. Furthermore, because many different bioinformatic pipelines are used to analyze the microbiome, possible means to standardize analysis of data will be discussed.
- Electroretinography: Current use, future needs and new developments
Dorothy Thompson — ERG clinical research in children
Jan Kremers (Moderator) — Diagnostics of inherited retina diseases with ERG that describe photoreceptor and visual pathway signals
Katarina Stingl (Moderator) — New protocols for ERG: A tool for clinical trials
Electroretinography (ERG) is an objective method for evaluation of the function of retinal cells. Applications of electroretinography range
from rare eye diseases to pediatric ophthalmology and medical retina diagnostics. The SIG presents discusses needs in the clinical ERG research.
- Full-field OCT techniques for in-vivo retinal imaging in both clinical and research applications
Pedro Mecê, Rainer Leitgeb, Gereon Hüttmann, Maciej Wojtkowski (Moderator), Michel Paques
Full-field OCT (FFOCT) describes a group of imaging techniques that allow simple systems to be designed without the need for scanning devices. Unlike conventional point-scan OCT, FFOCT uses flood-illumination and a 2D megapixel camera to record light backscattered from the retina. Such a detection scheme leads to the fastest realization of en-face OCT, potentializing high-speed acquisition of retinal volumes. Another important asset of FFOCT is its intrinsic phase stability in the en-face plane, making it particularly attractive for phase-sensitive extensions of OCT, including optoretinography, quantitative OCT angiography, dynamic OCT or digital correction of ocular aberrations. Furthermore, under spatially incoherent illumination, FFOCT resolution has been shown to be less sensitive to ocular aberrations, not requiring complex hardware or software to achieve cellular resolution. In this SIG, a panel of leading FFOCT scientists will discuss new technological advances in FFOCT, the impact and future of this imaging technique on in vivo retinal imaging in clinical and research applications, and the remaining challenges for clinical transfer and commercial deployment.
- Vitreous hyalocytes and vitreo-retinal interface diseases
Stefaniya Boneva — Transcriptomics and proteomics of human vitreous and hyalocytes in vitreo-retinal interface disease
Richard Rosen — Clinical imaging of hyalocytes at the human vitreo-retinal interface
Koen van Overdam (Moderator) — New insights into the pathophysiology, therapy, and prevention of proliferative vitreo-retinopathy
Clemens Lange, J. Sebag
The vitreous body is a complex organ, whose composition and biology change significantly during development, aging, and with disease. Abnormal molecular organization, vitreoschisis with cell proliferation at the vitreo-retinal interface, and vitreo-retinal traction are fundamental components of a number of vitreo-retinal diseases, including vision degrading myodesopsia, proliferative diabetic vitreo-retinopathy (PDVR), various vitreo-maculopathies, and proliferative vitreo-retinopathy (PVR). Hyalocytes play a key role in the pathophysiology of vitreo-retinal interface diseases, especially PDVR and PVR. This SIG session will bring together experts in vitreous biology, pharmacotherapy, and surgery to discuss new insights into vitreous molecular composition, hyalocyte biology and pathology, and age-related changes. Enhanced imaging for clinical evaluation of vitreous and the vitreo-retinal interface will be highlighted. New therapeutic modalities including novel pharmacologic approaches and surgical options for the management (both therapy and prevention) of the contribution of hyalocytes to vitreo-retinal pathology will be presented.
- Aging, the eye, and the brain: Considerations on the pathophysiology of major conditions and the development of neuroprotective therapies
Jeffrey Liebmann, Donald Fong, Anthony Caggiano
Gustavo De Moraes
Glaucoma and age-related macular degeneration (AMD) are the leading causes of irreversible vision impairment worldwide, while Alzheimer’s disease (AD) is the leading cause of cognitive impairment. These conditions have common underlying mechanisms that are ultimately linked with aging. This SIG will bring together members of Academia and Industry to review the pathophysiology of these conditions with focus on their commonalities. The group will discuss novel strategies for neuroprotective therapies and debate on endpoints for clinical trials. The 10-minute presentations will focus on 3 topics: “Glaucoma and Accelerated Aging” (Liebmann); “Neuroprotection in Geographic Atrophy” (Fong); “Alzheimer’s Disease and the Eye” (Caggiano). The Moderator (De Moraes) will coordinate the 10-minute discussions following each talk and engage speakers and audience. Finally, in the last 30 minutes, the discussion will be focused on how to integrate current knowledge to the design of clinical trials and regulatory requirements. Understanding the commonalities in the pathophysiology of glaucoma, AMD, and AD may help accelerate drug development for these highly prevalent and debilitating conditions.
- Gene therapy for retinal diseases: What’s new in 2023?
Arshad Khanani (Moderator), Szilard Kiss, Lejla Vajzovic, Nadia Waheed, Glenn Yiu
Gene therapy is moving forward at a fast pace with multiple different programs assessing the treatment of chronic retinal diseases, such as, neovascular age-related macular degeneration, dry age-related macular degeneration and diabetic retinopathy. Proper vector selection
is imperative for optimal targeting and transfection into the target tissue. Various routes are currently being explored in gene therapy, including subretinal, suprachoroidal, and intravitreal delivery. The careful balance of efficacy and safety is critical. Immunogenecity associated with gene therapy is well known and the effective management of inflammation will be critical for the adoption of a gene therapy product. Vector technology is also advancing, testing in human clinical trials increasing, and the demand for products with longer duration of action is propelling us closer to an era of gene therapy for non-inherited retinal diseases. This SIG will provide an update on the basic science rationale, as well as, the clinical trial data for gene therapy programs looking at the treatment of chronic retinal diseases. We will discuss the latest available data for all the ongoing gene therapy programs.
- Nanobiotechnology in the diagnosis and management of retinal disease: Current concepts and future directions?
Uday Kompella — Ocular gene therapy and nanotechnology for retinal diseases
Kannan Rangaramanujam — Nanotechnology and ocular drug delivery
Mark Humayun — Nanotechnology and retinal diseases: A clinical perspective
Nalin Mehta, Rajat Agrawal
Nanotechnology can provide transformative adjuncts to current and future management of retinal disease, potentially bypassing limitations of current diagnostics and therapeutics. The minute size of the retina, combined with its immune privilege and easy accessibility for both evaluation and treatment, are ideally suited for nanobiotechnological innovation. This SIG provides a forum within which to discuss nanobiotechnology and bionanotechnology as they pertain to nanoscale diagnostics, drug delivery and targeting, surgical adjuncts and regenerative medicine in the vitreoretinal space, with examples of current and future applications. During the course of this SIG speakers will discuss: potential risks and benefits of working with nanoparticles; limitations of viral versus non-viral delivery systems; structure and function of nanoparticles such as carbon nanotubules, Q-dots, and magnetic nanoparticles and their potential role in theranostics with regards to retinal disease; nanodiagnostic technologies such as next-generation DNA sequencing and single-molecule bionanosensing; and the potential for liposomes, micelles and dendrimers in retinal drug delivery and theranostics.
Thursday, Sept. 28
- Overcoming barriers to catalyze Big Data and Artificial Intelligence (AI) vision research
Pearse Keane, Aaron Lee, Felipe Medeiros, Daniel Ting, Carol Cheung
Lucia Sobrin, Tobias Elze
Big Data and Artificial Intelligence (AI) studies in vision research are growing exponentially and have great promise for generating discoveries that can be translated to clinical care. However, there are significant challenges that still exist to efficiently and effectively conduct Big Data and AI research in ophthalmology. These include but are not limited to (1) reliability of data in electronic health records (EHR), (2) difficulties in data extraction from diagnostic devices and EHRs due to proprietary software, (3) barriers to interinstitutional data sharing and (4) ensuring patient privacy and ethical application of discoveries. This panel session will bring together experts in these fields to discuss how to (1) better standardize and validate data cleaning of large datasets (particularly EHRs), (2) facilitate data extraction across the large range of testing and EHR programs in ophthalmology, (3) develop systems that allow efficient data sharing while protecting patient privacy, and (4) ensure clinically relevant and equitable application of insights garnered from Big Data and AI studies.
- The feasibility of using the eye as a surrogate to image Alzheimer's disease
Imre Lengyel (Moderator), Maya Koronyo (Moderator), Tom MacGillivray, Sharon Fekrat, Gianni Virgili
Alzheimer’s disease (AD) begins decades before the symptoms of dementia emerge. The progression spectrum is currently described in three stages: preclinical AD, where abnormal accumulation of amyloid beta (Aβ) plaque deposition and neurofibrillary tau tangles in the brain may already be in progress, with no significant clinical symptoms. Mild cognitive impairment (MCI) is a clinical condition described by a measurable decline in cognitive abilities. Alzheimer’s dementia is the final stage, with clinical presentation of symptoms that fit a pattern of memory dysfunction and loss of functional independence. While changes in blood and cerebrospinal fluid (CSF) protein biomarkers are good indicators of disease, definitive diagnoses rely on brain imaging, an invasive and expensive process. Therefore, effective and cost-efficient biomarkers for AD are highly desirable. Imaging Alzheimer's disease through the eye is very attractive for quick, well tolerated and inexpensive monitoring of the progression of neurodegeneration. In this SIG,> we assembled an expert panel to discuss the state of our current understanding of the feasibility of eye imaging as a surrogate for AD.
- Uveitic glaucoma: Challenges with treatment
Sapna Gangaputra, Jennifer Thorne, Mina Pantcheva, Marc de Smet
Uveitic glaucoma is a blinding, chronic ocular condition. Its diagnosis requires heightened suspicion with regular screening. Treatment can be challenging, with heightened risks of rapid progression. To improve the long-term outcomes of eyes with uveitic glaucoma enhanced communication between uveitis and glaucoma specialist is necessary, as well as an understanding of the challenges of the management in these cases. We will reflect on our collective experiences to determine best practice patterns for successful preservation of visual function. A panel of speakers well versed in uveitis and glaucoma will discuss case histories of patients with uveitic glaucoma and long term follow up. We will discuss treatment successes as well as failures using case-based examples. Discussion will include: available treatment options, screening guideline for patients with uveitis and uveitic glaucoma, as well as a platform to plan future research directions to gather evidence-based data to improve treatment and follow-up of these patients. We propose the development of research hypothesis and study designs via this SIG.
- Challenges in developing FDA recognized standards for gene validity and variant interpretation for inherited eye diseases
Emily Place (Moderator), Kristy Lee, Radha Ayyagari, Robert Hufnagel, Jacque Duncan, Panagiotis Sergouniotis
The Clinical Genome Resource (ClinGen) is an international consortium dedicated to the standardization of gene and variant interpretation. The Ocular Clinical Domain Working Group (CDWG) within ClinGen was established in 2019 to focus on gene and variant standardization for inherited eye disease.
Over the last four years, expert working groups in the Ocular CDWG have made great progress in developing standards for disease-gene associations as well as variant interpretation. Advances have included working with other ClinGen Clinical Domain groups to refine disease-gene associations, determining how to incorporate therapeutic outcomes in variant interpretation and expanding variant interpretation to allow for interpreting hypomorphic/risk allele/low penetrant variants.
This SIG's intent is to highlight some of the challenges the expert working groups in the Ocular CDWG have encountered in standardizing the ClinGen framework for disease-gene naming and variant interpretation and to provide a forum for a community discussion on ways to address these challenging issues.
- Corneal endothelial cells and microenvironment in aqueous humor: The connection in Fuchs endothelial corneal dystrophy and bullous keratopathy
Shigeru Kinoshita, Divya Srikumaran
Sophie Deng, Ula Jurkunas
Corneal endothelial cells (CEnCs) play a key role in maintaining the corneal transparency. CEnC dysfunction is the leading cause of corneal transplantation, accounting for 180,000 patients per year worldwide. Graft survival rate exceeds 90% at 5 years in Fuchs corneal endothelial dystrophy (FECD), in contrast, the graft survival rate in bullous keratopathy after glaucoma surgery is approximately 30-40% at 5 years. Thus, long-term prognosis is different based on its etiologies. However, mechanism is still elusive. Recently, novel findings have been reported from clinical studies, multiomic analyses of clinical samples, and basic research. The purpose of this SIG is to discuss the new perspective of corneal graft prognosis due to microenvironment of the aqueous humor (AqH). In the first part, the focus will be on the results of DMEK/DSAEK in eyes after glaucoma surgery, paying attention to the difference in CEnC loss rate among patients’ condition. Then, metabolomics of AqH in FECD will be presented, to reach a consensus on the association between CEnC and AqH. Finally, the translational approach will be described along with the inflammasome and CEnC loss in ex vivo experiments.
- Imaging technologies and analysis methods in ocular biomechanics
Guan Xu (Moderator), Ian Sigal, Sayoko Moroi, Ross Ethier, Kirill Larin, Haiyan Gong
There is growing understanding of the important role of biomechanical properties and behaviors of ocular tissues on the intraocular pressure regulation. Yet, there remain many gaps in knowledge about the role of ocular biomechanics to assist the diagnosis and outcome measures of ocular diseases, such as glaucoma. Recent advances of technologies substantially advance researchers' ability to study ocular biomechanics. This diverse panel of basic scientists, engineers and clinicians will discuss structural, physiological, molecular, biomechanical and clinical evidence of aqueous outflow pathway, cornea, and optic nerve head. The panel will cover imaging technologies ranging from conventional histopathological imaging to the state-of-the-art technologies such as atomic force microscopy, fluorescence imaging, optical coherence tomography, polarized light microscopy and photoacoustic microscopy. The panel will also discuss image analysis tools such as spatial feature tracking and finite element methods. The anticipated outcome from these discussions will lead to consensus on the complementary features of the existing technologies and future directions of ocular biomechanics research.
- Development of endpoints for successful translation of inherited retinal disease therapies
Daniel Chung (Moderator), Bart Leroy, Todd Durham, Rachel Huckfeldt, Tomas Aleman
Advances in the development of precision medicines have brought effective therapies for treatment of inherited retinal diseases (IRDs) within reach. The accompanying growth in IRD clinical trials has been met with great excitement. However, significant challenges remain toward the successful development of medicines for these complex diseases in small patient populations. IRDs, due to their clinical heterogeneity and diverse phenotypes, may require novel, specialized endpoints to evaluate clinically-meaningful improvements in the visual function of patients beyond standard measures such as visual acuity. Furthermore, clarity is needed to determine metrics of visual improvement vs. preservation of vision or delay of progression in these diseases. Clinically-relevant endpoints which relate to real-world visual function in specific IRD populations require high reproducibility with minimal measurement error across subjects differing in age, disease severity and visual function. This expert IRD specialist panel will discuss best practices and remaining challenges for the development of successful endpoints, drawing from learnings in recent clinical trials and emerging clinical research.
- Metabolomics and precision medicine in the post genomic era
Thierry Léveillard, James Hurley, Lois Smith, Connie Cepko
Stephen Tsang, Xian-Jie Yang
In the current era of precision medicine, we have identified a large number of genetic variants in patients with various diseases. Yet, a patient’s genetic code alone cannot universally explain their condition. It is the interplay between genomics, proteomics, and metabolomics from which phenotypes arise. The mechanisms by which genomic variations exert their phenotypic effects can be revealed through the study of the metabolome in the relevant target human cells. The metabolome lies at the intersection of the genome and the environment and is malleable to epigenetic influences, making it an ideal target for studying disease states and developing potential therapeutics that will be efficacious regardless of which genes produce a patient’s condition. In this session, forerunners in this field will present developments in metabolomics research and its utility for clinical interventions in cases of congenital disorders. Specifically, they will discuss strategies for interrogating the abundance of metabolites, performing metabolite profiling, and how this information can be used to assess the dynamic state of the cell in relation to both health and disease.
- Neuroimaging as a tool to understand visual discomfort and ocular pain across multiple disease states
Scott Mist — Neuroimaging as a tool to understand visual discomfort and ocular pain in traumatic brain injury
Jie Huang — Neuroimaging as a tool to understand visual discomfort and ocular pain in migraine
Daniel Clauw — Neuroimaging as a tool to understand visual discomfort and ocular pain in fibromyalgia
Anat Galor — Do shared neural pathways underlie visual discomfort and ocular pain across various eye and systemic diseases?
Eric Moulton — Neuroimaging as a tool to understand visual discomfort and ocular pain in individuals with ocular surface diseases
Neuroimaging is a promising tool that can be applied to the study of visual discomfort and ocular pain, presenting features of various eye (e.g., dry eye, neuropathic ocular pain, retinal degenerations) and systemic (e.g, migraine, fibromyalgia, and traumatic brain injury) diseases. The goal of this SIG is to bring together a group of diverse researchers who utilize neuroimaging to investigate various conditions which share visual discomfort (e.g., photosensitivity) and ocular pain as common and overlapping symptoms. Topics covered will include: 1) the utility of neuroimaging to examine function and structure of neural pathways related to visual discomfort and ocular pain; 2) highlight new developments and techniques in the field that can be applied to eye research; 3) examine shared pathways across diseases which may explain overlapping phenotypes.