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ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 136 Binocularity / Preferred retinal loci Sunday, May 03, 2015 1:30 PM–3:15 PM Exhibit Hall Poster Session Program #/Board # Range: 543–555/B0001–B0013 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Low Vision, Visual Psychophysics/ Physiological Optics, Visual Neuroscience Program Number: 543 Poster Board Number: B0001 Presentation Time: 1:30 PM–3:15 PM Visual function and distribution of the preferred retinal loci in patients with AMD Eli Kisilevsky2, 1, Luminita Tarita-Nistor2, Esther G. Gonzalez2, 3, Samuel Markowitz3, Mark Mandelcorn3, Michael H. Brent3, 2, Martin J. Steinbach2, 3. 1School of Medicine, University of Toronto, Toronto, ON, Canada; 2Vision Science Research Program, Toronto Western Hospital, Toronto, ON, Canada; 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. Purpose: Patients with AMD adapt to loss of central vision by developing preferred retinal loci (PRLs) in the eccentric, functional part of their retina. A PRL serves as a pseudo-fovea and is used in performing visual tasks. PRLs typically occur close to the border of the scotoma and most are in locations that correspond to the lower and left visual fields (VFs). This is a retrospective, observational case series study that examines whether visual acuity and ocular motor control during fixation correlates with the PRL’s location in the VF and whether the frequency distribution of the PRL locations differs for the better-seeing (BE) and the worse-seeing (WE) eye. Methods: A total of 137 eyes with AMD were included; based on their acuity measures, 88 were BE and 49 were WE. Visual acuity was measured at 6m. Fixation stability, PRL location, and PRL distance from the former fovea were evaluated with the MP-1 microperimeter. Fixation stability was measured with a bivariate contour ellipse area (BCEA). PRL location was categorized based on 5 areas in the VF: central, superior, inferior, left, and right. Results: For the BE, the PRL frequency distribution was significantly different for the 5 locations, χ2(4)= 19.9, p= .001. Most PRLs occurred in the inferior (31%) and left (32%) VFs, and the least in the right (7%) VF. Acuity and BCEA were best for PRLs in the central and superior VF, but PRL distance from the former fovea was smallest in these locations. Acuity and BCEA in the inferior VF were similar to those in the left VFs. Acuity correlated with BCEA and PRL eccentricity in the inferior VF [r(25)=0.51, p=0.007, and r(25)=0.47, p=0.013, respectively] and left VF [r(26)=0.55, p=0.003, and r(26)=0.40, p=0.033 respectively], but not in the superior or right VF. For the WE, the PRL frequency distribution was not different for the 5 locations. Acuity correlated only with PRL eccentricity in the inferior VF [r(9)=0.65, p=0.031]. No other relationships were significant. Conclusions: The PRL occurs most frequently in functional VFs that are preferred for locomotion and left-to-right reading although a PRL in the left VF is not adequate for reading. The relationship between BCEA and acuity provides valuable information for rehabilitation, but should be applied only for the BE. Commercial Relationships: Eli Kisilevsky, None; Luminita Tarita-Nistor, None; Esther G. Gonzalez, None; Samuel Markowitz, None; Mark Mandelcorn, None; Michael H. Brent, None; Martin J. Steinbach, None Program Number: 544 Poster Board Number: B0002 Presentation Time: 1:30 PM–3:15 PM Fixation stability as a function of viewing distance in patients with AMD Luminita Tarita-Nistor1, Esther G. Gonzalez1, 3, Taylor A. Brin1, Mark Mandelcorn1, 3, Anne-Catherine Scherlen2, Martin J. Steinbach1, 3 1 . Vision Science Research Program, Toronto Western Hospital, Toronto, ON, Canada; 2Essilor International, Paris, France; 3 Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. Purpose: People with normal vision perform activities of daily living binocularly, while changing the viewing distance frequently and effortlessly. Patients with AMD use preferred retinal loci (PRLs) from the functional eccentric retina to perform visual tasks, but their ocular motor control is impaired and this can affect visual performance. In this study we examined how viewing distance affects fixation stability during binocular viewing. Methods: Ten patients with bilateral AMD participated. Visual acuity at 6m was recorded with the ETDRS acuity test and monocular PRL location was recorded with the MP-1 microperimeter. Each patient’s better eye (BE) and worse eye (WE) were identified based on their visual acuity. Fixation stability during binocular viewing was recorded simultaneously for the two eyes with an eye-tracker at 3 viewing distances (40cm, 1m, 6m) in random order. At each viewing distance, patients were asked to look at a 3deg cross and their eyemovements were recorded at 120 Hz for 15s. Fixation stability was evaluated with a bivariate contour ellipse area. Results: Mean binocular visual acuity was .42 ± .18 logMAR, that of the BE was .42 ± .14 logMAR, and that of the WE was .83 ± .23 logMAR. Fixation stability during binocular viewing was analyzed with a 3 (distance: 40cm, 1m, 6m) x 2 (eye: BE, WE) repeated measures ANOVA. There was no effect of viewing distance on fixation stability (p =.72). Fixation stability of BE and WE were not different from each other (p=.80). There was no interaction effect (p = .93). Conclusions: Viewing distance does not affect fixation stability during binocular viewing in patients with AMD. Fixation stability data recorded during binocular viewing with an instrument with a fixed viewing distance can be used in conjunction with visual tasks performed at other viewing distances. Commercial Relationships: Luminita Tarita-Nistor, None; Esther G. Gonzalez, None; Taylor A. Brin, None; Mark Mandelcorn, None; Anne-Catherine Scherlen, Essilor International (E); Martin J. Steinbach, Essilor International (F) Support: Essilor International Program Number: 545 Poster Board Number: B0003 Presentation Time: 1:30 PM–3:15 PM Preferred Retinal Loci and Fixation Stability in Patients with Bilateral Ischemic Optic Neuropathy Anuradha Mishra, Alexandra Selivanova, Mary Lou Jackson. Ophthalmology, Harvard Medical School, Boston, MA. Purpose: To determine if patients with a bilateral ischemic optic neuropathy develop a preferred retinal locus (PRL) and asess their fixation stability. Methods: A retrospective review of 11 patients with bilateral ischemic optic neuropathy, seen in Vision Rehabilitation clinic. These patients underwent a history, ophthalmic examination and SLO microperimetry (Optos). A suprathreshold strategy was used for microperimetry testing and static fixation testing was performed with the patient fixating on a cross for 5-20 seconds. A template was made marking the fovea and disc margin in a healthy patient. This was used to identify the approximate position of the fovea, and determine ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology if there was a PRL present. Fixation stability was assessed by two methods. The first was the clinical classification proposed by Fujii et al. (2002) which categorizes the dynamic fixation data captured during microperimetery testing. Fixation is classified as being either “stable”, “relatively unstable” or “unstable”. The second method was using a 68% bivariate contour ellipse area (BCEA), which is based on the static fixation data obtained when the patient fixates on a cross. Results: There were 21 eyes included in the study. A no light perception eye was excluded from the study as no microperimetry data could be obtained. The mean age in this group was 63.9 years of age (SD 10.8 years), and the mean visual acuity was logMar 0.70 (SD 0.55). The mean duration of disease was 17 months (SD 26 months). PRLs were found in 11/21 eyes (52%) and were bilateral in 4/7 patients (57%). The odds of developing a PRL increased 1.51 times for every 0.1 unit increase in logMAR (p = 0.04) and decreased by 2% for every 1 month increase in duration. By Fujii classification 10/21 (48%) of eyes had “stable” fixation and 11/21 (52%) had “relatively unstable” fixation. The odds of a “relatively unstable” Fujii classification increased 3.52 times (p= 0.09) for patients who had a PRL compared to patients who did not have one. The mean BCEA was 1.66 deg2 (SD 2.49 deg2) and there was no effect of the presence of a PRL on the BCEA. Conclusions: Patients with bilateral ischemic optic neuropathy can develop a PRL and this is more likely to occur in eyes with a worse visual acuity. There were no patients who were classified as having “unstable” dynamic fixation and patients with a PRL were more likely to have “relatively unstable” fixation. Commercial Relationships: Anuradha Mishra, None; Alexandra Selivanova, None; Mary Lou Jackson, None Program Number: 546 Poster Board Number: B0004 Presentation Time: 1:30 PM–3:15 PM Do patients with Stargardt maculopathy fixate eccentrically or with their fovea when asked to look straight ahead? Mary Lou Jackson1, Alexandra Selivanova1, William Seiple2, 3. 1MEEI, Harvard Department of Ophthalmology, Boston, MA; 2Lighthouse Guild, New York, NY; 3NYU School of Medicine, New York, NY. Purpose: To assess if patients with Stargardt maculopathy change fixation location when asked to look straight ahead during fixation testing. Methods: Patients diagnosed to have Stargardt maculopathy had two 5-second fixation tests using SLO-based macular perimeter. During one test the patient was asked to,“Look at the cross” (LC). During the second the patient was asked to, “Look straight ahead even if you do not see the cross” (LS). Thirteen control subjects were tested under the same conditions. Foveal location was determined with OCT topographies scans in control subjects. The mean position of anatomic fovea relative to the disk in controls was used to localize the position of the fovea in Stargardt subjects. The mean vector length, mean angle, and angular dispersion from anatomic fovea to fixation for each subject under each condition were calculated. Data about visual acuity, contrast sensitivity and time since diagnosis was taken from the medical record. Results: Records of 38 patients with Stargardt maculopathy were reviewed. Fixation was most frequently in the superior retina (74% LC condition and 67% LS condition). The average PRL eccentricity was 11.02 degrees for the LC condition (median = 9.52 degrees) and 7.84 degrees for the LS condition (median = 5.9 degrees). This difference was statistically significant (P < 0.001). Sixty-nine percent of subjects had inter-ocular PRLs that were < 10 degrees apart. Approximately 43% of eyes did not statistically change fixation when asked to look straight ahead. When fixation did shift, the magnitude of the shift was correlated with the PRL eccentricity determined when asked to look at the cross (OD, r = -0.69, P < 0.001; OS, r = -0.76, P < 0.001; OU, r = -0.66, P < 0.001). The distance moved under the different conditions (LC and LS) was not correlated with age, disease duration, age of disease onset, visual acuity, contrast sensitivity or BCEA. Conclusions: Even after longstanding disease and established ability to use eccentric fixation, some patients will move their fixation from their preferred retinal locus (PRL) when asked to look in the direction that they believe is straight ahead. Verbal directions can change fixation in patients with Stargardt maculopathy and, therefore, may impact measured visual function, such as visual acuity assessments or PRL assessment. Commercial Relationships: Mary Lou Jackson, None; Alexandra Selivanova, None; William Seiple, None Program Number: 547 Poster Board Number: B0005 Presentation Time: 1:30 PM–3:15 PM Preferred retinal loci during binocular viewing at two viewing distances Esther G. Gonzalez1, 2, Luminita Tarita-Nistor1, Moshe Eizenman3, 2 , Mark Mandelcorn2, 1, Martin J. Steinbach1, 2. 1Vision Science Research Program, Toronto Western Hospital, Toronto, ON, Canada; 2 Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; 3Biomedical Engineering, University of Toronto, Toronto, ON, Canada. Purpose: To determine, in patients with AMD, whether the absolute location of monocular and binocular PRLs changes as function of viewing distance. The method presented here uses a remote eye-tracking system that measures the optical axes of both eyes without user calibration. This method yields the absolute location of monocular and binocular PRLs which, until now, could only be done monocularly. We hypothesized that the locations of the binocular PRLs would not change as a function of viewing distance. Methods: Fifteen eyes from 8 patients with AMD fixated a 3 deg cross for 15sec. The PRL location for the patients was recorded monocularly with both the MP-1 microperimeter and the eye-tracking system and then binocularly with the eye-tracking system. The eyetracker measured the horizontal and vertical components of angle Kappa, which is the angle between the optical and the visual axis (PRL for patients, fovea for controls) in each eye. Using the values of 10 control eyes, a transformation from the eye-tracking to the MP-1 coordinate systems was created to predict the absolute location of the monocular and binocular PRLs in patients. Measurements were made at two viewing distances: 70 cm and 6m. Results: For the patients, the mean prediction errors for the monocular PRLs (MP-1 - eye-tracker system) ranged from 0.03 to 1.05 deg. Viewing distance did not affect PRL location during binocular viewing. For the 7 patients with complete data for the two eyes, there were no consistent changes in PRL when viewing changed from monocular to binocular as a function of viewing distance: 3 patients showed no appreciable changes in PRLs, 2 patients showed larger changes at 70cm than at 6m and 2 patients showed the reverse. For all patients, the PRLs of the better eye changed less than the PRLs of the worse eye. Conclusions: Binocular PRL location did not change as a function of viewing distance. Changes in PRL location from monocular to binocular viewing depended on the characteristics of the patients’ scotomas and not on the viewing distance. The absolute location of the PRLs (i.e., relative to the optic disk) can be predicted with acceptable accuracy with the method presented here. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Esther G. Gonzalez, None; Luminita Tarita-Nistor, None; Moshe Eizenman, ElMar Inc. (I); Mark Mandelcorn, None; Martin J. Steinbach, None Support: Supported by the Natural Sciences and Engineering Research Council of Canada (NSERC) grant 130149 (ME); Vision Science Research Program, Toronto Western Hospital; and an anonymous donor. Program Number: 548 Poster Board Number: B0006 Presentation Time: 1:30 PM–3:15 PM Augmented reality eyewear for home-based vision training after biofeedback rehabilitation of eccentric fixation Marco U. Morales1, Paolo G. Limoli2, Celeste Limoli2. 1Ophthal & Visual Sciences, Nottingham University, Nottingham, United Kingdom; 2Centro Studi Ipovisione, Milano, Italy. Purpose: Eccentric viewing training with microperimetry biofeedback (MBF) is a rehabilitation technique aim to improve fixation stability in patients with central scotoma and unstable fixation. However home-based exercises under controlled environment are difficult to implement due to the cost of technology. The current pilot study explored the use of Augmented Reality Eyewear (ARE) to perform eccentric viewing exercises on patients with large central scotoma after MBF. Methods: Fixation stability was measured in 10 patients with bilateral central geographic atrophy. Patients performed a MAIA microperimetry to evaluate the position of the preferred retinal locus (PRL) and measure fixation stability. Secondly, all patients underwent 2 weekly MBF sessions during 2 weeks. In 5 patients, home-based exercises were performed using the VIZUX eyewear (Rochester, N.Y.) to perform vision exercises during 1 month, three times a week, 10 minutes per session. The ARE, connected to an iPad, showed 2 screens with a horizontal red line crossing the field of view. Such line was positioned superiorly or inferiorly from the horizontal meridian of the visual field corresponding to the PRL selected on the MAIA during the MBF training. On the center of the screen, 2 different targets were shown: a black dot, and a 5 letters word. Patients were advised to move their gaze towards the horizontal line to attempt fixation on the central target. The other 5 patients did not perform any exercise during 1 month as a control group. All patients performed a last MBF session to evaluate the consistency of fixation stability outcomes. The MAIA P1 fixation stability index was used to evaluate fixation performance. Results: In the control group, the MAIA P1 fixation stability index on the 5th MBF session showed a decrease of stability (mean = -13%) when compared to the 4th MBF session. On the contrary the group with ARE, showed the same, or slightly improved fixation stability on the 5th MBF session (mean = +9.8%). Conclusions: The results of this pilot study, suggest that augmented reality eyewear with a dedicated home-based vision training application, may help maintaining fixation stability outcomes obtained during eccentric viewing training in vision centers with microperimetry and biofeedback. Commercial Relationships: Marco U. Morales, None; Paolo G. Limoli, None; Celeste Limoli, None Program Number: 549 Poster Board Number: B0007 Presentation Time: 1:30 PM–3:15 PM Binocular Microperimetry with Simulated Asymmetric Bilateral Scotomas Emily K. Wiecek1, 2, Mary Lou Jackson3, Peter J. Bex2. 1 Ophthalmology, University College London, Boston, MA; 2 Psychology, Northeastern University, Boston, MA; 3Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: It is difficult to perform visual field testing on patients with central field loss (CFL) because they may fixate with a Preferred Retinal Location (PRL) in an unknown location outside the former fovea. Microperimeters combine simultaneous imaging and testing to measure the PRL location and CFL in retinal coordinates, but are expensive and limited to monocular measurement. We develop and evaluate a binocular microperimetry system that uses eye tracking to track the optic nerve head (ONH) and stereo shutter glasses that support simultaneous and independent presentation of stimuli to each eye. Methods: PRL location, and monocular and binocular microperimetry were assessed in 6 normally sighted participants with and without independent binocular simulated scotomas. The simulated scotoma was presented as a 3° or 6° circular patch of pink noise in a raised cosine window (λ=0.5°) to each eye monocularly and required the participant to use a PRL to fixate a central cross. To determine the location of the PRL and map stimulus presentation in retinal coordinates, the ONH was mapped in each eye with kinetic perimetry. The ONH location in each eye was compared with fundus images offline and provided retinotopic references for monocular and binocular microperimetry with Goldman III targets presented in a polar 3-21 pattern. Results: The ONH location in our system corresponded to its location in fundus images and was an average location of 15.5° temporal and 2° superior to fovea, across observers. The ONH location mapped with asymmetric, binocularly-simulated scotomas shifted vertically from the central cross an average of 6° (the size of the larger scotoma) consistent with the use of a PRL in upper visual field. The ONH location measured with a monocular scotoma, however, corresponded to a shift the size of the independent monocular scotoma, highlighting a difference in monocular and binocular assessment of PRL location. Both binocular and monocular perimetry accurately mapped the location and extent of the simulated scotoma in all six participants after accounting for eye movements with eye tracking data. Conclusions: A computer-based binocular microperimetry system can offer binocular assessment of CFL induced with simulated gazecontingent scotomas. This system can provide reliable information about the binocular nature of visual field loss, fixation stability, and PRL location in CFL patients. Commercial Relationships: Emily K. Wiecek, None; Mary Lou Jackson, None; Peter J. Bex, None Support: R01EY021553 Program Number: 550 Poster Board Number: B0008 Presentation Time: 1:30 PM–3:15 PM Fixational eye movements during binocular rivalry Rajkumar Nallour Raveendran, William R. Bobier, Amy Chow, Raiju J. Babu, Benjamin Thompson. School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada. Purpose: We have recently shown that the stability of fixational eye movements (FEM) was decreased by suppression resulting from strabismic amblyopia. To further investigate the impact of suppression on fixation stability (FS), we measured FEM during periods of binocular rivalry in normal individuals. Methods: FEM were measured using an infrared video based eyetracker at 500 Hz in 15 normal participants (age: 28±4 yrs). Stimuli were sinusoidal gratings (3.6° diameter, 1.1cpd, central fixation target 0.5° at 40cm). Binocular rivalry was created by dichoptically presenting orthogonal gratings using a haploscope. There were three control conditions: (1) grating to the left eye (LE) and mean luminance to the right eye (RE) (monocular grating); (2) identical gratings to both eyes dichoptically viewed through the ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology haploscope (dichoptic fusion); (3) binocular viewing of a single grating without the haploscope (binocular fusion). Note that the stimulus presented to the LE was the same in every condition whereas the RE stimulus varied across conditions. Each trial took 40 seconds and grating orientation was varied every 4 seconds to minimize adaptation in all conditions. There were 6 trials per condition. Fixational stability (FS) was quantified using bivariate contour ellipse area (BCEA). Results: The effect of viewing condition (rivalry vs. control conditions) differed significantly between the two eyes (p=0.003) [Fig-1]. This effect involved a significant increase in LE FS for the monocular condition compared to the rivalry condition (p=0.03). However, the FS of the right eye did not differ in any of the dichoptic conditions. Further, the FS in both eyes was significantly better for the binocular fusion condition than the three dichoptic conditions (p=0.0001). Conclusions: We conclude that the FS in the fixing eye (LE) was significantly improved when the fellow eye was suppressed (monocular grating) compared to when the suppression was alternating (binocular rivalry). Further we found that the stability of FEM was improved with “normal” binocular fusion compared to dichoptic fusion achieved through the haploscope. Figure 1: Fixation stability (FS) across three dichoptic conditions and normal binocular fusion. FS was quantified using bivariate contour ellipse area (BCEA). Commercial Relationships: Rajkumar Nallour Raveendran, None; William R. Bobier, None; Amy Chow, None; Raiju J. Babu, None; Benjamin Thompson, None Support: NSERC-Canada to WRB Program Number: 551 Poster Board Number: B0009 Presentation Time: 1:30 PM–3:15 PM The relationship between ocular sensory dominance and stereopsis Ziming Liu1, 2, Hua Bi2, Bin Zhang2, Zuopao Zhuo3, 2, Qingxia Fan1, Ling Xu1, Wei He1. 1Shenyang He Eye Hospital, Shenyang, China; 2 College of Optometry, Nova Southeastern University, Davie, FL; 3 Optometry, The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China. Purpose: Stereopsis is the highest form of binocular visual processing, in which relative depth information is extracted from two slightly different retinal images. During the process, the visual brain receives and compares the signals sent from the two eyes. However, the two eyes do not always have equal access to the visual brain. Just as hand dominance, ocular dominance, the tendency to prefer visual input from one eye to the other, also exists. It is not clear whether fine stereopsis(lower stereothreshold and quicker response) would only be found in persons with two balanced eyes. This hypothesis has never been tested before because traditional methods to measure ocular dominance were qualitative, which can only identify the dominant eye without showing the degree of dominance. In this study, we set to quantify the relationship between stereopsis and ocular sensory dominance. Methods: Thirty subjects participated in the study. For each subject, ocular dominance was quantified with the continuous flashing technique and ocular dominance index(ODI) was computed. For stereopsis, the stereothresholds were measured with 5 viewing durations ranged from 25 to 400ms. The functions for stereothresholds versus viewing durations were analyzed by an empirical model of quadratic summation, in the form of th= Dmin(t2 +Tmin-2)0.5 where th is the stereothreshold at a given viewing duration(t), Tmin is the constant that determines the horizontal position of the function, which is related to the time at which the stereothreshold becomes independent of duration(critical duration). Dmin is the constant that determines the vertical position of the function and is equal to the stereothreshold when t=Tmin. Results: 60% of the subjects showed two relative balanced eyes(ODI < 3db), 29% had moderate ocular dominance(3db≤ODI≤ 9db), and approximately 11% showed strong ocular dominance(ODI> 9db). For subjects with two relatively balanced eyes or moderate ocular dominance, the Dmin values significantly lower than those with strong ocular dominance. Also, the Tmin values were significantly shorter in subjects with two relatively balanced eyes or moderate ocular dominance. Conclusions: People with two relatively balanced eyes tend to have better stereopsis(small Dmin and short Tmin). Commercial Relationships: Ziming Liu, None; Hua Bi, None; Bin Zhang, None; Zuopao Zhuo, None; Qingxia Fan, None; Ling Xu, None; Wei He, None Support: Nova Southeastern University Health Professions Division Grant Program Number: 552 Poster Board Number: B0010 Presentation Time: 1:30 PM–3:15 PM Objective Assessment of Eye Dominance Kevin T. Willeford2, Kenneth J. Ciuffreda2, George A. Zikos1. 1 Manhattan Vision Associates, New York, NY; 2Biological and Vision Sciences, SUNY State College of Optometry, New York, NY. Purpose: The electrophysiological correlates of monocular defocus during binocular viewing have yet to be explored with respect to eye-dominance using the visual-evoked potential (VEP). Following determination of both sensory and motor eye-dominance with subjective clinical tests, a counterbalanced experimental design was used to test the hypothesis that monocularly defocused dominant eyes differentially affect the objective, pattern-VEP waveform as compared to non-dominant eyes. Thus, the goal was to determine whether one or both subjective tests of eye-dominance could predict the binocular VEP waveform with a range of monocular defocus, with application to monovision refractive correction. Methods: The DiopsysTM NOVA-TR system was used to record the pattern-VEP waveforms of 10 visually-normal, presbyopic, adult subjects aged 50-70 yrs (x = 60). VEP amplitude and latency were used as the outcome measures. First, eye dominance was assessed in two ways: a sensory-based “sensitivity to blur task” and a motorbased “sighting task”. Next, while monocularly defocused, subjects binocularly viewed a black-and-white checkerboard (20 min arc check size, 74 cd/m2), pattern-reversal stimulus under 7 different test conditions: baseline (full refractive correction), dominant (DE) eye defocused +1 D, non-dominant (NDE) eye defocused +1 D, DE +2 D, NDE +2 D, DE +3 D, and NDE +3 D. Data were analyzed in twoways: first, each eye was classified as either “sensory dominant” or ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology “non-sensory dominant”, and second as either “motor dominant” or “non-motor dominant”. Two one-way, repeated-measures ANOVAs were used to investigate the effect of increasing monocular defocus with both classifications. Results: Under nearly all conditions (22/24=92%), the amplitude and latency significantly decreased and increased, respectively, from baseline with any amount of monocular defocus (p < 0.05). Conversely, there was no difference in amplitude or latency between the monocular defocus conditions themselves (p > 0.05). Moreover, there were no significant differences revealed when comparing defocused dominant vs. non-dominant eyes (p > 0.05): this was true for both sensory and motor eye-dominance classifications. Conclusions: Neither eye-dominance status (i.e., DE or NDE) nor type (i.e., sensory or motor) provided a differential effect with respect to the VEP findings. Thus, the VEP technique does not show promise as an objective adjunct in the determination of eye-dominance. Commercial Relationships: Kevin T. Willeford, None; Kenneth J. Ciuffreda, None; George A. Zikos, None Program Number: 553 Poster Board Number: B0011 Presentation Time: 1:30 PM–3:15 PM Development of a binocular advantage for the performance of complex manipulation skills in healthy children 5 to 13 years old Fatimah A. Alramis1, Eric Roy1, Lisa Christian2, Ewa NiechwiejSzwedo1. 1Kinesiology, University of Waterloo, Waterloo, ON, Canada; 2School of Optometry, University of Waterloo, Waterloo, ON, Canada. Purpose: Individual studies have shown that visuomotor coordination and fine stereopsis continue to improve in normally developing children from birth to early teenage years; however, no study has systematically addressed the relationship between the development of stereopsis and fine manipulation skills. Therefore, the aim of this study is to examine the significance of binocular vision by comparing monocular and binocular viewing in the performance of complex manipulation tasks. Methods: Seventy children (5-13 years old) with normal visual acuity (0.0 logMAR) and stereoacuity (range: 25-100 arc sec) were tested. Children performed 2 manipulation tasks: peg board and bead threading under randomized viewing conditions (binocular, right and left eye monocular). The main outcome measure was movement time to complete the task. Binocular summation ratio was calculated to determine the relative advantage in motor performance between binocular and monocular viewing. Results: Age and stereoacuity were significant predictors for movement time during binocular viewing in the bead threading task (R2=0.44), while age was the only significant predictor for movement time in the peg board task (R2=0.46). The binocular summation ratio for the bead threading task also indicated that older children relied on binocular vision more than younger children (5-6 years old: 0.896; 7-8 years old: 0.879; 9-13 years old: 0.792). Results from the multiple regression analysis for the bead threading task revealed a 7.3% variance in the binocular summation ratio was explained by age and 3.6% was due to stereoacuity (p<0.05). In contrast, binocular summation ratio was close to 1 for the peg board task and there was no significant difference in movement time between binocular and monocular viewing in children in different age groups (5-6 years old: 1.086; 7-8 years old: 1.01; 9-13 years old: 0.944). Thus, fine stereopsis is an independent predictor of performance on a complex manipulation task; however, the extent of binocular advantage is dependent on the task. Conclusions: This research shows that 9-13 year-old children have a greater binocular advantage during performance of a complex manipulation task which requires precision grasping and object placement. Thus, the bead threading task offers a more sensitive assessment of the role of binocular vision in development of fine manipulation skills. Commercial Relationships: Fatimah A. Alramis, None; Eric Roy, None; Lisa Christian, None; Ewa Niechwiej-Szwedo, None Support: Saudi Arabian Cultural Bureau and University of Waterloo Program Number: 554 Poster Board Number: B0012 Presentation Time: 1:30 PM–3:15 PM Pitfalls in the Use of Stereopsis for the Diagnosis of Non-organic Visual Loss Kevin Sitko1, Jason Peragallo1, 2, Samuel Bidot1, Valerie Biousse1, 3 , Nancy J. Newman1, 4, Beau B. Bruce5, 6. 1Ophthalmology, Emory University, Atlanta, GA; 2Pediatrics, Emory University, Atlanta, GA; 3Neurology, Emory University, Atlanta, GA; 4Neurology and Neurosurgery, Emory University, Atlanta, GA; 5Ophthalmology and Neurology, Emory University, Atlanta, GA; 6Epidemiology, Emory University, Atlanta, GA. Purpose: Titmus stereoacuity testing is used to estimate visual acuity (VA) in the diagnosis of non-organic visual loss (NOVL), but only predicts mean VA and doesn’t account for normal inter-subject variability. These predictions were derived from optical degradation of VA in normal subjects and may not account for the variability seen in patients with neuro-ophthalmic pathologies included in the differential diagnosis of NOVL. The purpose of this study was to evaluate the relationship between Titmus stereoacuity and minimal visual acuity based on a real-world testing environment. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Methods: All patients presenting to our service between 4/25/2014 and 6/26/2014 underwent routine neuro-ophthalmic examination, including Titmus stereoacuity measurements. A compound Bayesian logit-lognormal model accounting for heteroskedasticity was used to determine 95% and 99% prediction intervals of the worse eye’s near visual acuity (VA) based on stereoacuity. LogMAR acuity and log stereoacuity were analyzed. Results: Of 561 patients, 28 were excluded for missing stereoacuity or VA measurements, 4 for cognitive issues, 3 for suspected NOVL, and 119 for heterotropia or history of strabismus/amblyopia. Patients who correctly identified zero circles (43) were also excluded from the calculation. 364 subjects were analyzed [median age: 45-yo (range: 11-91); 258 (71%) women; median worse-eye VA 20/25; median Titmus: 7 circles correct]. Titmus stereoacuity was positively associated with VA: 9 circles correct (40 seconds of arc) indicated VA of at least 20/41 with 95% confidence and 20/88 with 99% confidence; 6 circles correct (80 seconds of arc): 20/63 and 20/197; and 4 circles correct (140 seconds of arc): 20/106 and 20/582, respectively. Conclusions: When fully accounting for individual variation and the full spectrum of neuro-ophthalmic diseases affecting VA, stereoacuity remains associated with VA, but commonly-used VA estimates based on stereoacuity overestimate VA. Our results more accurately predict minimum VA from Titmus stereoacuity and should be preferentially used when evaluating patients with suspected non-organic visual loss. We demonstrate that Titmus stereoacuity cannot establish definitively normal VA, and therefore can only suggest, but not establish, the diagnosis of NOVL. Commercial Relationships: Kevin Sitko, None; Jason Peragallo, None; Samuel Bidot, None; Valerie Biousse, None; Nancy J. Newman, None; Beau B. Bruce, None Support: RPB; NIH/NEI core grant P30-EY006360; NIH/NEI K23EY019341 Program Number: 555 Poster Board Number: B0013 Presentation Time: 1:30 PM–3:15 PM Stereroacuity in glaucoma patients Chang Kyu Lee. Ophthalmology, Maryknoll Hospital, Busan, Korea (the Republic of). Purpose: In this study, we compared the near and distant stereo acuity between glaucoma patients and normal group, analyzed the near and distant stereoacuity according to the severity of glaucoma and the type of visual field defect in the glaucoma patients. Methods: 94 eyes in 47 patients with glaucoma and 80 eyes in 40 subjects (normal group) enrolled in cross-sectional study between January 2014 and March 2014. Overall 87 subjects were tested about near and distant stereoacuity and all glaucoma patients were evaluated about visual field. Results: There were statically significant differences in the mean value of near and distant stereoacuity between glaucoma patients and normal group (p=0.000, p=0.000), and the median of near and distant stereoacuity in glaucoma patients showed higher value than normal group. In HAP grading system, mean value and median of near stereoacuity were increased proportionately to severity of glaucoma (p=0.007), but distant stereoacuity showed no correlation according to the severity of glaucoma (p=0.120). The near and distant stereoacuity showed no differences between the subjects with threat to fixation and the subjects with no threat to fixation (p=0.005, p=0.980), but upward tendency of value of near steroacuity appeared in the subjects with threat to fixation. Proportion of reduced stereoacuity in near stereoacuiy was higher in glaucoma patients in compared to normal group (76.2%, 45.5%). In comparison, the proportion of absence of stereoacuity was higher in distant stereoacuity in glaucoma patients comparing to normal group (61.9%, 0%). Conclusions: Stereoacuity, both near and distant, was significantly higher in glaucoma patients than normal group. In distance stereoacuity test, the proportion of absence of stereoacuity was remarkably high in glaucoma patients. In near stereoacuity test, the more glaucomatous defect progressed, the poorer stereoacuity was scored. But no correlation was detected in the distant stereoacuity. The result that distant stereoacuity seriously deteriorated than the near stereoacuity in glaucoma patient despite no correlation between severity of glaucoma and distant stereoacuity can suggest that distant stereoacuity may be considerably damaged in early stage of glaucoma. Commercial Relationships: Chang Kyu Lee, None 137 Extraocular muscles / Thyroid eye disease Sunday, May 03, 2015 1:30 PM–3:15 PM Exhibit Hall Poster Session Program #/Board # Range: 556–572/B0014–B0030 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Clinical/Epidemiologic Research Program Number: 556 Poster Board Number: B0014 Presentation Time: 1:30 PM–3:15 PM Novel Reverse Compressibility of Contracting Human Extraocular Muscles (EOMs) indicated By High Poisson Ratio (PR) Lawrence H. Yoo, Robert A. Clark, Andrew Shin, Joseph L. Demer. Ophthalmology, Jules Stein Eye Inst UCLA, Los Angeles, CA. Purpose: A fundamental descriptor of the mechanical behavior of a material is its PR, the ratio of transverse to axial strain, i.e., the ratio of change in cross sectional area to change length during uniaxial loading. A material having a PR <0.5 is said to be compressible. Measurement of PR requires accurate 3-D determination of specimen dimensions, typically by quantitative imaging during mechanical loading. During passive, ex vivo tensile elongation, computed x-ray tomography showed the PR of bovine EOM to be ~0.45 (Kim et al., BioMed. Res. International, 2013), but optical coherence tomography demonstrated the PR of extraocular tendon to slightly exceed the ideal incompressible value of 0.5 (Shin et al, ARVO, 2013). Since the PR of contracting EOM is unknown, we used magnetic resonance imaging (MRI) to determine the PR of all 4 rectus EOMs whose axial dimensions change physiologically during horizontal & vertical duction. Methods: Surface coil MRI of 40 orbits of 20 normal adults was performed at 312 micron resolution in ~20° target-controlled horizontal and vertical eccentric gazes. Lengths were measured in axial or quasi-sagittal images parallel to EOM long axes. Cross sections were measured in quasi-coronal images perpendicular to the long axes of each orbit. EOMs were outlined in coronal planes to obtain area centroids cross sectional areas, and areal strain by Green’s theorem. To correct for path curvature, centroids were sequentially aligned to straighten each EOM for analysis. EOMs were then discretized into elements 10-20 microns long. Changes in longitudinal thickness of each element were determined to calculate strain. Results: Mean (±SD) PR values from discretized 3-D models for the 20 superior, inferior, medial and lateral rectus muscles were 0.87±0.06, 0.79±0.03, 0.75±0.04 and 0.78±0.02 respectively. Conclusions: PR values markedly exceeding the ideal compressible value of 0.5 for contracting rectus EOMs imply that total volume in the active contraction significantly exceeds that in relaxation, a ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology behavior termed reverse compressibility. Heretofore demonstrated for tendons, reverse compressibility of EOMs would strongly impact accuracy of finite element analysis simulations of EOM cooperative biomechanics, and also provides a strong rationale for use of EOM volume metrics as functional indices of contractility. Commercial Relationships: Lawrence H. Yoo, None; Robert A. Clark, None; Andrew Shin, None; Joseph L. Demer, None Support: NIH EY08313 Program Number: 557 Poster Board Number: B0015 Presentation Time: 1:30 PM–3:15 PM Comparison of myogenesis in human Extraocular muscle and limb muscle in vitro Hee-Young Choi1, Hye Shin Jeon1, Jeong Hyo Ahn1, Jin Hong Shin2, Si Hyun Kim2. 1Ophthalmology, Pusan National University hospital, Busan, Korea (the Republic of); 2Neurology, Pusan national university Yangsan hospital, Yangsan, Korea (the Republic of). Purpose: We investigated the myogenesis in human extraocular muscle and compared with that in human limb muscle in vitro. Methods: We obtained human extraocular muscle and limb muscle during extraocular muscle surgery and limb muscle biopsy. Myoblast was isolated and harvested until enough fraction of myoblast had been achieved. Myogenesis was induced with F10 medium on collagen-coated dish for 18 days. When myotube formation and multiple nucleuses fusion were observed, cells were immunostained with desmin (muscle specific protein) and myoD (determination of the myogenic lineage) using each primary antibodies at day 10. We evaluated morphologic characteristics of extraocular muscle and limb muscle and compared extraocular muscle with limb muscle using daily taken phase contrast photograph. Results: Myoblasts fusion to form multinucleate myotube in both human extraocular muscle and limb muscle primary culture started at day 4. Immunocytochemistry for desmin and myoD were shown positively stained at day 10 in both cells. Morphologic evaluation revealed that extraocular muscle myoblasts were smaller and round shape than limb muscle myoblasts at day 0. The process of myotube formation and multinucleus fusion were similar time course in extraocular muscle and limb muscle until day 7, but total area of myotube formation and total number of nucleus in extraocular muscle was smaller than limb muscle until day 10. However, total area of myotube formation and total number of nucleus in limb muscle at day 2,4 was lower than day 10 (All, p<0.05) and total area of myotube formation and total number of nucleus in extraocular muscle at day 3,5,7 was similar to day 10(All, p>0.05). Conclusions: We have succeeded in primary culture of human extraocular muscle myoblast and inducing myogenesis to form multinucleated myotube in vitro. Our study reflects the differences in myoblast and myogenesis between human extraocular muscle and limb muscle Commercial Relationships: Hee-Young Choi, None; Hye Shin Jeon, None; Jeong Hyo Ahn, None; Jin Hong Shin, None; Si Hyun Kim, None Program Number: 558 Poster Board Number: B0016 Presentation Time: 1:30 PM–3:15 PM Also Compartmentalized: Innervation of the Inferioir Oblique (IO) Muscle in Primates Alan Le1, 2, Vadims Poukens1, Joseph L. Demer1, 2. 1Ophthalmology, University of California, Los Angeles, Los Angeles, CA; 2 Bioengineering, University of California, Los Angeles, Los Angeles, CA. Purpose: Innervation of the superior oblique muscle is separated into minimally overlapping lateral and medial compartments in primates, and superior and inferior compartments in non-primate mammalian species. The horizontal rectus muscles are divided into superior and inferior zones innervating non-overlapping sets of muscle fibers. We explored the innervation pattern of the IO muscle and determined the possibility of a compartmentalized model. Methods: Whole orbits were obtained from two adult humans and three rhesus monkeys. Each orbit was formalin fixed, embedded in paraffin, coronally sectioned at 10 μm thickness, and stained with Masson trichrome. In digital micrographs, oculomotor nerve (CN3) branches were traced in serial sections using Photoshop and reconstructed using ImageJ to create 3-D overlays of CN3 innervation in the IO muscle fibers. Results: CN3 travels from the deep orbit and innervates at the muscle belly of the IO. In both humans and monkeys, CN3 bifurcated into two major branches prior to entering the IO muscle. Arborization of the CN3 splits the IO muscle into two halves along its length. One branch enters immediately as it reaches the muscle belly and arborizes within muscle fibers from the posterior half. The other branch straddles externally along the muscle belly before it penetrates and arborizes in fibers of the anterior half. Conclusions: Innervation of the IO muscle appears to follow a compartmental model with the arborization dividing the muscle along its length. Branching of the CN3 external to the muscle fibers allows for independent movement between the two compartments. One compartment could be more effective for elevation during adduction while the other might have a greater effect on extorsion in primary gaze. Commercial Relationships: Alan Le, None; Vadims Poukens, None; Joseph L. Demer, None Support: NIH EY08313, Research to Prevent Blindness Program Number: 559 Poster Board Number: B0017 Presentation Time: 1:30 PM–3:15 PM Desmin in extraocular muscles Fatima Pedrosa Domellof1, Kimmo Parkkonen1, Mona Lindström4, Hanna Nord3, Jonas von Hoffsten3, Zhenlin Li2. 1Dept of Clinical Sciences/Ophthalmology, UMEA University, Umea, Sweden; 2 UPMC Université Paris 6 - CNRS - INSERM, Institute of Biology Paris-Seine, Paris, France; 3Umeå Centre for Molecular Medicine (UCMM), Umea University, Umea, Sweden; 4Dept of Integrative Medical Biology, Umea University, Umea, Sweden. Purpose: To determine whether the lack of desmin reported in the slow tonic muscle fibers of human extraocular muscles (EOMS) is related to the presence of slow tonic myosin heavy chain (MyHC) or multiple innervation or a feature specific to extraocular muscles and to determine whether the EOMs are affected in a model of desmin muscle dystrophy. Methods: Immunohistochemistry was used to investigate the presence of desmin in i) chicken anterior latissimus dorsi (ALD), a muscle rich in slow tonic muscle fibers, ii) muscle spindles, whose muscle fibers contain MyHC slow tonic and are multiply innervated and iii) EOMs of rabbit, rat and zebra fish. The morphology, muscle fiber size and muscle fiber integrity was evaluated in the EOMs of desmin knockout mice and compared to that of wild type controls. Results: Chicken ALD and muscle spindle fibers were labeled with antibodies against desmin in similar patterns to those seen in control skeletal muscle fibers. Muscle fibers containing slow tonic MyHC in the EOMs of the different animals studied showed absence or very low levels of expression of desmin, as previously observed in the human EOMs. The EOMs of the desmin KO mice showed no obvious signs of muscle dystrophy, in contrast to other highly used skeletal muscles. More animals are under evaluation. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: The very low levels of expression or lack of desmin in the slow tonic muscle fibers was a feature typical for the EOMs across species and not related to the presence of multiple innervation or slow tonic MyHC, in other muscles. Preliminary data indicate that the EOMs remain apparently unaffected in desmin muscle dystrophy. Commercial Relationships: Fatima Pedrosa Domellof, None; Kimmo Parkkonen, None; Mona Lindström, None; Hanna Nord, None; Jonas von Hoffsten, None; Zhenlin Li, None Support: Swedish Research Council (K2012-63x-20399-06-3), County Council of Västerbotten (Cutting Edge Medical Research; Central ALF), Stiftelsen Kronprinsessan Margaretas Arbetsnämnd för Synskadade (KMA), The Kempe Foundation, The Swedish Society of Medicine, The Medical Faculty, Umeå University Program Number: 560 Poster Board Number: B0018 Presentation Time: 1:30 PM–3:15 PM The Effect of Amniotic Membrane Grafting on healing and wound strength in a Rabbit Model of Strabismus Surgery Jeffrey B. Kennedy, Robert Enzenauer. Ophthalmology, University of Colorado School of Medicine, Denver, CO. Purpose: Postoperative scarring and adhesions after strabismus surgery are common and may affect surgical outcomes. Amniotic membrane grafts (AMG) have previously been shown to serve as a successful platform for healing and to reduce scarring in cases of ocular surface disease. Mixed results have been observed when using AMG in conjunction with strabismus surgery. This study was designed to evaluate the wound strength and histopathologic changes on postoperative wound strength of amniotic membrane grafting in conjunction with strabismus surgery using an in-vivo animal model. Methods: Inferior rectus hang-back recession with processed dehydrated amniotic membrane allograft (Ambiodry2, IOP Inc., Costa Mesa, CA) placed both between the sclera and the extraocular muscle and between the extraocular muscle and the repositioned conjunctiva was performed on 10 eyes of 10 New Zealand white rabbits. Inferior rectus recession without amniotic membrane grafting was performed on the alternate eye as a control. At postoperative month 1, tensile strength of the muscle and overlying conjunctiva was measured. Eyes were then enucleated and histopathologic analysis performed to evaluate scarring and inflammatory response. Results: Mean tensile strength of the AMG treated muscle and conjunctiva was 441.4 +/- 274.4g and 640.3 +/-266.4g respectively. The tensile strength of the control muscle and conjunctiva was 365.8 +/-199.8g and 595.2 +/- 315.3g respectively. No statistically significant difference was detected based on ANOVA testing. Histopathology demonstrated an increase in inflammatory infiltrate at the muscle stump in AMG treated muscle. Conclusions: There was no significant change in tensile strength of the muscle insertion at post op month one in muscles treated with amniotic membrane graft at the time of strabismus surgery. Significant intra-animal variation in tensile strength was observed, making a change difficult to detect. Further study is required to determine the long term effect of amniotic membrane grafting on post-operative scarring in strabismus surgery. Commercial Relationships: Jeffrey B. Kennedy, None; Robert Enzenauer, None Program Number: 561 Poster Board Number: B0019 Presentation Time: 1:30 PM–3:15 PM Growth factors regulate early events in adult zebrafish extraocular muscle (EOM) regeneration Alfonso Saera Vila, Alon Kahana. Ophthalmology and Visual Sciences Department, University of Michigan, Ann Arbor, MI. Purpose: Zebrafish are able to regenerate complex tissues, whereas in mammals this ability is limited. Our laboratory uses EOMs as an experimental model to study regeneration in sexually mature adult zebrafish. Fibroblast growth factors (FGFs) have been shown to promote tissue regeneration so we hypothesize that FGFs regulate EOM regeneration in zebrafish. Methods: A myectomy surgery that excised about 50% of the lateral rectus (LR) muscle was performed to sexually mature adult α-actin:EGFP zebrafish. At the end of the experiment, fish treated with DMSO or the FGF receptor inhibitor SU5402 (17 μM) were craniectomized and imaged. Muscle regeneration was calculated using the uninjured contralateral muscle as a reference (100%). Additionally, a-actin:EGFP or hsp70:dnfgfr1a-EGFP (a line that expresses a dominant negative FGF receptor under control of the heat shock protein 70 promoter) zebrafish were myectomized and analyzed as described. Cell proliferation was analyzed injecting fish with EdU to label cells in the S-phase of the cell cycle. The involved cell signaling pathway was analyzed by testing the effect of the MEK inhibitor U0126 (25 μM) in EOM regeneration and proliferation as described. The activation of ERK was analyzed by immunofluorescence and western blot. Results: LR myectomy resulted in loss of abduction and, therefore, the optokinetic response. Within 7 days, a new and functional LR muscle regenerated. Both pharmacologic and genetic approaches were used to analyze the role of FGFs. Treating myectomized fish with the inhibitor SU5402 for 3 days reduced LR regeneration from 70% to 58% (p<0.05). FGF role was confirmed using hsp70:dnfgfr1a-EGFP in a time course experiment showing a significant regeneration delay at 3 (13%, p<0.05), 5 (15%, p<0.05), 9 (36%, p<0.05), and 14 days (25%, p<0.01). Cell proliferation was decreased in hsp70:dnfgfr1a-EGFP fish compared to WT fish (19% and 27%, respectively; p<0.05). U0126 treated fish showed a decrease in LR regeneration (71% vs 57%, p<0.05) and cell proliferation (17% vs 9%, p<0.05). Immunofluorescence and western blot confirmed the activation of ERK in the regenerating LR. Conclusions: Our results show that FGFs, and most likely other growth factors, play a significant role in the regeneration of EOMs in zebrafish. Additional studies will be required to further uncover the molecular mechanisms and target genes involved. Commercial Relationships: Alfonso Saera Vila, None; Alon Kahana, None Support: NEI Grant R01EY022633 Program Number: 562 Poster Board Number: B0020 Presentation Time: 1:30 PM–3:15 PM Medial rectus tendon elongation with bovine pericard (Tutopatch®): an alternative to correct large horizontal squint angles in graves’ orbitopathy Monika Wipf. Augenklinik, Universitätsspital Basel, Basel, Switzerland. Purpose: Patients with Graves’ orbitopathy (GO) often present large squint angles, especially following decompression surgery of the medial orbital wall. These angles cannot be corrected with conventional recession of the muscle alone. In this pilot study, we report on four patients, where tendon elongation with Tutopatch® was applied, to study the feasibility of this method, in particular the dose- effect relationship. Methods: We reviewed the charts of four patients with GO who underwent bilateral recession of the medial rectus muscle and tendon elongation with Tutopatch® within the last 5 years. At the time of surgery, all patients had been stable for at least six months. Squint angles were evaluated at distance and at near fixation preoperatively ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology as well as at postoperative week one, twelve and ≥52 (mean followup 49 months). Results: Three patients had undergone previous orbital decompression, one of whom had undergone previous bilateral 6mm and 4.5mm, respectively, medial rectus recession with a residual angle of 8°. The mean [range] preoperative angle was 38.8 [8- 68.7]° at distance and 37.5 [6.9- 68.7]° at near fixation. This compared to a mean postoperative angle of 1.1 [0- 2.9]° at distance and 5.1 [-2.0- 8.0]° at near fixation. Per muscle, the mean length of tendon elongation was 6.8 [3.75- 13.5] mm with a mean total recession of 9.8 [3.75- 17.5] mm. The mean dose- effect response was 1.83 [1.0-2.66] °/mm for the distance angle and 2 [1.4- 2.8] °/mm for the near angle. All patients achieved a good functional outcome with orthotropia, however in one patient following additional vertical squint surgery. Conclusions: We found the dose-effect response for medial rectus recessions with Tutopatch® in GO to be comparable to reported findings for dose-effect response for the inferior rectus muscle recession with Tutopatch® (2°/mm), albeit with a slightly reduced response at distance. This compares well to an effect of 1.99°/mm for conventional inferior rectus recessions in GO as found in the literature. However, in GO the dose-effect response for conventional bilateral recessions of the medial rectus is considerably less (1.41.58°/mm). Commercial Relationships: Monika Wipf, None Program Number: 563 Poster Board Number: B0021 Presentation Time: 1:30 PM–3:15 PM Clinical and Radiographic Features of Extraocular Muscle Entrapment Margaret L. Pfeiffer1, 2, Helen Merritt1, 2, Karina Richani1, 2, Margaret E. Phillips1, 2. 1Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX; 2Robert Cizik Eye Clinic, Houston, TX. Purpose: This is a retrospective chart review to investigate the clinical and radiographic features of extraocular muscle entrapment in patients presenting to the emergency department with orbital wall fractures. Methods: Patients who presented to the Memorial Hermann Hospital emergency department, diagnosed with an acute orbital wall fracture with extraocular muscle entrapment, and evaluated by ophthalmology from January 2013 through November 2014 were included. Clinical data were analyzed for the presence of symptoms and signs associated with entrapment: diplopia, pain with eye movements, nausea or vomiting, syncope, bradycardia, and restriction in extraocular movements. Radiographic data were obtained including interpretation of computed tomography (CT) by both ophthalmology and radiology. Results: Eight patients with an orbital wall fracture with extraocular muscle entrapment confirmed by forced ductions were identified. The median age was 22 (range: 9 to 72) years with 6 (75%) males and 4 (50%) white. Mechanisms of injury included 3 (37.5%) sportsrelated, 2 (25%) assault, 2 (25%) motor vehicle collision, and 1 (12.5%) fall. Diplopia and pain with eye movements were the most common symptoms in 7 (87.5%) patients followed by nausea or vomiting in 3 (37.5%). No patients had syncope. Two patients (25%) were bradycardic with a pulse of less than 60 beats per minute; an additional 2 had a pulse of 60. All had restricted extraocular motility. Radiology accurately identified entrapment on CT in 3 (37.5%) cases and interpreted an additional 3 (37.5%) as suspicious for entrapment. Ophthalmology accurately identified entrapment on CT in 5 (62.5%) cases and interpreted an additional 1 (12.5%) as suspicious. Overall, ophthalmology correctly diagnosed entrapment in 5 (62.5%) cases based on clinical and radiographic data. Three (37.5%) patients were found to have entrapment on follow-up examination. In those patients whose entrapment was not diagnosed, forced ductions were not performed on initial evaluation. Conclusions: Diplopia and pain with eye movements were the most common symptoms of entrapment. Ophthalmology correctly identified more cases of entrapment on CT than radiology, but 3 cases were misdiagnosed by ophthalmology. We recommend high suspicion for entrapment when both diplopia and pain with eye movements are present and recommend performing forced ductions in all cases with definite or suspicious imaging and clinical findings. Commercial Relationships: Margaret L. Pfeiffer, None; Helen Merritt, None; Karina Richani, None; Margaret E. Phillips, None Support: National Eye Institute Vision Core Grant P30EY010608; Challenge Grant from Research to Prevent Blindness; Hermann Eye Fund Program Number: 564 Poster Board Number: B0022 Presentation Time: 1:30 PM–3:15 PM Quantitative Assessment of Ocular Motility Disturbance in Orbital Blow-out Fractures Jung Wook Lee1, EunHee Hong1, Moon sang won1, Heeyoon Cho1, Sei yeul oh2, Yoon Duck Kim2, Han Woong Lim1. 1Ophthalmology, Hanyang University Guri Hospital, Seoul, Korea (the Republic of); 2Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of). Purpose: To measure the range of ocular motility using modified limbus test (Fig 1) and to investigate the correlation with other factors in patients with blow out fractures. Methods: We enrolled 35 subjects with orbital blow-out fractures who presented ocular motility disturbance. We measured the maximum angle of ocular movements in the positions of restricted motility of gaze using modified limbus test (Fig 2). We evaluated number of points of contact of extraocular muscles to the fracture edge (points of muscle contact) and the extent of blow out fracture based on CT. The correlation between the degree of ocular motility disturbance and the associated factors was estimated with linear regression analysis. Results: The mean of the angle of ocular motility disturbance classified into grades 1,2,3, and 4 according to the clinical grage were 8.0±4.5°, 17.6±5.6°, 26.4±4.3°, and 40.2±8.3, respectively (P<0.001). The angle of ocular motility disturbance showed significant correlation with the clinical grading scale(R=0.730, P=0.015). The extent of blow out fracture and the number of points of contact of extraocular muscles to the fracture edge based on CT did not show significant correlation with the angle of ocular motility disturbance (R=0.250, P=0.127; R=0.453, P=0.072). Conclusions: The modified limbus test using photographs in the cardinal positions of gaze is an objective and reproducible tool for quantifying ocular motility disturbance in the posttraumatic evaluation of orbital blow-out fractures. The extent of blow out fracture and number of points of contact of an extraocular muscle to the fracture edge are not enough to predict posttraumatic limitation of ocular movement in patients with blow out fractures in this study. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Figure 1. Image processing by Photoshop and Image J for quantitative measurement of the ocular movement. A, Semitransparent image of depression was overlapped with the primary position image using Photoshop. B, The overlapping image was converted to identify the margin of the limbus using Photoshop. C, Geometrical analysis with Image J showing degrees of ocular rotation of the limbus. Additional data providing specific guidelines for SEM surgeries will make a strong impact on surgical planning and outcome. The purpose of this study was to formulate a nomogram for SEM strabismus surgery, rendering an effective reference and strategy. Methods: This retrospective chart review (13 years, January 2000 - April 2013) is a single centre study approved by University of British Columbia Research Ethics Board. We looked at the type of strabismus and the initial type of surgery performed. The orthoptics data pre- and post- SEM correction surgery was analyzed. We also gathered intraoperative data showing the position of the SEMs and the amount corrected. The primary analysis involved determination of how much correction of alignment was achieved (in prism diopters [PD]) per millimetre of the eye muscle corrected. Other data included gender, age at the time of initial surgery, visual acuity, timing of SEM at presentation (recent <6 weeks; distant >6 weeks), and pathology results. Results: Total of 70 patient [26 (37.1%) male, 44 (62.9%) female] were included in the study. Twelve (17.1%) cases were recent (<6 weeks) and 58 (82.8%) cases were distant (>6 weeks) events. Pseudotendon was identified clinically and/or pathologically in 67 (95.7%) cases. Effect of muscle advancement for slipped muscles ranged between 0.6 and 9.1 PD/mm. The average effect was 3.92 PD/ mm. The median effect was 3.76 PD/mm. Conclusions: The effect of SEM advancement can be very powerful but also unpredictable and variable. Other factors to consider in assessing each patient and performing the surgery are the quality of muscle and the tightness of the antagonists. It is also likely that sensory suppression and fusion play a major role in the outcome, particularly in the secondary strabismic patients. It is important to remember management and outcome of SEM surgery are multifactorial and surgeons must be aware of the variabilities for each case. Figure 2. An example of patient with blow-out fracture of right inferior wall. Semitransparent image of elevation was overlapped with the primary position image using Photoshop. The maximum angle of elevation in right eye (the injured eye) was 22.6° which was compared with 37.6° in left eye (the fellow eye). Commercial Relationships: Jung Wook Lee, None; EunHee Hong, None; Moon sang won, None; Heeyoon Cho, None; Sei yeul oh, None; Yoon Duck Kim, None; Han Woong Lim, None Program Number: 565 Poster Board Number: B0023 Presentation Time: 1:30 PM–3:15 PM Retrieval of Slipped Muscles: Strategies and Impact Ashley S. Ko1, Roy A. Cline2. 1Ophthalmology, University of Iowa, Iowa City, IA; 2Ophthalmology, University of British Columbia, Vancouver, BC, Canada. Purpose: Slipped extraocular muscle (SEM) is an important and serious complication of a strabismus surgery that is underdiagnosed, often leading to intolerable symptoms and inappropriate reoperations by misguided surgeons. Incidence and management data of SEM is rare. While reference tables with projected corrective change per millimeter of extraocular muscles correction with no previous surgery is readily available, no such reference tables are available for SEMs. Clinical appearance of slipped muscle seen intraoperatively. Commercial Relationships: Ashley S. Ko, None; Roy A. Cline, None Program Number: 566 Poster Board Number: B0024 Presentation Time: 1:30 PM–3:15 PM The role of the MRTFA-SRF pathway in fibroblast to adipocyte transdifferentiation in thyroid eye disease Lilani Abeywickrama. NHS, London, United Kingdom. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Purpose: Thyroid eye disease (TED) is a progressive autoimmune disease in which orbital fibroblasts transdifferentiate into adipocytes and extraocular muscles undergo fibrosis. Myocardin-related transcription factor A (MRTFA) is a co-factor of the transcription factor Serum Response Factor (SRF). MRTFA binds to cytoplasmic G-actin and translocates to the nucleus, upon stimulation of actin polymerization. The actin-MRTF-SRF circuit regulates the expression of target genes responsible for regulation of the actin cytoskeleton. The downregulation of MRTFA causes a decrease in SRF activation, which facilitates the conversion of fibroblasts to adipocytes. We hypothesize the two phenotypes, seen in TED, are associated with the SRF-MRTFA pathway. Our study focuses on how diseased cells differ from control cells in terms of their MRTFA content and how this relates to their propensity to differentiate into adipocytes. Methods: This project was divided into 3 sections: 1) Oil Red O staining to examine for the presence of adipocytes in TED cells; 2) Immunostaining for MRTFA and IGFR1 in diseased cells; and finally 3) Western Blot Analysis to determine whether levels of specific proteins (MRTFA, IGFR-1) are present in samples of affected cells. Results: Our results demonstrated that fibroblasts underwent adipocyte differentiation in vitro. We found a significantly high nuclear-cytoplasmic ratio in diseased cells that implied greater baseline activity of SRF-MRTFA in affected OF and our final experiment identified similar quantities of protein MRTFA in both control and TED cells. Conclusions: In conclusion, SRF-MRTFA is linked with the process of adipogenesis and a dual pathway is involved in the pathology of TED. Commercial Relationships: Lilani Abeywickrama, None Program Number: 567 Poster Board Number: B0025 Presentation Time: 1:30 PM–3:15 PM Systemic and Immune Thyroid Status in Hispanic Patients with Recently Diagnosed Thyroid Eye Disease at the Conde Valenciana Institute of Ophthalmology – Mexico City. A 7 year review Alberto Carlos Abdala Figuerola, Sharon Ball-Burstein, Angel Nava-Castaneda, Gerardo Graue-Moreno. Oftalmologia, Instituto Oftalmologia Fundacion Conde Valenciana, Mexico DF, Mexico. Purpose: To determine primary systemic and immune thyroid status in hispanic patients debuting with thyroid eye disease (TED). Methods: Retrospective, descriptive, transversal and comparative study. Thyroid status based on TSH levels, antithyroglobulin (TG Ab) and antithyroperoxidase (TPO Ab) levels and clinical activity score (CAS) were recorded for each patient at their first visit. Other relevant clinical and demographic data were obtained from the clinical records. Results: 60 patients (36 women and 24 men) were eligible for this study. 28 patients (47%) were hyperthyroid (17 on inflammatory/ active phase and 11 non-inflammatory/non active), 28 (47%) were euthyroid (20 on active phase and 8 non-active) and only 4 (6.6%) were hypothyroid (1 active and 3 non-active) at presentation. From the active phase patients (n= 38), 9 had positive TPO Ab (23%) while 11 had negative TPO Ab (28%), 7 had positive TG Ab (18%) and 13 had negative TG Ab (34%). From the non-active patients (n= 22), 3 had positive TPO Ab (13%), 4 had negative TPO Ab (18%), 5 had positive TG Ab (22%) and 3 had negative TG Ab (13%). A Spearman correlation test showed no evidence of significant correlation between TSH and antibodies levels regarding inflammatory activity as evaluated using the CAS classification. Conclusions: A distinctive, non previously reported distribution regarding endocrine and immune status was found in Hispanic TED patients, which reveals that as high as 47% of primary TED patients were euthyroid at the time of diagnosis. Interestingly, no correlation was found between active TED and the immune status of the patients regarding TPO and TG antibodies. Prospective studies with larger samples are warranted to confirm these findings. Commercial Relationships: Alberto Carlos Abdala Figuerola, None; Sharon Ball-Burstein, None; Angel Nava-Castaneda, None; Gerardo Graue-Moreno, None Program Number: 568 Poster Board Number: B0026 Presentation Time: 1:30 PM–3:15 PM Thyroid-associated ophthalmopathy: Epidemiologic characteristics in a reference institution in Mexico City. Paulina Nunez, Juan Carlos Serna-Ojeda, Alberto Abdala Figuerola, Osiris Olvera Morales. Instituto de Oftalmologia Conde de Valenciana, Mexico City, Mexico. Purpose: Describe the epidemiological characteristics in Mexican population with thyroid-associated ophthalmopathy and a comparison with other series reported in literature. Methods: A descriptive, retrospective and observational study was performed in the Thyroid Clinic of the Department of oculoplastic and orbital surgery in a reference institution through the revision of clinical records. Patients of any age and gender with confirmed diagnosis of thyroid-associated orbitopathy were included. We excluded patients with high myopia and other causes of proptosis, incomplete files, or patients with a history of any ocular surgery related to thyroid eye disease. The variables included in the study were sex, age, smoking history, thyroid status, exophthalmometry and presence of clinical signs like eyelid retraction at the time of first consultation through a thyroid profile. A descriptive investigation was performed for the variables according to its distribution and the intergroup analysis was done with Student’s t test. Results: A total of 241 patients, 187 (77.6%) females and 54 (22.4%) males were included. The 40 to 59 years interval was the predominant group (56.4%) for the presentation of the disease. In relation to smoking history, 42.3% of patients reported a positive history for smoking. The thyroid status that predominated at the time of diagnosis of thyroid-associated ophthalmopathy was euthyroidism with 47.3%. The exophthalmometry had a media of 19.8mm. The most common clinical sign was eyelid retraction in 83.4% of the patients. Conclusions: Variables such as age, sex and eyelid retraction presented in similar proportions to those reported in studies conducted in different countries and ethnic groups. In Mexican population the initial thyroid hormone status is variable and patients may present with eye manifestations despite of having a profile in normal ranges. Commercial Relationships: Paulina Nunez, None; Juan Carlos Serna-Ojeda, None; Alberto Abdala Figuerola, None; Osiris Olvera Morales, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 569 Poster Board Number: B0027 Presentation Time: 1:30 PM–3:15 PM Effect of Orbital Decompression on Corneal Topography in patients with thyroid ophthalmopathy Su Ah Kim1, Kui Dong Kang2, Ji Sun Paik1, Su Kyung Jung1, Suk-Woo Yang1. 1Ophthalmology, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea (the Republic of); 2Ophthalmology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea (the Republic of). Purpose: This study was performed to evaluate the changes of corneal astigmatism in patients undergoing orbital decompression surgery. Methods: This retrospective, nonrandomized comparative study comprised 42 eyes from 21 patients with thyroid ophthalmolpathy who underwent orbital decompression surgery between September 2011 and September 2014. The 42 eyes were divided into three groups: control (9 eyes), two wall decompression (24 eyes), and three wall decompression (8 eyes). Control was defined as the contralateral eyes of 9 patients who underwent orbital decompression surgery only in one eye. Corneal topography (Orbscan II), Hertel exophthalmometry, and intraocular pressure were measured at 1 month before and 3 months after surgery. Corneal topographic parameters analyzed were the total astigmatism(TA), steep axis(SA), central corneal thickness(CCT), and anterior chamber depth(ACD). Results: Exophthalmometry values and intraocular pressure were significantly decreased after the decompression surgery. The change (the absolute value (|x|) of the difference) of astigmatism at 3mm zone was significantly different between the decompression group and the control (P = .0250). There was also significant change of the steepest axis at 3mm zone between the decompression group and the control (P = .0331). An analysis of relevant changes in astigmatism showed that there is a dominant tendency of incyclotorsion of the steepest axis in eyes which underwent decompression surgery. Using Astig PLOTTM, the mean surgically induced astigmatism (SIA) was 0.21±0.88D with the axis of 46±22° which suggest that decompression surgery did change the corneal shape and induced incyclotorion of the steepest axis. Conclusions: There is a significant change in corneal astigmatism after orbital decompression surgery and this change is sufficient to affect the optical function of the cornea. Surgeons and patients should be aware of these changes. Commercial Relationships: Su Ah Kim, None; Kui Dong Kang, None; Ji Sun Paik, None; Su Kyung Jung, None; Suk-Woo Yang, None Program Number: 570 Poster Board Number: B0028 Presentation Time: 1:30 PM–3:15 PM Surgical treatment of proptosis secondary to Thyroid Eye Disease without a cutaneous incision Paul Petrakos1, Benjamin M. Levine1, Ashutosh Kacker2, Aaron Pearlman2, Gary J. Lelli1. 1Ophthalmology, Weill Cornell Medical College, New York, NY; 2Otolaryngology, Weill Cornell Medical College, New York, NY. Purpose: To evaluate the improvement of proptosis secondary to Thyroid Eye Disease in patients treated surgically without the use of a cutaneous incision. Methods: A retrospective study of 24 eyes of 13 patients who were surgically treated for proptosis secondary to Thyroid Eye Disease (TED) without the use of a cutaneous incision. Patients included in the study underwent either (1) bony decompression (endoscopic medial orbital wall and orbital floor decompression with removal of bone with or without fat), or (2) orbital fat decompression. Pre- operative and post-operative Hertel measurements, as well as patient satisfaction, were documented to assess surgical outcomes. Results: The average pre-operative Hertel measurement for all eyes was 24mm (SD 3.75), 25mm (SD 4.96) for the bone decompression group (n=8), and 23mm (SD 1.69) for the fat decompression group (n=8). The average post-operative Hertel measurement for all eyes was 19.6mm (SD 1.08), 19.8mm (SD 1.39) for the bone decompression group (n=8), and 19.4mm (SD 0.69) for the fat decompression group (n=8). The mean post-operative improvement in Hertel measurement for all patients regardless of surgical modality was 4.6mm (SD 3.03) with a two-tailed p value <0.0001. For the eyes that underwent bone decompression improvement was 5.3mm (SD 3.65), while fat decompression was 3.9mm (SD 2.28). The difference in proptosis between the two different surgical groups was not statistically significant (p=0.373). Hertel pre and post-operative measurements were not recorded for 8 patients. Subjectively all patients (100%) reported satisfaction with their post-operative outcomes. No postoperative infections or inadequate decompression were seen in any cases. One patient required subsequent strabismus surgery for diplopia, but had a history of strabismus and patching as a child. Conclusions: Orbital decompression with removal of bone or orbital fat decompression without the use of a cutaneous incision is an efficacious and safe modality for the treatment of proptosis in TED patients. There was a statistically significant improvement in proptosis for all patients treated surgically. The difference between the two surgical groups was not statistically significant. Employing this modality in aesthetically-minded patients who are concerned over the potential for a cutaneous scar may be advantageous. Commercial Relationships: Paul Petrakos, None; Benjamin M. Levine, None; Ashutosh Kacker, None; Aaron Pearlman, None; Gary J. Lelli, None Program Number: 571 Poster Board Number: B0029 Presentation Time: 1:30 PM–3:15 PM Comparative study of ganglion cell-inner plexiform layer (GCIP) and circumpapillary retinal nerve fiber layer (cpRNFL) measurements by spectral-domain optical coherence tomography for the detection of dysthyroid optic neuropathy Wai U IAO, Kam-lung, Kelvin K. Chong. The Chinese University of Hong Kong, Hong Kong, Hong Kong. Purpose: To compare ganglion cell-inner plexiform layer (GCIP) and circumpapillary retinal nerve fiber layer (cpRNFL) measurements in thyroid associated orbitopathy (TAO) eyes with no, suspected and definite dysthyroid optic neuropathy (DON). Methods: Retrospective, cross-sectional study. Thirty-four TAO eyes, including 10 eyes with no DON, 7 with suspected DON and 17 with definite DON were analyzed. All subjects received complete ophthalmic evaluation, visual field (VF) examination with the Humphrey Visual Field Analyzer and optical coherence tomography (OCT) imaging in the macular and circumpapillary regions with Cirrus HD-OCT. Mann-Whitney U tests were used to compare GCIP and cpRNFL thicknesses among the three groups with bootstrap resampling with 10000 replications using one eye from each subject. Results: The median GCIP thickness was 83.46 mm for the group with no DON, 81.30 mm for the group with suspected DON, and 78.02 mm for the group with definite DON. Reduced GCIP thickness was observed in the definite DON group (p < 0.017, after Bonferroni adjustments) when compared with the groups with no or suspected DON. The comparison of cpRNFL thickness among different groups showed no significant differences. Conclusions: In patients with TAO, GCIP thickness with SD-OCT is a better objective test than cpRNFL for detection of optic neuropathy. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Wai U IAO, None; Kam-lung, Kelvin K. Chong, None Program Number: 572 Poster Board Number: B0030 Presentation Time: 1:30 PM–3:15 PM Outcomes of Surgical Management of Thyroid Eye Disease: A Single-Centre Retrospective Study Jia Quan Chaung1, 2, Raghuraj Hegde1, Shantha Amrith1, Inez Wong1, Siew Shuen Chao1, Gangadhara Sundar1. 1Ophthalmology, National University Hospital, Singapore, Singapore; 2National University of Singapore, Singapore, Singapore. Purpose: To study the outcomes of surgical management of thyroid eye disease (TED) in a South East Asian Population Methods: Retrospective single-centre case series of all TED patients requiring surgery from Nov 2002 to August 2014 by 2 Oculoplastic surgeons. Data recorded included demographic data, pre-operative and post-operative visual acuity and exophthalmometry for orbital decompression; ocular alignments, revision surgeries for both strabismus and eyelid retraction. Results: Of the 336 TED patients seen, 57 patients underwent surgery, 24 male (42.1%) and 33 female (57.9%). Ethnicity: Chinese (73.7%), Malay (14.0%), Indian (5.3%), Others (7.0%). Mean age was 44.2 years (Range 2-81). Surgical indications: Eyelid retraction (52.6%), proptosis (45.7%), cosmesis (33.3%), Exposure Keratopathy (10.5%), Compressive optic neuropathy (8.8%). Surgical procedures included orbital decompression (54.4%), eyelid surgery (52.6%) and strabismus surgery (24.6%). 60 orbits of 31 patients were decompressed: 2-wall (36.7%), pure fat (23.3%) 3-wall (21.7%), 1-wall (18.3%). Medial wall access – retrocaruncular (61.1%) or endonasal (38.9%). Most 2-wall decompressions involved balanced lateral and medial walls (72.7%). The mean reduction in exophthalmometry was 4.5mm (Range -2 - 17) with an improvement of at least one Snellen line in 62.9% of patients. Rate of induced strabismus was 3.2%. Strabismus surgery was performed on 23 eyes of 14 patients of which 1 required surgical revision. Medial rectus was most frequently recessed (34.6%). Diplopia was resolved in 85.7%. Most eyelid surgeries involved the upper lid (55.1%) and Muller’s muscle resection (69.7%). Mean reduction of MRD by 1.5mm. Satisfaction with appearance was achieved in 89.7% while 20.7% of eyelid surgeries required revision. Other eyelid procedures performed included entropion surgery, permanent tarsorrhaphy, epiblephron repair, ptosis repair and blepharoplasty. Conclusions: Surgery for TED is not uncommon in our SouthEast Asian population. Orbital decompression was efficacious in reducing proptosis and improving visual acuity. Complications observed included diplopia and paresthesia. Strabismus and eyelid surgery were used to effectively reduce diplopia and lid retraction respectively. However, they may require revision surgeries to achieve adequate correction. Commercial Relationships: Jia Quan Chaung, None; Raghuraj Hegde, None; Shantha Amrith, None; Inez Wong, None; Siew Shuen Chao, None; Gangadhara Sundar, None 138 Pupil Sunday, May 03, 2015 1:30 PM–3:15 PM Exhibit Hall Poster Session Program #/Board # Range: 573–586/B0031–B0044 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 573 Poster Board Number: B0031 Presentation Time: 1:30 PM–3:15 PM Divergent effects of rapid and slow photoreceptor degenerations on the pupil light reflex of mice. Stewart Thompson, Gabrielle Bui, Pratibha Singh, Xiu-Ying Liu, Randy H. Kardon, Edwin M. Stone. Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA. Purpose: Pupillometry is increasingly being applied as a measure of retinal function in the clinic and in laboratory studies of inherited retinal disease. However, the pupil light reflex axis is complex and the effects of diverse disease mechanisms and pathologies on pupil function are poorly understood. The purpose of this study was to determine how two distinct disorders of the rod and cone photoreceptor cells affected the pupil response in mice. Methods: We measured the pupillary light reflex in mice with early and (rd1) and slow (Rd2P90) degeneration of the rod and cone photoreceptor cells. At 90 days of age, Rd2 mice retain ~60% of rods and cones, but these cells lack an outer segment making them relatively insensitive to light. The effect of disease on the melanopsin and rod/cone generated components of the pupil response were assessed using 1-s red and blue, and 60-s blue stimuli at 0.01, 0.1, 1.0 and 10.0 μW.cm-2. Results: Responses were severely reduced in rd1, having low amplitude and no post-stimulus residual constriction even at the highest irradiance. Remarkably, in Rd2P90 mice, responses were only slightly reduced in compared to wild-type, with a deficit more apparent to red than blue light. Indeed, there was no apparent difference in post-stimulus residual constriction and steady state responses at higher irradiances. Conclusions: In rd1 mice, deficits in pupil responses largely track deficits in rod/cone function: requiring 5-log units higher irradiance to elicit responses to brief stimuli. However, the limited reduction in sensitivity in Rd2P90 mice did not reflect the severity of the structural or functional deficit in the rod and cone photoreceptor cells. In our previous work, an unexpectedly high amplitude ERG b-wave (12% of wild-type) pointed to an outer-retinal signal gain mechanism. These pupillometry data suggest there may be additional signal gain mechanisms acting on the pupil light reflex axis in slow photoreceptor degeneration of Rd2P90 mice. Commercial Relationships: Stewart Thompson, None; Gabrielle Bui, None; Pratibha Singh, None; Xiu-Ying Liu, None; Randy H. Kardon, None; Edwin M. Stone, None Support: Stephen A. Wynn Institute for Vision Research Program Number: 574 Poster Board Number: B0032 Presentation Time: 1:30 PM–3:15 PM Characterization of the pupil responses to selective wavelength (colored) light stimulation in Rhodopsin knockout (Rho-/-) mice during retinal degeneration Corinne Kostic1, Sylvain V Crippa1, Catherine Martin1, Randy H. Kardon2, Yvan Arsenijevic1, Aki Kawasaki1. 1Dpt of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland; 2Department of Ophthalmology and Visual Science, University of Iowa, Iowa, IA. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Purpose: Pre-selected light stimuli were used to characterize the pupillary light reflex (PLR) and monitor its modification during retinal degeneration in the Rho-/- mouse model. Methods: Wild type SV129 (n=6 to 9) and Rho-/- mice (n= 4 to 9, age 1 month to 6 months) were all tested following overnight dark adaptation. An alternating, full-field red and blue light of short duration (500 milliseconds) and of increasing intensity over 4 log-units was used to stimulate one eye. The pupil response of the stimulated eye was recorded continuously using the A2000 Neuroptics system. The initial response during the first 2.5 seconds (s) following the stimulus onset was described from maximal contraction amplitude and the dynamics of immediate recovery from this maximal contraction. Results: Compared to wild type mice, one month-old Rho-/- mice showed decreased maximal contraction amplitude to all blue and red light stimuli except at the highest intensity blue stimulus (2 loglux). With increasing age and progressive photoreceptor degeneration, the amplitude of this maximal contraction and the dynamic of the initial response are differently affected depending on the intensity and wavelength of the stimuli. Following low and intermediate red stimuli, the maximal contraction was reduced drastically while contraction amplitude to high intensity red stimuli remained relatively prserved. Following low blue stimulation, the contraction amplitude is maintained despite the progression of the photoreceptor degeneration. However, the early dynamic of the initial response is modified with age with the loss of the characterized rapid partial recovery observed with the first 2.5 s revealing the loss of photoreceptor input to the initial response. Conclusions: The Rho-/- model to study PLR responses provides one model to study functional responses during the selective and sequential loss of rods and cones. With progressive rod and cone loss, the input of melanopsin photoreception to the pupil light reflex proportionately increases and may be the only remaining photosensitive cells at end-stage. The loss of photoreceptors during degeneration in the Rho-/- model affects the PLR response to blue light differently compared to red stimuli. Commercial Relationships: Corinne Kostic, None; Sylvain V Crippa, None; Catherine Martin, None; Randy H. Kardon, None; Yvan Arsenijevic, None; Aki Kawasaki, None Support: Provisu foundation Program Number: 575 Poster Board Number: B0033 Presentation Time: 1:30 PM–3:15 PM Chromatic pupillography in patients with Achromatopsia Jolanta Lisowska1, 2, Lucasz Lisowski1, 2, Carina Kelbsch3, 2, Torsten Strasser2, Ditta Zobor3, Helmut Wilhelm2, 3, Barbara Wilhelm2, Tobias Peters2. 1Medical University of Bialystok, Bialystok, Poland; 2Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany; 3Department for ophthalmology, University of Tuebingen, Tuebingen, Germany. Purpose: The aim of the study was to characterize the function of rods, cones and intrinsic photosensitive retinal ganglion cells (ipRGCs) in patients with Achromatopsia by using a new, diseasespecific protocol for chromatic pupillography. Methods: 4 Patients with Achromatopsia were tested after 10 min light adaptation with stimulus duration of 4ms and 1s using shortwavelength (420nm; blue) and long-wavelength (605nm; red) with stimulus intensities of 0,01 lux corneal illumination. Higher illumination 28 lux was used for 1s short wavelength and longwavelength stimulus. The same stimulus conditions were repeated after 20 min dark adaptation. For every stimulus the consensual pupil response was recorded by using Compact Integrated Pupillography (CIP by AMTech, Germany). Pupillary responses were compared with 4 age- matched controls. Relative amplitudes (percent of initial pupil diameter) of pupillary light reactions were evaluated as an average of four reliable pupil traces. Results: After light adaptation, the stimulation with 4ms and 1s short-wavelength and long wavelength stimulus of 0,01 lux corneal intensity did not show any responses either in Achromatopsia patients or normal subjects. Compared to normal subjects, patients with Achromatopsia showed a reduction of the pupil response to 1s short-wavelength and long-wavelength bright stimulus (28 lux) in the light adapted state. In addition, after 1s short- wavelength light stimulus (28 lux) in dark adapted state Achromatopsia patients had smaller amplitudes compared to controls. Similar responses of patients with Achromatopsia and normal subjects were obtained after dark adaptation when using the long-wavelength stimuli of 28lux intensity. In contradiction, Achromatopsia patients showed higher amplitudes than normal controls to 4ms, 1s short-wavelength and long-wavelength light stimuli of 0,01 lux intensity in the dark adapted state. Conclusions: Pupil responses to chromatic stimuli indicate a hypersensitivity of rod photoreceptors to low-intensity light stimuli after 20 minutes dark adaptation (Achromatopsia patients compared to controls). The presented stimulus protocol for chromatic pupillography seems an easy applicable, non-invasive tool for the diagnosis of Achromatopsia. As an objective and easy test method it may be useful for clinical trials with novel interventions in order to monitor treatment effects in Achromatopsia patients. Commercial Relationships: Jolanta Lisowska, None; Lucasz Lisowski, None; Carina Kelbsch, None; Torsten Strasser, None; Ditta Zobor, None; Helmut Wilhelm, None; Barbara Wilhelm, None; Tobias Peters, None Support: Egon Schumacher-Stiftung, Germany Program Number: 576 Poster Board Number: B0034 Presentation Time: 1:30 PM–3:15 PM Study of the pupil light reflex in patients with Obstructive Sleep Apnea Gloria L. Duque-Chica1, 2, Carolina Gracitelli3, Ana Laura D. Moura1, 3, Balázs V. Nagy1, 4, Geraldine de Melo3, Michel B. Cahali5, Augusto Paranhos3, Dora F. Ventura1, 2. 1Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil; 2Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), Universidade de São Paulo, São Paulo, Brazil; 3Departamento de Oftalmologia, Universidade Federal de São Paulo, São Paulo, Brazil; 4Department of Mechatronics, Optics and Engineering Informatics, University of Technology and Economics, Budapest, Hungary; 5Departamento de Otorrinolaringologia do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Purpose: To investigate the impact of obstructive sleep apnea (OSA) on the vision of patients through the contribution of the inner and outer retinae (melanopsin ganglion cells, cone and rod photoreceptors, respectively) to the pupillary light reflex (PLR). Methods: 56 eyes from 18 patients with OSA aging from 36-64 years (mean age of 51.26 ± 7.84 years, 9 females) and 13 healthy control participants aging from 39-74 years (mean age of 54.15 ± 9.59 years, 11 females) were studied. All were submitted to a complete ophthalmological exam. OSA severity was quantified by the number of apneas and hypopneas per hour during polysomnography using the Apneas/hypopneas index (AHI) from moderate (15≤AHI<30, 17 eyes) to severe (AHI≥30, 15 eyes). PLR was measured with an eye tracker (View Point, Arrington); stimuli were presented in a Ganzfeld (Q450, Roland). Pupil responses were measured monocularly, to 1s blue (470 nm) and red (630 nm) flashes with -3, -2, -1, 0, 1, 2, and 2.4 log cd/m2 luminances. The normalized peak amplitude (PA) of ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology the PLR and the amplitude of the sustained response (SR) at 6-8 s (median value) after the light offset were measured. Mann-Whitney U test was used for comparison among groups. Results: The PA for blue stimuli was smaller for patients with severe OSA compared to controls from -2 to 1 log cd/m2 (p<0.025). The red PA was significantly (p<0.05) reduced in moderate and severe OSA patients, respectively at 1 and 2 log cd/m2; and at -1, 1 and 2.4 log cd/ m2. Relative to controls, the SR for blue stimuli was smaller at -2 and 0 log cd/m2 in severe OSA (p<0.05). Conclusions: To our knowledge, this is the first report using PLR to investigate inner and outer retinal function in patients with OSA. Patients with severe OSA had reduced rod and cone contributions to the PLR. They also showed reduced melanopsin-driven responses (but not statistically significant) compared to controls. In moderate OSA only the cone response was reduced. Our data allow to conclude that there is an association between number of apneas in OSA patients and reduced contributions of the outer retinae to PLR. Commercial Relationships: Gloria L. Duque-Chica, None; Carolina Gracitelli, None; Ana Laura D. Moura, None; Balázs V. Nagy, None; Geraldine de Melo, None; Michel B. Cahali, None; Augusto Paranhos, None; Dora F. Ventura, None Support: CAPES, FAPESP 2013/03553-0 Program Number: 577 Poster Board Number: B0035 Presentation Time: 1:30 PM–3:15 PM Test–Retest Reliability of Hemifield, Central-field and Fullfield Chromatic Pupillometry For Assessing the Function of Melanopsin-containing Retinal Ganglion Cells Shaobo Lei3, Herbert C. Goltz2, 3, Manokaraananthan Chandrakumar1, Agnes M. Wong1, 2. 1Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada; 2 Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; 3Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada. Purpose: The post-illumination pupil response (PIPR) is an index of melanopsin-driven intrinsically photosensitive retinal ganglion cell (ipRGC) activity. Hemifield analysis of PIPR may have important clinical implications. We developed a novel method to induce PIPR during hemifield stimulation and evaluated the test–retest reliability of current methods of measuring PIPR under hemifield, central-field and full-field stimulation. Methods: Pupil response was recorded with an eye tracker in 10 visually normal subjects (6 females, mean age 30 years, range 1956). Light stimuli were presented using a Ganzfeld screen with a custom built device to control the extent of retina being stimulated. Blue light stimulation at 400 cd/m2 intensity was presented for 400 ms to the lower and upper halves of the central 30° (hemifields), central 30° (central-field) and full-field to induce PIPR. Red fullfield stimulations at the same intensity and duration were also presented as an internal control condition. Test-retest reliability of the PIPR measures were assessed by calculating the intra-class correlation coefficient (ICC) of 6 repetitions for lower and upper hemifield stimulation, and 3 repetitions for central-field and full-full stimulation. Results: Hemifield, central-field and full-field blue light stimulation induced increasingly greater PIPR in ascending order, while fullfield red light stimulation induced no PIPR. Mean lower and upper hemifield PIPR were highly symmetric (Figure 1). Mean ICC of blue light PIPR was 0.87 for lower/upper hemifield, 0.88 for central-field, and 0.94 for full-field stimulation. Conclusions: We described a convenient yet reliable method to measure PIPR induced by hemifield, central-field and full-field light stimulation. Good PIPR measurement reliability was obtained under all viewing area conditions. This protocol will facilitate the clinical applications of PIPR testing. Figure 1: Mean pupil responses from 10 visually-normal subjects. Pupil diameter data were normalized to baseline recording for 5 s prior to the onset of blue or red light stimulation (400ms, 400cd/m2). LHF, Lower Hemifield; UHF, Upper Hemifield; CF, Central-field; and FF, full-field. Commercial Relationships: Shaobo Lei, None; Herbert C. Goltz, None; Manokaraananthan Chandrakumar, None; Agnes M. Wong, None Support: Supported by the Canada Foundation for Innovation, John and Melinda Thompson Endowment Fund for Vision Neuroscience Program Number: 578 Poster Board Number: B0036 Presentation Time: 1:30 PM–3:15 PM Pupillary post-illumination response is dissociated from visual function in OPA1 c.983A>G and c.2708_2711delTTAG autosomal dominant optic atrophy Claus Nissen, Cecilia Rönnbäck, Birgit Sander. Eye Department Ø 37, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. Purpose: To examine whether the intrinsically photosensitive retinal ganglion cells (ipRGCs) are preserved in genetically confirmed autosomal dominat optic atrophy (ADOA). Methods: 29 patients, aged 18 to 72 years, with either the c.983A>G (n=14) or the c.2708_2711delTTAG mutation (n=15) were examined with monochromatic pupillometry, using isoluminant (300 cd/m2) red (660 nm) or blue (470 nm) light, optical coherence tomography (OCT), automated visual field analysis (VFA), and with determination of best corrected visual acuity (BCVA). Since two different mutations were examined, initially we compared all outcome variables between the two, and finding no statistically significant difference (p> 0.05) between them, we pooled them and compared this sample of 29 patients to an age matched control group of 40 healthy controls Results: BCVA was poor (56 letters ETDRS, compared with 91 letters in controls, p<0.0001, t-test) in the ADOA patients, but their post-illuminatory pupil response (PIPR) did not differ significantly from those of an age matched control group (blue light: ADOA/controls = 1.04, p=0.45; red light: ADOA/controls = 1.06, p=0.49, t-tests) and no statistically significant effect was noted of peripapillary retinal nerve fiber layer thickness, ganglion cell-inner plexiform layer thickness or age. Conclusions: The pupillary light reflex (PLR) to blue light of 300 cd/m2 was preserved in both mutations despite severe visual loss and optic nerve atrophy. The study confirms, in a large study of two genetically homogeneous groups, that the intrinsically photosensitive ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology retinal ganglion cells (ipRGCs) are spared in ADOA, and that the decline of their function with age is nonsignificant as compared with that of a healthy control group. Commercial Relationships: Claus Nissen, None; Cecilia Rönnbäck, None; Birgit Sander, None Program Number: 579 Poster Board Number: B0037 Presentation Time: 1:30 PM–3:15 PM Chromatic multifocal pupillometer for objective perimetry Ifat Sher-Rosenthal1, 2, Ron Chibel1, Soad H. Yahia1, Mohamad O. Mahajna1, Daniel Ben-Ner1, Michael Belkin1, 2, Ygal Rotenstreich1, 2 1 . Goldschleger Eye Research Institute, Sheba Medical Center, Tel Hashomer, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Purpose: We present infrared chromatic multifocal pupillometry for objective perimetry and determination of retinal cell function in healthy subjects and patients with macular and retinal degeneration. Methods: A computerized infrared video pupillometer was used to record pupillary responses to short- and long-wavelength stimuli (peak 485 nm and 620 nm, respectively) presented by 76 LEDs, 1.8mm spot size, at increasing light intensities of 10-500 cd/m2 and duration of 1 sec at different points of the 30 degree visual field. Latency, amplitude, constriction velocity and re-dilation velocity of pupillary responses were measured in 19 retinal and macular dystrophy patients and 40 aged-matched controls. Results: Comparison between control and retinal dystrophy patients demonstrated statistically significant differences (p<0.05) in amplitude and constriction velocity in vast majority (69) of locations in response to short-wavelength stimuli and mostly in peripheral targets in response to long-wavelength stimuli. Macular dystrophy patients demonstrated significantly lower pupillary responses to long wavelength stimuli in majority of the visual field and nearly normal pupillary responses to short wavelength stimuli in majority (58) of visual field locations. High consistency was observed in pupillary responses recorded in serial testing (P<0.001, R=0.74 for longwavelength and P<0.001, R=0.683 for short-wavelength, n=870). Conclusions: This study demonstrates the feasibility of using pupillometer-based chromatic perimetry for objective assessment of visual field defects. The device requires minimal patient cooperation and demonstrates defects in rods or cones preferentially according to the light stimuli. Commercial Relationships: Ifat Sher-Rosenthal, None; Ron Chibel, None; Soad H. Yahia, None; Mohamad O. Mahajna, None; Daniel Ben-Ner, None; Michael Belkin, None; Ygal Rotenstreich, Accutome Inc (F) Support: Maratier Institute (TAU), Baharav grant (TAU), Accutome Research Fund (USA) Clinical Trial: NCT02014389 Program Number: 580 Poster Board Number: B0038 Presentation Time: 1:30 PM–3:15 PM Color pupillography in Glaucoma and Ocular Hypertension - the role of the intrinsically photosensitive retinal ganglion cells Carina Kelbsch, Fumiatsu Maeda, Torsten Strasser, Tobias Peters, Helmut Wilhelm, Barbara Wilhelm. University of Tübingen, Pupil Research Group at the Centre for Ophthalmology, Tübingen, Germany. Purpose: Intrinsically photosensitive retinal ganglion cells (ipRGCs) mediate the sustained post-illumination pupil response (PIPR) following a visual stimulation with bright blue light. The purpose of this study was to quantify this PIPR by means of color pupillography in manifest glaucoma and ocular hypertension to find out how ipRGCs are involved respectively and whether color pupillography could be a useful tool for glaucoma diagnostics. Methods: 25 patients with manifest glaucoma, 16 patients with ocular hypertension and 16 healthy control subjects were examined by stimulating one eye with either red (605nm) or blue (420nm) colored light of 28 lx intensity and a stimulus duration of either 1s or 4s. The consensual pupil light reaction was recorded by means of infrared pupillometry over a period of 16 seconds. As primary variable the post-illumination pupil response, PIPRblue-red, was calculated and compared using t-test (Tukey-Kramer) for statistical analysis. Results: Using the 1s stimulus conditions we found significant differences of the PIPRblue-red between glaucoma and normals (p<0,001) and between glaucoma and ocular hypertension (p<0,007) whereas there was no significant difference between ocular hypertension and normals (p=0,9). However, when applying the 4s stimulus conditions we could only identify significant differences between glaucoma and normals if the PIPR was calculated starting 2s after stimulus offset. This may be explained by strong differences in the dynamics (slope of the fitted line) of the pupillary responses during the 4s red stimulus between the groups (p<0,001). Conclusions: We demonstrated a significantly reduced PIPR in manifest glaucoma that was consistent with the hypothesis of an early impairment of the ipRGCs in glaucoma. Furthermore we observed a pupillary escape during the 4s red stimulus in the glaucoma group that cannot be fully explained so far but indicates an interaction of ipRGCs and outer photoreceptors. Commercial Relationships: Carina Kelbsch, None; Fumiatsu Maeda, None; Torsten Strasser, None; Tobias Peters, None; Helmut Wilhelm, None; Barbara Wilhelm, None Support: Egon-Schumacher-Stiftung, Germany Program Number: 581 Poster Board Number: B0039 Presentation Time: 1:30 PM–3:15 PM Ocular determinants of pupillary light responses to red and blue light: a population-based study Sourabh Sharma1, Baskaran Mani1, Rukmini A. V2, Hla M. Htoon1, Tin Aung1, Joshua Gooley2, Dan Milea1. 1Singapore Eye Research Institute, Singapore, Singapore; 2Duke-NUS, Singapore, Singapore. Purpose: The pupillary light reflex is assumed to be primarily governed by neural responses to light. The aim of this study was to explore the potential influence of ocular anatomical factors on pupillary responses to light at different wavelengths and intensities, using a novel pupillometer. Methods: In this cross-sectional, population-based study, we included 177 normal subjects (94.4% ethnic-Chinese, 65.5% female), recruited from a general Polyclinic population. Direct pupillary responses to continuously increasing irradiances (6.8 to 13.8 log photons cm-2 s-1) of red (631nm) and blue (469nm) light were measured, using an infra-red pupillometer. Swept source Optical Coherence Tomography performed in mesopic light allowed measurement of lens vault (LV), anterior chamber width (ACW), iris thickness (IT), iris volume and iris curvature (IC). Axial length (AL), Anterior chamber depth (ACD) and lens thickness (LT) were measured by noncontact partial coherence laser interferometry. Univariate and multivariate regression analyses were performed to determine ocular and systemic factors correlated associations with pupillometry measurements. Results: Pupil diameter measured in darkness was negatively correlated with age (β = -0.334, p < 0.001). The amplitude (β = -0.233, p = 0.006) and latency (β = 0.205, p = 0.014) of pupillary constriction to blue light were associated with age. The iris thickness was correlated with the amplitude of constriction to both blue (β = ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology -0.321, p < 0.001) and red light stimuli (β = -0.336, p < 0.001). Other ocular parameters (LV, ACW, Iris volume, IC, AL, ACD, LT and refractive errors) were not significantly associated with pupillometric outcomes. The pupil responses to blue light were more invariable, as compared to the red light, in terms of latency (p<0.001), amplitude (p<0.001) and velocity (p<0.001) of constriction. Conclusions: Pupillary responses to chromatic stimuli may be affected by anterior segment parameters. Iris thickness seem to affect pupillary responses to both blue and red light. Additional colour pupillometric studies coupled with simultaneous anterior segment video OCT recordings are needed in order to confirm these preliminary results. Commercial Relationships: Sourabh Sharma, None; Baskaran Mani, None; Rukmini A. V, None; Hla M. Htoon, None; Tin Aung, None; Joshua Gooley, None; Dan Milea, None Support: Singapore National Eye Centre HREF Grant: R1005/20/2013 Program Number: 582 Poster Board Number: B0040 Presentation Time: 1:30 PM–3:15 PM Pupillary Response to Corneal Mechanical Stimulation. Emmanuel B. Alabi, Varadharajan Jayakumar, Yunwei Feng, Trefford L. Simpson. SCHOOL OF OPTOMETRY AND VISION SCIENCE, UNIVERSITY OF WATERLOO, Waterloo, ON, Canada. Purpose: Ocular somatosensory-autonomic reflexes play critical roles in maintaining homeostasis of the eye. The purpose of this study was to examine the pupil reflex before and after delivery of nociceptive corneal mechanical stimuli. Methods: Using a computerized Belmonte pneumatic esthesiometer, mechanical stimuli from levels of detection threshold to twice (2x) the threshold in 0.5x steps were delivered in random order to the central cornea of 15 healthy subjects, aged 20 - 55 years. Threshold was estimated using an ascending method of limits. Contralateral pupil imaging was performed using a modified Logitech c920 digital camera (Logitech c920; Logitech International S.A., Newark, CA) for 5 seconds before and after the stimulus. Consensual pupil sizes were then measured (average of horizontal and vertical measures) using ImageJ software (NIH, Bethesda, MD). Statistical analyses were performed using Statistica 8.0 (StatSoft Inc., Tulsa, OK) and P ≤ 0.05 was considered statistically significant. Repeated-measures ANOVA and post hoc Tukey HSD tests were used to examine the effect of intensity on pupil size. Results: The figures below show 8-bit processed images of the contralateral pupil before and after delivery of the painful corneal stimulus. The average pupil sizes were 5.82 ± 0.66mm (before stimulus delivery), 6.41 ± 0.63mm (at threshold), 6.62 ± 0.65mm (1.5x threshold) and 6.97mm ± 0.79 (2x threshold). Pupil sizes increased with increasing stimulus intensity (P < 0.05) and the maximum mechanical stimulus intensity induced the largest pupil sizes (all P < 0.05). Conclusions: Noxious, mechanical, central, corneal stimuli evoke dose dependent sympathetic autonomic consensual pupillary dilation. This study serves as a basis for the characterization of the local stimulus-response neural circuitry relating nociceptive stimuli to autonomic responses. Commercial Relationships: Emmanuel B. Alabi, None; Varadharajan Jayakumar, None; Yunwei Feng, None; Trefford L. Simpson, None Support: NSERC - Canada Program Number: 583 Poster Board Number: B0041 Presentation Time: 1:30 PM–3:15 PM A New Pupil Light Reflex Test for Detecting Optic Neuropathy Independent of the Fellow Eye Which Highly Correlates to Visual Field Volume Pieter Poolman1, 2, Susan C. Anderson1, 2, Jade Grimm2, Jan M. Full1, 2 , Matthew Thurtell1, 2, Michael Wall1, 2, Randy H. Kardon1, 2. 1Iowa City VA Health Care System, Iowa City, IA; 2Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA. Purpose: Our purpose was to develop and test a new paradigm for detecting optic nerve disease in one eye, independent of the fellow eye, so that patients with bilateral involvement can be diagnosed and monitored using objective pupil responses. We also sought to determine which stimulus light condition and pupil response parameter (transient vs. sustained contraction) would provide the greatest difference between normal and abnormal eyes and the highest correlation with visual field sensitivity. Methods: 39 patients seen in the neuro-ophthalmology clinic and 44 normal subjects were prospectively tested by computerized pupillometry (NeurOptics DP2000, Irvine, CA) using a 1 second red or blue light stimulus at 1 lux and 400 lux. The percent pupil contraction from baseline pre-stimulus size was calculated for the transient, initial response to the light stimulus and the sustained pupil contraction at 6 seconds following offset of light. Visual fields were obtained using standard kinetic Goldmann perimetry and the volume of visual field sensitivity was determined and correlated with pupil responses. Results: We found the greatest statistically significant separation between eyes of normal subjects vs. those with optic neuropathy occurred with the transient pupil contraction using the 1 second, 400 lux blue light, compared to the sustained post-illumination contraction. In response to 400 lux blue light, the transient contraction gave the highest correlation with volume visual field (r=0.85) compared to the sustained contraction (r=0.52). Conclusions: The transient pupil contraction to bright blue light provides an objective, easily recordable reflex, which correlates well with visual field sensitivity. Under these stimulus conditions, both photoreceptor input and direct activation of photosensitive retinal ganglion cells summate the visual field input to the brain. This approach provides a clinical tool for estimating visual dysfunction that has important applications for remote diagnosis and monitoring of vision threatening disorders. Commercial Relationships: Pieter Poolman, None; Susan C. Anderson, None; Jade Grimm, None; Jan M. Full, None; Matthew Thurtell, None; Michael Wall, None; Randy H. Kardon, Department of Veterans Affairs Research Foundation (S), Fight for Sight (S), Novartis (F) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Support: C9251-C: Department of Veterans Affairs Rehabilitation Research and Development Division, Iowa City VA Center for the Prevention and Treatment of Visual Loss; W81XWH-10-1-0736: Department of Defense, TATRC Program Number: 584 Poster Board Number: B0042 Presentation Time: 1:30 PM–3:15 PM Blue and red light-evoked pupil responses in photophobic individuals with traumatic brain injury Andrew T. Hartwick, Phillip Yuhas, Patrick Shorter, Catherine McDaniel, Michael Earley. Optometry, Ohio State University, Columbus, OH. Purpose: Photophobia is a common symptom in individuals who have suffered a traumatic brain injury (TBI). Recent evidence has implicated blue light-sensitive intrinsically photosensitive retinal ganglion cells (ipRGCs) in contributing to the neural circuitry mediating photophobia in migraineurs. The goal of this work is to test the hypothesis that ipRGC function is altered in TBI patients with photophobia by assessing relative pupillary responses to blue and red light. Methods: Data was collected from 22 case subjects (mean age = 43.3±2.4; 59% female) with a prior TBI and self-reported photophobia, along with 12 control subjects (mean age = 42.6±4.5; 58% female). After a 10 min dark adaptation period, light stimuli were generated by blue (470 nm, 1x1013 phots/s/cm2) and red (625 nm, 7x1013 phots/s/cm2) LEDs. Each stimulus flashed on and off at 0.1 Hz for 30s and was delivered to the dilated left eye while the right pupil was recorded. The amplitude of normalized pupil fluctuation was quantified using Fourier fast transforms. Results: As ipRGCs continue to fire after light offset, smaller values of the Fourier-derived pupil fluctuation are indicative of greater ipRGC contribution to the pupil responses. In either the case or the control group, the Fourier-derived pupil fluctuation was significantly (P<0.05) less for the blue (25.4±6.6 [SD], 23.8±2.4) versus red light (28.4±5.6, 28.1±3.1), consistent with the greater contribution of ipRGCs to the former stimulus. As evident in the standard deviation of the fourier-derived data, case subjects displayed greater variability in their pupil responses, especially to blue stimuli. On a 5-point scale, the case subjects rated the first blue pulse to be significantly brighter (4.3±0.1) than the second (4.0±0.2) or third pulses (3.7±0.2), and these subjective brightness grades were significantly higher that obtained from the controls for the same stimuli. Conclusions: Similar to control subjects, case subjects showed robust ipRGC-mediated components in their pupil responses to blue light. The mean Fourier-derived amplitude of pupil fluctuation evoked by flashing blue stimuli did not differ between the two subject groups. However, greater pupil response variability in the case subjects suggests that ipRGC function may be more heterogeneous in this group. Subjectively, the case subjects reported the stimuli to be brighter than that reported by the control subjects. Commercial Relationships: Andrew T. Hartwick, None; Phillip Yuhas, None; Patrick Shorter, None; Catherine McDaniel, None; Michael Earley, None Support: DoD grant W81XWH-12-1-0434 Clinical Trial: NCT01942564 Program Number: 585 Poster Board Number: B0043 Presentation Time: 1:30 PM–3:15 PM The Effect of Age and Refractive Error on Pupil Size Kathryn Dumbleton1, Michel Guillon1, 3, Panagiotis Theodoratos1, C. Benjamin Wooley2, Kurt Moody2. 1OCULAR TECHNOLOGY GROUP - International, Berkeley, CA; 2Johnson & Johnson Vision Care Inc., Jacksonville, FL; 3School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. Purpose: The size of the pupil plays a critical part in controlling the performance of all vision correction modalities incorporating a presbyopic correction, including contact lenses, refractive surgery and intraocular lenses. While the effect of luminance, the dominant factor affecting pupil size, is well known, little information is available regarding other contributing factors such as aging and refractive status. Methods: Three hundred and four patients (127 Male, 177 Female) aged 18 to 78 year made up the cohort population in this study. The non-interventional investigation involved a single visit to the OTG-i clinic. The pupil size was measured at three controlled luminance levels 250cd/m2 (daytime), 50cd/m2 (indoor lighting) and 2.5cd/m2 (night driving). Results: The results obtained showed that: (i) Pupil size decreases with age, the effect being most marked at low luminance. At 250cd/ m2 means: 18-39 yrs = 2.8mm, 40-54 yrs = 2.67mm, 55+yrs = 2.56mm (p=0.046). At 50cd/m2 means: 18-39 yrs = 3.68mm, 40-54 yrs = 3.37mm, 55+yrs = 3.21mm (p<0.001). At 2.5cd/m2 means: 1839 yrs = 6.15mm, 40-54yrs = 5.49mm, 55+yrs = 4.99mm (p<0.001). (ii) Pupil size at low luminance is significantly greater for myopes (high myopes mean = 5.98mm; low myopes mean = 5.91mm) than hyperopes (mean = 5.15mm) (p =0.020). (iii) Pupil size changes modelled by multi linear regression (p<0.001) identified age (p<0.001) and refractive error (p=0.019) as significant factors at low luminance. Conclusions: The study demonstrates that both age and refractive status affect pupil size with larger pupils measured for younger patients and myopes. The implications for the design of multifocal corrections are that the design should take into consideration both the age (faster progression for higher near additions) and refractive power (faster progression for hyperopic corrections). Commercial Relationships: Kathryn Dumbleton, Alcon Inc. (R), Johnson & Johnson Vision Care Inc. (C), Johnson & Johnson Vision Care Inc. (F), Johnson & Johnson Vision Care Inc. (R); Michel Guillon, Alcon Inc. (R), Johnson & Johnson Vision Care Inc. (C), Johnson & Johnson Vision Care Inc. (F), Johnson & Johnson Vision Care Inc. (R); Panagiotis Theodoratos, Johnson & Johnson Vision Care Inc. (F); C. Benjamin Wooley, Johnson & Johnson Vision Care Inc. (E); Kurt Moody, Johnson & Johnson Vision Care Inc. (E) Support: This study was funded by Johnson & Johnson Vision Care Inc. Program Number: 586 Poster Board Number: B0044 Presentation Time: 1:30 PM–3:15 PM The degree of anisocoria in pediatric patients with Horner syndrome when compared to children without disease Christy Benson1, Sarah Suh2, Donny W. Suh1, 2. 1Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE; 2Ophthalmology, Children’s Hospital and Medical Center, Omaha, NE. Purpose: To study the magnitude of anisocoria in pediatric patients using the plusoptiX A08 photoscreener as compared to pediatric patients with Horner syndrome to determine if anisocoria alone should raise suspicion for the diagnosis. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Methods: The medical records of 592 consecutive patients, neonates to nine years of age, were collected and analyzed. All patients had complete ophthalmologic examinations that included photoscreening with the plusoptiX A08. Data included age, pupil sizes, and degree of anisocoria. This was then compared with pupillary sizes of 32 pediatric patients with a known diagnosis of Horner syndrome. Results: Of the 592 children without Horner syndrome, 404 had anisocoria of ≤0.5 mm (68.13%), 167 had anisocoria of 0.6-1.2 mm (28.16%), and 21 had anisocoria of >1.3 mm (3.70%). There was no correlation between increasing age and severity of anisocoria (p=0.55). The average degree of anisocoria was 0.5 mm. For pediatric patients with a diagnosis of Horner syndrome, the average level of anisocoria in room light was 1.37 mm and 2.0 mm in darkness. In room light, 3 children had anisocoria of ≤0.5 mm (9.4%), 14 had anisocoria of 0.6-1.2 mm (43.8%), and 15 had anisocoria of >1.3 mm (46.9%). In darkness, the level of anisocoria increased in 19 patients, causing the first category, ≤0.5 mm, to include 1 child (3.1%), the second group to include 5 patients (15.6%), and the last group to include 26 patients (81.3%). Of the 32 Horner syndrome cases reviewed, ptosis was present in 100% of cases. Other associated signs included heterochromia (28.1%), anhidrosis (9.4%), straight hair on affected side/curly unaffected (9.4%), neck mass (6.3%). In 37.5% of cases, imaging results were negative and no specific etiology was determined Conclusions: In a study of 592 children without Horner syndrome, pupillary size was found to increase with age, while the degree of anisocoria remained stable in both light and dark. About half of the pediatric population studied had anisocoria of up to 0.5 mm. In children with a diagnosis of Horner syndrome, the majority had anisocoria ≥1.3 mm, with the discrepancy in pupil size becoming more apparent in levels of low light intensity. The level of anisocoria increased in the dark in 19 of 32 Horner syndrome cases reviewed (59.3%), with an average increase of 0.57 mm. In this study, anisocoria greater than 1.3 mm was rarely found to be physiologic (3.4%). Commercial Relationships: Christy Benson, None; Sarah Suh, None; Donny W. Suh, None 212 Strabismus, I Monday, May 04, 2015 8:30 AM–10:15 AM 4CD Mile High Blrm Paper Session Program #/Board # Range: 1327–1333 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 1327 Presentation Time: 8:30 AM–8:45 AM Reliability of dichotomizing strabismus outcome by diplopia descriptors Jonathan M. Holmes, David A. Leske, Sarah R. Hatt. Ophthalmology, Mayo Clinic, Rochester, MN. Purpose: We previously developed a Diplopia Questionnaire capturing frequency of diplopia on a 5-point Likert scale (always, often, sometimes, rarely and never) in specific gaze positions (reading, distance straight ahead, right, left, up, down), to incorporate patient reported symptoms into outcome assessment for strabismus. For some analyses of diplopia, we have proposed defining “success” as “never or rarely” in distance straight ahead and reading positions. We investigated the test-retest reliability of such a classification. Methods: 64 adults (18 to 87 years old) with stable strabismus and no intervention within the previous 6 months, completed the Diplopia Questionnaire at a clinic visit and at least 5 days later (5 to 154 days), 30 (47%) by mail and 34 (53%) at a return visit. Strabismus types included childhood, neurologic and mechanical and no change in treatment was allowed between test and retest. For analysis we categorized patients by defining “success” as “never or rarely” in distance straight ahead and reading positions. Agreement was assessed by calculating kappa values and frequencies. Results: At the first exam, 20 (31%) would have been classified as success, and 19 (30%) at the second exam. Even though agreement would have been designated “substantial” with a kappa of 0.74 (95% CI 0.56 to 0.92), 4 patients (6%, 95% CI 2% to 15%) would have been classified as success on the first exam but not on the second, and 3 (5%), 95% CI 1% to 13%) would have been classified as success on the second but not the first. Of these 7 discrepancies (11%, 95% CI 5% to 21%), the most common was a difference between “sometimes” and “rarely” (5/7, 71%). Discrepancies occurred across the spectrum of strabismus types and ages. Conclusions: Despite the importance of incorporating patient report into outcome assessment, test-retest variability may lead to misclassification, particularly when data are being used to dichotomize into “success-failure.” Alternative strategies for cohort studies include scoring on a continuous scale (as we previously described for the Diplopia Questionnaire). Other approaches might include using visual analog scales rather than descriptors, or standardized definitions of those descriptors. Commercial Relationships: Jonathan M. Holmes, None; David A. Leske, None; Sarah R. Hatt, None Support: NIH Grants EY024333 (JMH) and EY018810 (JMH), Research to Prevent Blindness, and the Mayo Foundation. Program Number: 1328 Presentation Time: 8:45 AM–9:00 AM Quantitative Intraoperative Torsional Forced Duction Test Jae Ho Jung1, 2, David A. Leske2, Jonathan M. Holmes2. 1 Ophthalmology, Pusan Nat’l Univ Yangsan Hospital, Yangsan, Korea (the Republic of); 2Ophthalmology, Mayo Clinic, Rochester, MN. Purpose: We developed a method for quantifying intraoperative torsional forced ductions. We now describe performance of the torsional forced duction test in patients with oblique dysfunction and in controls, using photographic recording and reading of torsional position. Methods: We studied 25 patients with oblique dysfunction (9 with presumed congenital superior oblique palsy (SOP), 10 with presumed acquired SOP, and 6 with Brown syndrome) and 31 controls (entirely normal forced duction tests prior to planned horizontal muscle surgery). We also studied 3 of these patients while the superior oblique (SO) was disinserted. After induction of deep general anesthesia, the 6 and 12 o’clock positions at the limbus were marked. A Mendez-ring was aligned with these reference marks and a photograph was taken. The limbus was grasped with forceps, the globe was maximally excyclorotated without retroplacement and then maximal incyclorotated, and photographs were taken at each position. Photographs were duplicated for evaluation of test-retest reliability, and maximal excyclorotation and incyclorotation were read (in degrees) by a masked observer. Intraclass correlation coefficients (ICC) and 95% limits of agreement (LOA) were calculated. Maximal excyclorotation and incyclorotation in each oblique dysfunction condition were compared with controls. Results: Test-retest reliability was excellent with a 95% LOA of 4.4 degrees and an ICC of 0.97. Eyes with presumed congenital SOP had greater maximal excyclorotation than controls (mean±SD, 38.3±10.5 vs 29.3±5.5, p=0.01). Maximal excyclorotation in presumed acquired SOP was similar to controls (27.3±4.7 vs 29.3±5.5, p=0.50). Eyes with Brown syndrome had lower maximal excyclorotation than ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology controls (11.2±6.6 vs29.3±5.5, p=0.0007). Maximal excyclorotation in cases with disinserted SO was greater than controls (52.0±3.5 vs 29.3±5.5, p=0.005). Maximal incyclorotation of presumed congenital SOP, presumed acquired SOP, and Brown syndrome were similar to controls (29.1±6.1, 28.7±4.7, 29.6±10.5 vs 32.5±6.6, all p>0.1). Conclusions: Photographic reading of the new torsional forced duction test shows excellent test-retest reliability. The torsional forced duction test allows precise assessment of oblique muscle tightness and laxity, and reflects differences between congenital SOP, Brown syndrome, SO disinsertion and controls. Commercial Relationships: Jae Ho Jung, None; David A. Leske, None; Jonathan M. Holmes, None Support: NIH Grants EY024333 (JMH) and EY018810 (JMH), Research to Prevent Blindness, and the Mayo Foundation. Program Number: 1329 Presentation Time: 9:00 AM–9:15 AM Magnetic Resonance Imaging (MRI) Suggests New NonMuscular Constraints on Ocular Rotation in High Myopia Joseph L. Demer. 1Ophthalmology, University of California, Los Angeles, Los Angeles, CA; 2Neurology, University of California, Los Angeles, Los Angeles, CA. Purpose: Traditional concepts of motility assume a spherical globe freely rotated by extraocular muscles (EOMs). This study employed MRI to investigate the hypothesis that globe irregularity and the optic nerve (ON) length may constrain ocular rotation in axial high myopia.. Methods: High resolution, surface coil axial MRI using T1 or T2 fast spin echo sequences was obtained in 8 normal adults, 12 adult esotropes (ET) with normal axial length (AL) <25.3 mm, 11 myopic esotropes with mean AL 28.7±3.6 (SD) mm, and 7 exotropes (XT). ON length was measured in eccentric horizontal gaze positions where it became straight. Results: ON straightening occurred only in adduction, at 23.6±9.0° in normal subjects, not significantly different from XT at 22.2±11.8°, but significantly greater in ET at 36.3±9.3°, and in myopic ET at 34.1±11.7° (P<0.003). ON length at straightening was 30.4±3.4 mm in normals, not significantly different from XT at 30.7±2.6 mm, but less in ET at 27.8±2.7 mm and 25.5±2.0 mm in myopic ET (P<0.03). ET was associated with globe retraction and elongation in adduction, suggesting ON tethering with forces concentrated at the scleral canal. Eight globes of the myopes exhibited prominent irregular nasal posterior, temporal posterior, nasal and temporal posterior, or equatorial staphylomata. These scleral ectasias were positioned to contact and elongate horizontal rectus EOM paths in some gaze positions. Conclusions: Concepts of strabismus in axial high myopes should be expanded to include irregular posterior staphylomata, and tethering in adduction by the ON. Staphylomata act like “cams” affixed to the normally spherical globe, exerting no mechanical effect until ecentrically rotating against EOMs. After rotational contact, staphylomata would stretch and thus add tension to the EOM that increases non-linearly with further duction. Tethering by the ON can add a further strong nonlinear force opposing adduction, even sufficient to deform the posterior pole. Axial MRI in a highly myopic esotropic subject demonstrates optic nerve straightening in adduction with globe retraction seen as posterior shift of the corneal surface (green line). Posterior staphylomata in this subject are evident from angulated posterior contour of each globe. Ghost images anterior to the corneal surface are motion artifacts due to retraction as the extraocular muscles pull against the tethering optic nerve. Commercial Relationships: Joseph L. Demer, None Support: NIH Grant EY08313 and Research to Prevent Blindness Program Number: 1330 Presentation Time: 9:15 AM–9:30 AM Evidence for a Novel Genetic Link between Strabismus and Schizophrenia Austin J. Christensen1, Andrea B. Agarwal1, Cheng-yuan Feng1, Dan Wen2, L. A. Johnson3, 1, Christopher S. von Bartheld1. 1Physiology and Cell Biology, University of Nevada School of Medicine, Reno, NV; 2Ophthalmology, Central South University, Xiangya Hospital, Xiangya, China; 3Sierra Eye Associates, Reno, NV. Purpose: Children with ocular misalignment (specifically exotropia) have a greatly increased risk of developing schizophrenia decades later, suggesting an overlapping genetic predisposition for both diseases. The association of schizophrenia with exotropia but not esotropia suggests that the two relevant rectus muscles (medial and lateral) differ in their susceptibility to schizophrenia-related gene products. We here determined (1) which genes that encode signaling molecules are differentially expressed between strabismic and normal human extraocular muscles, (2) how many of these genes overlap with biomarkers or predisposing genes for schizophrenia, and (3) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology which of these genes are differentially expressed between medial and lateral rectus muscles. Methods: Strabismic lateral and medial rectus muscle samples were obtained during corrective surgeries according to IRB-approved protocols; normal samples were obtained from deceased organ donors. Consistent gene expression differences of 2-fold or more on targeted or customized PCR arrays were compiled from paired comparisons (n=4 per condition). We selected 84 genes of interest based on known risk factors for schizophrenia. Results: (1) Among 381 genes encoding signaling molecules, 22 were dysregulated in strabismic medial rectus muscle when compared with normal medial rectus muscle. (2) Among those 22 genes, almost half (10) were biomarkers for schizophrenia. (3) Among the 84 schizophrenia-related genes, 19 (=22.6%) were differentially expressed in the medial rectus muscle, including cytokines, growth factors and their receptors, and downstream signaling pathways (AKT1, BDNF, BMP4, CNTF-R, ERBB2, MMP9, NGF, NOTCH1, NTRK1, OSM, OLIG2, and multiple interleukins or their receptors). Conclusions: Our data establish a molecular link between exotropia and schizophrenia. This suggests that a combination of defects in signaling molecules is relevant in the pathogenesis of both diseases. Differences between medial and lateral rectus muscles in the susceptibility to imbalanced signaling molecules may explain the previously mysterious specific association between exotropia (but not esotropia) and schizophrenia. The new findings may guide the design of selective, muscle type-specific treatments of strabismus, as well as enable the creation of a customized PCR array that can predict the risk of schizophrenia 20 years prior to any symptoms, and possibly its prevention. Commercial Relationships: Austin J. Christensen, None; Andrea B. Agarwal, None; Cheng-yuan Feng, None; Dan Wen, None; L. A. Johnson, None; Christopher S. von Bartheld, None Support: NIH Grants EY012841, GM103554 Program Number: 1331 Presentation Time: 9:30 AM–9:45 AM Eye Movement Abnormalities in patients with Spinocerebellar ataxia 3/Machado-Joseph disease Fatema F. Ghasia1, George Wilmot2, Anwar Ahmed3, aasef shaikh3. 1 Ophthamology and visual science, Cole Eye Institute-Cleveland Clinic, Lakewood, OH; 2Neurology, Emory University, Atlanta, GA; 3 Neurology, Cleveland Clinic, Cleveland, OH. Purpose: Spinocerebellar Ataxia type 3(SCA3) or Machado-Joseph disease is the most common inherited spinocerebellar ataxia. It is the most common SCA associated with diplopia. We aimed to characterize the type of strabismus and ocular motor abnormalities in SCA3. Methods: Eye movements and strabismus were clinically assessed in 12 patients with SCA3. The saccadic eye movements and gaze holding was objectively measured with a corneal curvature tracker (Jazz Novo, Ober Consulting, Poland) and Eyelink SR 1000. Results: Eight patients had ophthalmoplegia with mild abduction deficit and three patients later developed an upward deficit. Ten patients had strabismus.Three patients had esotropia, one patient had skew deviation,one had a hypotropia accompanying the asymmetric upward deficit, four patients had mild-moderate intermittent exotropia, and one had moderate exophoria. The near point of convergence was normal in the exotropic patients. Eight patients had gaze-evoked nystagmus, eight had saccadic dysmetria, whereas all twelve patients had saccadic pursuit. Two patients had slowing of the saccades and five had microopsoclonus. Conclusions: Strabismus and ophthalmoplegia were most common, but saccadic oscillations were also notable in many patients. The type of strabismus could not be explained by the co-existing ophthalmoplegia or vergence abnormalities in our patients with exotropia that comprised 50% of the cohort. It is possible that involvement of the brainstem, the deep cerebellar nuclei and the superior cerebellar peduncle are driving the exotropia in these patients. Brainstem and deep cerebellar nuclei lesion also explains microopsoclonus, while brainstem deficits can describe slow saccades seen in our patients with MJD. Commercial Relationships: Fatema F. Ghasia, None; George Wilmot, None; Anwar Ahmed, None; aasef shaikh, None Support: Knights Templar Eye Foundation, Fight for Sight Grant in Aid Program Number: 1332 Presentation Time: 9:45 AM–10:00 AM Lingering fusional adaptation influences the Bielschowsky head tilt test in superior oblique paresis Kristina Irsch1, 2, David L. Guyton1, Howard S. Ying1. 1The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD; 2Clinical Investigation Center – CIC 1423 INSERM, Quinze-Vingts National Eye Hospital, Paris, France. Purpose: To investigate how fusion influences the Bielschowsky head tilt test in unilateral superior oblique paresis. Methods: In eight fusing patients, we correlated haploscopicdetermined fusional mechanisms with Bielschowsky head tilt test differences. Results: Five patients used the vertical recti for vertical fusional vergence and had a mean Bielschowsky head tilt test difference ± SD of 22 ± 8 PD. After a 30-minute patch test one of those, in whom the test was performed, showed a decrease of 10 PD. Two patients used the “paretic” superior oblique muscle and the contralateral superior rectus muscle to fuse, and had a mean Bielschowsky head tilt test difference ± SD of 6 ± 8 PD. The Bielschowsky head tilt test difference of one, in whom a patch test was performed, increased by 11 PD. The remaining patient used the “paretic” superior oblique muscle and contralateral inferior oblique muscle to fuse, and had a Bielschowsky head tilt test difference of only 3 PD, increasing to 21 PD after patching. One explanation for this behavior in the last patient involves lingering vergence adaptation of the “paretic” superior oblique muscle and contralateral inferior oblique muscle, which makes these muscles more effective when activated on ipsilateral head tilt, lessening the expected increase in hyperdeviation. Similarly, in our patients with oblique/rectus-mediated fusion, the vergence-adapted “paretic” superior oblique muscle and contralateral superior rectus muscle are activated on ipsilateral and contralateral tilt respectively, lessening the hyperdeviation in both directions. In the other five patients, however, the vergence-adapted ipsilateral inferior rectus muscle and contralateral superior rectus muscle are activated on contralateral tilt, accentuating the Bielschowsky head tilt test difference. Conclusions: Fusion influences the Bielschowsky head tilt test difference, either decreasing or increasing this difference depending on the particular muscle groups that are being used for fusion. The absence of a positive Bielschowsky head tilt test should not be relied upon to rule out the diagnosis of superior oblique paresis. In suspected superior oblique paresis patients with fusion, performing the Bielschowsky head tilt test after a patch test may be necessary to bring out the Bielschowsky head tilt test difference supporting the diagnosis. Commercial Relationships: Kristina Irsch, None; David L. Guyton, None; Howard S. Ying, None Support: NIH R01 EY019347 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 1333 Presentation Time: 10:00 AM–10:15 AM Complications of Botulinum Toxin-A for Treatment of Esotropia in Children Stephen P. Christiansen1, Danielle Chandler2, Katherine A. Lee3, Rosanne Superstein4, Alejandra G. De Alba Campomanes5, Erick D. Bothun6, David K. Wallace7, Raymond T. Kraker2. 1OphthalmologyBoston Med Ctr, Boston University School of Medicine, Boston, MA; 2Jaeb Center for Health Research, Tampa, FL; 3St. Luke’s Children’s Hospital, Boise, ID; 4Ophthalmology, Centre Hospitalier Universitaire Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada; 5Ophthalmology, University of California, San Francisco, San Francisco, CA; 6Ophthalmology, University of Minnesota, Minneapolis, MN; 7Duke Eye Center, Durham, NC. Purpose: To report operative complications in children treated for esotropia by botulinum toxin A (BTX-A) injection. Methods: Subjects <17 years of age with esotropia were enrolled in a 9-month data-collection study following BTX-A injection of one or both medial rectus muscles. Subjects were managed as per investigators’ routine clinical practice. Demographic, historical, and pre-injection clinical data as well as details of the BTX-A injection and perioperative complications were collected at enrollment. Post-injection data from each visit through 9 months was collected retrospectively. Results: Twenty-seven subjects were enrolled at 13 sites. Esotropia onset occurred before 6 months of age in 13 (48%) subjects and after 6 months of age in 14 (52%). Eight (30%) subjects had prior strabismus surgery, and 1 (4%) had prior BTX-A injection. Mean age at injection was 3.9 ± 3.3 years (9 months to 13.8 years). BTX-A injection was unilateral (n=7) or bilateral (n=20) and dosage ranged from 3.0 to 6.0 units per muscle. Preoperative esodeviation, measured by prism and alternate cover test, ranged from 10 to 65 PD (mean = 26 PD) at distance and from 12 to 65 PD (mean = 28) at near. Four of 27 subjects (15%; 95% confidence interval [CI] = 4% to 34%) experienced a complication from the injection. One subject (4%; 95% CI = 0% to 19%) had a left eye scleral perforation which was noted at the time of injection and was treated by laser retinopexy the same day with good visual and motor outcomes. Three subjects (11%; 95% CI = 2% to 29%) developed tonic pupil noted at the first post-injection visit. All three cases occurred in the left eye of subjects who underwent BTX-A injection by the same surgeon, and were characterized by delayed denervation hypersensitivity to pilocarpine 0.125%. The anisocoria diminished during the data collection period, and there were no visual deficits. Conclusions: Complications of BTX-A injection were encountered in this small cohort of children with esotropia. Globe perforation is a well-known complication of periocular injection. However, there are few reports of tonic pupil after BTX-A injection. The mechanism of action is unknown, but it may be direct trauma to the ciliary ganglion. Other possible explanations include anticholinergic toxicity from intraconal diffusion of BTX-A affecting the ciliary ganglion and/or intraocular diffusion affecting the pupillary sphincter. Commercial Relationships: Stephen P. Christiansen, None; Danielle Chandler, None; Katherine A. Lee, None; Rosanne Superstein, None; Alejandra G. De Alba Campomanes, None; Erick D. Bothun, None; David K. Wallace, None; Raymond T. Kraker, None Support: NIH Grants EY018810, EY023198, and EY011751 236 New insights into strabismus mechanisms: Central and peripheral influences - Minisymposium Monday, May 04, 2015 11:00 AM–12:45 PM 4CD Mile High Blrm Minisymposium Program #/Board # Range: 1705–1709 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 1705 Presentation Time: 11:00 AM–11:05 AM New Insights into Strabismus Mechanisms: Central and Peripheral Influences Howard S. Ying. Johns Hopkins University, Baltimore, MD. Presentation Description: Strabismus is most commonly a developmental disorder wherein disruption of binocular vision in the critical period of visual and oculomotor development leads to permanently misaligned eyes. This symposium will provide an overview of recent basic science work that has examined the role of various central (brain) and peripheral (extraocular muscle) factors in the development and maintenance of the strabismic state. Commercial Relationships: Howard S. Ying, Lutronics, Inc. (C), The Johns Hopkins University (P) Support: NIH grant EY19347 Program Number: 1706 Presentation Time: 11:05 AM–11:30 AM The Control of Ocular Alignment During Infancy and Early Childhood T. R. Candy. Indiana University, Bloomington, IN. Presentation Description: Infants are typically hyperopic while having a reduced interpupillary distance relative to adults. Despite the neural coupling between the two systems, infants must overcome the relatively increased accommodative demand and reduced vergence demand in order to remain aligned and avoid refractive strabismus. Interestingly, the mean age of onset of refractive esotropia is not until two to three years of age, and only a subset of hyperopes develop the deviation. This presentation will explore the control of ocular alignment during infancy and early childhood, specifically examining the role of accommodative performance, heterophoria, vergence ranges and vergence adaptation during this period. The implications for the management of young hyperopes will also be addressed. Commercial Relationships: T. R. Candy, None Support: NIH: R01 EY014460, P30 EY019008 Program Number: 1707 Presentation Time: 11:30 AM–11:55 AM MRI studies of extraocular muscle in humans with strabismus Joseph L. Demer. Stein Eye Institute and Departments of Ophthalmology & Neurology, University of California, Los Angeles, Los Angeles, CA. Presentation Description: Externally observable oculomotor behavior consists of only 3 degrees of rotational freedom for each of 2 eyes. Unsurprisingly, contractile states and pulling directions of 12 oculorotary muscles (EOMs), each consisting of at least 2 functional compartments, cannot be uniquely determined from eye movement observations. This “overdetermination” is problematic in understanding mechanistic causes of strabismus, which may variously arise from central or peripheral disorders of neural control, or disorders of EOM strength, elasticity, and pulling direction. High resolution magnetic resonance imaging (MRI) provides a useful approach to this conundrum. MRI can demonstrate orbital connective tissue anatomy, and the anatomy and contractile states of EOMs. Surface coils and target-controlled fixation enable near microscopic ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology structural resolution. Repeated MRI in varying gaze positions enables demonstration of EOM contractility evidenced by changes in cross section distribution and volume, and changes in EOM paths indicating pulling directions. MRI demonstrates several mechanical causes of strabismus. For example, congenital A and V patterns are due to heterotopy of rectus pulleys. The sagging eye syndrome is a common degenerative cause of acquired distance esotropia and cyclovertical strabismus resulting principally from failure of a ligament interconnecting the lateral and superior rectus pulleys, along with EOM elongation. Globe position and shape abnormalities interact with connective tissue and EOM pathology in strabismus associated with axial high myopia. MRI also clarifies strabismus caused by neural or muscular disorders that alter EOM stiffness, or impair force generation. MRI also demonstrates deficient contractility and hypoplasia in congenital dysinnervation disorders, and in acquired innervation abnormalities, including trochlear, abducens, and oculomotor palsy. MRI demonstrates regional lateral rectus atrophy presumably due to selective denervation of one of the two abducens motor nerve branches. Since motor neurons in the ocular motor system innervate EOMs to indirectly influence rather than directly control EOM force and eye orientation, EOM functional anatomy should have a closer relationship with motor neuron behavior than does eye position. Commercial Relationships: Joseph L. Demer, None Support: USPHS National Eye Institute EY08313 Program Number: 1708 Presentation Time: 11:55 AM–12:20 PM Cellular changes in extraocular muscle in strabismus and nystagmus Linda K. McLoon. University of Minnesota, Minneapolis, MN. Presentation Description: The extraocular muscles are normally precisely controlled by the ocular motor system to ensure that the same areas of the visual world land on the fovea of each eye. Strabismus and infantile nystagmus syndrome represent a failure of that precise control. Extraocular muscles removed as surgical waste from these patients were examined to demonstrate patterns of innervational changes. In the extraocular muscles of subjects with nystagmus, innervation was sparse and the neuromuscular junctions smaller than normal with many more junctions expressing the immature subunit of the acetylcholine receptor. In the extraocular muscles of subjects with “motor” strabismus, there was a higher density of innervation. In addition, in the strabismic extraocular muscles, increased connective tissue density was seen. We are currently looking to see if these changes are adaptations to abnormal signaling derived from their innervating motor neurons, and whether these abnormal findings can be corrected by treatments at the level of the extraocular muscles. Commercial Relationships: Linda K. McLoon, None Support: Supported by NIH grants RO1EY15313 (LKM) and EY11375 from the National Eye Institute, University Medical Foundation, Minnesota Lions and Lionesses, and an unrestricted grant to the Department of Ophthalmology and Visual Neurosciences from Research to Prevent Blindness, Inc. Program Number: 1709 Presentation Time: 12:20 PM–12:45 PM Investigation of oculomotor structures in monkey models for strabismus Vallabh E. Das. College of Optometry, University of Houston, Houston, TX. Presentation Description: Disruption of binocular vision during the early critical period for development leads to disruption in development and calibration of visual and oculomotor areas and eventually misaligned eyes. Our approach to investigate the neural component of this disorder has been to first develop appropriate non-human primate models and thereafter to perform behavioral and neurophysiological investigation of oculomotor circuits in these animals. In this symposium presentation, we will present results from these studies that together suggest that a circuit that serves slow vergence eye movements in the normal animal is involved in setting the state of eye misalignment in a sensory form of strabismus. We will also present preliminary data showing the nature of neural plasticity following strabismus correction surgery in animals with strabismus. Commercial Relationships: Vallabh E. Das, None Support: NIH Grant R01 EY015312; NIH Grant R01 EY022723; NIH Grant P30 EY07551 276 Amblyopia / Refractive errors Monday, May 04, 2015 3:45 PM–5:30 PM Exhibit Hall Poster Session Program #/Board # Range: 2183–2215/B0036–B0068 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Clinical/Epidemiologic Research, Visual Psychophysics/Physiological Optics Program Number: 2183 Poster Board Number: B0036 Presentation Time: 3:45 PM–5:30 PM Characteristics of Anterior Polar Cataracts in Children Lena Dixit1, Michael Puente1, Kimberly Yen2. 1Ophthalmology, Baylor College of Medicine, Houston, TX; 2Ophthalmology, Texas Children’s Hospital, Houston, TX. Purpose: To evaluate pediatric patients with unilateral or bilateral anterior polar cataracts and assess the development of astigmatism, rate of amblyopia, change in visual acuity, and need for surgery over time. Methods: A retrospective chart review was performed on patients examined at Texas Children’s Hospital in Houston, Texas from 2008 to 2014. Patients with unilateral or bilateral anterior polar cataracts (APCs) were included in the study. Patients with mixed etiology cataracts or other causes of poor visual acuity were excluded. Size, location, and type of anterior polar cataract were assessed. Best corrected visual acuity and refraction were recorded from the initial visit and subsequent encounters. Development of amblyopia, anisometropia, and astigmatism were recorded. Size and type of cataract were correlated with the development of each outcome. Statistical analysis was performed on each categorical variable with significance set at p < 0.05. Results: A total of 31 patients were included in the study. 17 patients had unilateral APCs and 14 had bilateral APCs. 83% were centrally located and 17% were non-central. 40% of patients had concurrent ocular conditions and 10% had systemic associations. 21% of patients with bilateral cataracts developed amblyopia compared to 35% in the unilateral population. 29% of patients with bilateral cataracts had anisometropia compared to 24% in the unilateral population. 3 patients required surgical intervention. Conclusions: Most anterior polar cataracts are less than 1 mm in size and of the polar type. Risk of amblyopia is higher than the general population. Anisometropia is the most common cause of amblyopia. Ocular and systemic associations can occur but are uncommon. Surgical treatment is uncommon; however, growth of APCs, ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology pyramidal type, and associated cortical changes may be risk factors for surgery. Commercial Relationships: Lena Dixit, None; Michael Puente, None; Kimberly Yen, None Program Number: 2184 Poster Board Number: B0037 Presentation Time: 3:45 PM–5:30 PM The effects of Monocular Training on Binocular Functions in Adult Amblyopia Chang-Bing Huang1, Wuli Jia1, WUXIAO ZHAO3, Zhong-Lin Lu2. 1 Institute of Psychology, CAS, Beijing, China; 2Department of Psychology, The Ohio State University, Columbus, OH; 3Center for Optometry and Visual Science,, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. Purpose: It’s now clear that intensive monocular perceptual learning can improve visual acuity, contrast sensitivity, and vernier acuity in the amblyopic eye of adults with amblyopia. It is however not clear how much monocular training can enhance binocular vision. In the current study, we aimed to determine the effects of monocular training on a variety of binocular visual functions. Methods: Eleven adults with anisometropic amblyopia (22±1.4 yrs) were trained in a grating contrast detection task near each individual’s cutoff spatial frequency for 8 to 10 days, with 630 trials/day. Visual acuity, stereo acuity, monocular and binocular contrast sensitivity functions (CSF) with the quick CSF method (Lesmes, et al., 2010), perceived phase of binocularly combined sinewave gratings as a function of interocular image contrast ratio (Huang et al., 2009), pAE dominance in viewing dichoptically presented incompatible images of equal contrasts were measured before and after training. Results: Training substantially improved contrast sensitivity at the trained spatial frequency (by 75.4%), area under the CSF (by 94%), and visual acuity (logMAR from 0.62 to 0.42 or 2 lines) in the amblyopic eye. It also significantly improved stereo acuity (from 1530.9” to 110.7”) and increased the dominance duration of the amblyopic eye (from 2% to 13% in binocular rivalry). The improved dominance of the amblyopic eye was through elongation of each dominant phase without alteration of the switching frequency between the two eyes. On the other hand, training didn’t significantly improve the ratio of the areas under binocular and monocular fellow eye CSFs (from 1.1 to 1.08, p>0.1) and the interocular contrast ratio at which the two eyes contribute equally to binocular phase combination (from 0.11 to 0.13, p>0.10). There is no significant correlation between improvements in visual acuity, stereo acuity, and binocular rivalry. Conclusions: Although monocular training can improve visual acuity and contrast sensitivity and eye dominance of the amblyopic eye, the magnitudes of improvements didn’t correlate with each other; the impact on binocular summation and binocular phase combination was not significant. The results strongly suggest that structured monocular and binocular training is necessary to fully recover deficient visual functions in amblyopia. Commercial Relationships: Chang-Bing Huang, None; Wuli Jia, None; WUXIAO ZHAO, None; Zhong-Lin Lu, Adaptive Sensory Technology, LLC. (I), The Ohio State University (P) Support: Supported by National Natural Science Foundation of China (NSFC 31230032 and 31470983), the Knowledge Innovation Program of the Chinese Academy of Sciences (Y3CX102003), Institute of Psychology, CAS to Chang-Bing Huang, and NEI (EY021553) to Zhong-Lin Lu. Program Number: 2185 Poster Board Number: B0038 Presentation Time: 3:45 PM–5:30 PM A Randomized Trial of AmblyzTM Intermittent Occlusion Glasses vs Traditional Patching for Treating Children with Moderate Unilateral Amblyopia Jingyun Wang, Daniel Neely, Jay Galli, Joshua Schliesser, Tina Damarjian, Heather Smith, Dana Donaldson, Kathryn M. Haider, Derek Sprunger, David Plager. Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN. Purpose: PEDIG studies suggest a 2-hour patching treatment is effective for children with moderate amblyopia. Amblyz™ liquid crystal occlusion glasses are able to occlude the eye intermittently for periods of 30 seconds. Therefore, we hypothesized that 4-hour daily intermittent occlusion from Amblyz™ glasses is equally effective to 2-hour daily patching occlusion. Although a previous nonrandomized pilot study suggested that liquid crystal occlusion glasses are effective treating amblyopia (Spierer et al. 2010), there has not been prior comparison to a patching control group. This randomized clinical trial is designed to compare the effectiveness of Amblyz™ glasses versus adhesive patching for treating moderate, unilateral amblyopia in children. Methods: Children (N=28, age=5.3±1.4YR, 3- to 8-year-old) with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/100 in the amblyopic eye) were enrolled. All subjects had worn optimal refractive correction (if needed) for at least 12 weeks without improvement and their amblyopia was associated with strabismus, anisometropia, or both. Subjects were randomized into one of two treatment groups: a 4-hour daily Amblyz™ Glasses Group with liquid crystal shutter set at 30-second opaque/transparent intervals, or the 2-hour adhesive Patching Control Group. For each patient, visual acuity was measured with ATS-HOTV methods before and after 12 weeks of treatment. Results: At the conclusion of the first 12 week-treatment interval, visual acuity in the amblyopic eye improved an average of 0.22±0.11logMAR in the Amblyz™ Glasses Group and 0.21±0.16logMAR in the Patching Group. Vision improvements in both groups were clinically significant (p<0.05, over 2 lines). There was no statistically significant difference between groups (P-value=0.75). We did not find reverse amblyopia in the fellow eye. Compliance and treatment experience are reported in a related abstract. Conclusions: Our pilot data showed that intermittent occlusion associated with AmblyzTM glasses is equally effective to patching occlusion when treating 3-8 year old children with moderate amblyopia. This new device is a promising alternative treatment for amblyopia. The apparent effectiveness of Amblyz™ glasses warrants further investigation with longer follow-up and larger sample size. Commercial Relationships: Jingyun Wang, None; Daniel Neely, None; Jay Galli, None; Joshua Schliesser, None; Tina Damarjian, None; Heather Smith, None; Dana Donaldson, None; Kathryn M. Haider, None; Derek Sprunger, None; David Plager, None Support: Research to Prevent Blindness (RPB) Unrestricted Grant to the Glick Eye Institute Clinical Trial: NCT01973348 Program Number: 2186 Poster Board Number: B0039 Presentation Time: 3:45 PM–5:30 PM Compliance with AmblyzTM Liquid Crystal Glasses Versus Traditional Adhesive Patches Paxton Ott, Daniel Neely, Jingyun Wang, Jay Galli, Heather Smith, Dana Donaldson, Kathryn M. Haider, Derek Sprunger, David Plager. Ophthalmology, Indiana University School of Medicine, Clayton, IN. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Purpose: Amblyopia treatment with adhesive occlusion patches is frequently inhibited by poor compliance and complaints. Amblyz™ liquid crystal glasses utilize an intermittent occlusion technique (at 30-second opaque/transparent intervals) and avoid adhesives, potentially improving compliance. Despite the easier administration of Amblyz glasses, they require double the amount of wearing time compared to patching which may undercut compliance. This study compares compliance with AmblyzTM glasses versus patching. Methods: Children (N=28, age=5.3±1.4YR, 3- to 8-year-old) with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/100 in the amblyopic eye) were enrolled. All subjects wore optimal refractive correction (if needed) for at least 12 weeks and their amblyopia was associated with strabismus, anisometropia, or both. Subjects were randomized into one of two treatment groups: a 4-hour Amblyz™ Glasses Group, or a 2-hour Patching Control Group. After 12 weeks, compliance was reported with a calendar log and an Amblyopia Treatment Index (ATI) questionnaire characterizing the experience. Weekly compliance was calculated using the total weekly-treated minutes divided by the total weeklyprescribed minutes. Results: At the conclusion of the first 12 week-treatment interval, compliance averaged 85% in the Patching Group and 79% in the AmblyzTM Group (P=0.23, no statistical difference). Weekly compliance varied among individuals. No adverse effects were reported. Similar to the Patching Group, children in the AmblyzTM Group struggled with some outdoor activities, but reported no issues with indoor activities. In the AmblyzTM Group, some parents reported that their child had trouble seeing outside at night secondary to the tint inherent to the liquid crystal lenses; also, some parents complained that the glasses were easily subject to damage by their child. The ATI questionnaire demonstrated a high level of enthusiasm from parents and children with the Amblyz™ glasses, commonly remarking that they were easier to wear and generated fewer complaints. Visual outcome measures are reported in a related abstract. Conclusions: Compliance with AmblyzTM glasses is similar to patching, even when wearing time was doubled in this trial. This device promotes a relatively comfortable experience for the child and is a promising alternative to the traditional patching amblyopia treatment. Commercial Relationships: Paxton Ott, None; Daniel Neely, None; Jingyun Wang, None; Jay Galli, None; Heather Smith, None; Dana Donaldson, None; Kathryn M. Haider, None; Derek Sprunger, None; David Plager, None Clinical Trial: NCT01973348 Program Number: 2187 Poster Board Number: B0040 Presentation Time: 3:45 PM–5:30 PM Feasibility Study in Normal Children of a Liquid Crystal Spectacle Filter (LCSF) for Potential Treatment of Amblyopia Megan Cochran1, 2, Richard W. Hertle1, Paul Luchette3, Kajal Jassemnejad3, Sandip Bhatta3, Tamas Kosa3, Bahman Taheri3, Volodymyr Bodnar3. 1Akron Children’s Hospital, Akron, OH; 2Ohio University Heritage College of Osteopathic Medicine, Athens, OH; 3 Alpha Micron, Kent, OH. Purpose: To evaluate a new LCSF device applied to commercial eyeware for both comfort and the potential to reduce visual acuity Methods: AlphaMicron Inc. Kent, Ohio, has developed a liquid crystal system designed specifically for eyewear which uses a polymer liquid crystal mixture consisting of “guest” monomers in a liquid crystal “host”. This mixture is sandwiched between two curved flexible plastic substrates coated with transparent electrodes. By applying voltage to the substrates, the electro-optic response of the liquid crystal mixture is used to control the opacity of the device. The voltage is applied manually with a touch of a button or automatically through a sensor, providing instantaneous control over transmission. 20 normal children ages 7-10 were testing while wearing the LCSF. The amount of light transmission measure as a voltage was correlated to monocular and binocular visual acuity degradation using the PEDIG acuity testing paradigm. Results: The LCSF is successfully able to depress visual acuity in a linear fashion by changing the “haze” or light transmission function in a stepwise fashion from 20/20 to light perception. Conclusions: The LCSF filter may provide multiple benefits in the treatment of, including; ease of application to commercially available eyeware, cosmetic appeal, comfort, versatility in occlusion dosage and the potential to improve adherence. This is the LCSF prototype showing full light transmission above and no light transmission below. This curve shows the relationship between light transmission and visual acuity. Commercial Relationships: Megan Cochran, None; Richard W. Hertle, None; Paul Luchette, Alpha Micron (E); Kajal Jassemnejad, Alpha Micron (E); Sandip Bhatta, Alpha Micron (E); Tamas Kosa, Alpha Micron (E); Bahman Taheri, Alpha Micron (E); Volodymyr Bodnar, Alpha Micron (E) Program Number: 2188 Poster Board Number: B0041 Presentation Time: 3:45 PM–5:30 PM Objective compliance, dose, and response for atropine penalization amblyopia treatment Scott O’Brien, Lyne Racette, Heather Smith, Kathryn M. Haider, Dana Donaldson, Derek Sprunger, Daniel Neely, David Plager, Jingyun Wang. Glick Eye Institute Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN. Purpose: According to previous studies, a daily regimen (7 drops a week) of atropine penalization is equally effective to a 2-drop regimen (2 drops a week) in treating moderate and severe amblyopia. These results suggest that the dose-response relationship of atropine penalization is not fully understood. Parental self-reported subjective ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology compliance to atropine penalization ranges from 59% to 94%. (PEDIG, 2002, 2008, 2009) Objective measurement of compliance to atropine penalization has not been reported. This study aims to investigate objective compliance, dose, and vision improvement response to atropine penalization in amblyopic children. Methods: Twelve amblyopic children (3-8yr; 20/40-20/125 in the amblyopic eye, not previously treated with atropine) were enrolled. Twice weekly or daily regimen was prescribed by physicians. To measure objective compliance, we used Medication Event Monitoring System (MEMS) caps, which are designed to record the time and date when the bottle was opened. Objective compliance was calculated as the ratio of MEMS weekly recording times to weekly regimen. Participants were provided a calendar log to report subjective compliance and were scheduled for follow-up visits at 4 and 12 weeks. To measure the usage of atropine, we weighed the atropine eyedropper before and after treatment. Visual acuity was measured with ATS-HOTV. Correlation of visual acuity improvement with total atropine usage and regimen were calculated. Results: At 4 weeks, objective compliance averaged 78% (range 57-100%), while subjective compliance was reported to be 84% (range 64-100%). At 12 weeks, the average objective compliance was 62% (range 41-100%), while subjective compliance was 84% (range 78-100%). Interestingly, we found that the twice a week regimen had significantly higher objective compliance than the daily regimen (p=0.03). Visual acuity in the amblyopic eye improved 0.23±0.18logMAR. Data suggests that visual acuity improvement is correlated to total atropine usage (R-squared =0.73), instead of regimen (R-squared =0.10). Conclusions: Objective compliance with atropine instructions can be monitored with MEMS, which may facilitate more effective communication between clinicians and patients. Our pilot data showed that objective compliance with atropine penalization treatment decreases over time and varies with regimen. On average, subjective parental reporting of compliance is overestimated. Commercial Relationships: Scott O’Brien, None; Lyne Racette, None; Heather Smith, None; Kathryn M. Haider, None; Dana Donaldson, None; Derek Sprunger, None; Daniel Neely, None; David Plager, None; Jingyun Wang, None Support: Indiana CTSI PDT Program Number: 2189 Poster Board Number: B0042 Presentation Time: 3:45 PM–5:30 PM Problems in occlusion therapy – a qualitative study with parents and educators Charlotte Schramm1, Sybille Gräf1, Natalia Radionova1, Monika A. Rieger2, Dorothea Besch1, Kai Januschowski1. 1Ophthalmology, University hospital, Tuebingen, Germany; 2Institute for Occupational, Social Medicine and Health Services Research, Tuebingen, Germany. Purpose: The main problem while treating amblyopia (weaksightedness) is malcompliance of both - children and parents - to occlusion instructions/ guidelines. The aim of this study is a description of the current situation and problems of occlusion therapy in Germany using structured interviews. Methods: We performed 25 single structured interviews with adults who are involved in occlusion therapy as parents, educators or former patients who were treated with occlusion therapy in their childhood. Interviews were performed with persons of each of the following groups: parents and day-care workers of children with well-functioning therapy as well as parents and day-care workers of children with mal-functioning therapy and adults who received an occlusion therapy themselves in their childhood. The interview partners were recruited over the outpatient clinic in the University Eye Clinic Tuebingen, Department for strabology, motility disorders and children diseases. For the interviews standardized questions were used and different sociodemographic data according to the interview partner assessed additionally. Qualitative data analysis was carried out using Mayring’s content analysis method. Results: The analysis shows that occlusion therapy works fine in public day-care centers in spite of the anxiety of the most parents. In the age of 2 to 6 years social discrimination or isolation is not common. But an important point and potential pitfall in therapy compliance is the missing information about amblyopia of day-care workers. Day-care workers in Germany are officially not authorized care about the childrens’ health issues like administering drugs. However, the interviewed day-care workers felt responsible and coped well with patching therapy. The social background of the patients seems not to have an impact on dealing with occlusion therapy. Conclusions: Against current view performing occlusion therapy in day-care centers is a good alternative to patching at home. This is important considering that mothers tend to return to their working life soon following childbirth. Therefore day-care is more and more carried out in different forms (like kindergarten or nanny) and an official authorization for day-care workers to care about the childrens` health issues has to be politically discussed. Moreover, a better information of day-care workers about occlusion therapy is necessary. Commercial Relationships: Charlotte Schramm, None; Sybille Gräf, None; Natalia Radionova, None; Monika A. Rieger, None; Dorothea Besch, None; Kai Januschowski, None Support: This study was supported by an external peer reviewed funding of the “Nachwuchsakademie Versorgungsforschung BadenWuerttemberg” Program Number: 2190 Poster Board Number: B0043 Presentation Time: 3:45 PM–5:30 PM Visual outcomes of treatment of anisometropic and strabismic amblyopia in Mexican children older than 7 years Raul Alfaro, Guillermo Mendoza, Juan Homar Paez, Hector Morales. Tecnologico de Monterrey, Monterrey, Mexico. Purpose: To evaluate visual outcomes of patients treated for anisometropic or strabismic amblyopia in children aged 7 to 17 years, treated in our clinic from 2008 to 2014, and compare the visual acuities from these groups. Methods: Retrospective, longitudinal, and observational study. Were included patients in our clinic with diagnosis of anisometropic or strabismic amblyopia without any other eye disease, which have at least 6 months follow up visit. All patients with anisometropic amblyopia were provided with optical correction and depending on visual acuity were treated with patching 2, 4 or 6 hours. The patients with strabismic amblyopia were treated with patching depending their visual acuities and with optical correction if was needed, and surgery. Analysis of variance and analytical observation were used to compare visual outcomes presented through time. Results: The visual acuity at the diagnosis was .88logMar (20/150) in anisometropic patients and for the strabismic was .56logMar. (20/70). The visual acuity mean after 6 months of treatment was .34logMar. (20/42) for anisometropic patients and for strabismic patients was .28logMar (20/38). After analysis of variance it was found a statistically significant difference in visual acuity (P <.05) in both groups at 3 months and 6 months of treatment, nevertheless comparatively both groups gained visual acuity without any statistically significant variation,which means there was not founded any significant distinction in visual acuity improvement related to an ocular condition, but there is improvement during treatment. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: According to the results of this analysis treatment of amblyopia in patients older than 7 years is effective, and the outcomes in visual acuities are similar in both strabismic and anisometropic patients. To date, there are few studies on this subject and to our knowledge the are no studies comparing the result of treating strabismic vs anisometric amblyopia in this group age. Commercial Relationships: Raul Alfaro, None; Guillermo Mendoza, None; Juan Homar Paez, None; Hector Morales, None Program Number: 2191 Poster Board Number: B0044 Presentation Time: 3:45 PM–5:30 PM Dichoptic virtual reality therapy for amblyopia in adults Christopher M. Aderman1, Michael Deiner1, Manish Gupta2, James Blaha2, Marc H. Levin1. 1Ophthalmology, University of California, San Francisco, San Francisco, CA; 2Apollo VR, San Francisco, CA. Purpose: Studies suggest binocular video game therapies may effectively treat amblyopia in older children and adults, who are outside the critical window for traditional patching. Dichoptic video game training involves complementary game elements shown to both eyes, with the amblyopic eye seeing a higher contrast image. We are evaluating the safety and efficacy of a new immersive virtual reality (VR) system as a dichoptic amblyopia therapy. An additional study aim is to validate at home VR-based therapy and to compare visual parameters with in-office clinical examinations. Methods: We are conducting a single-center, masked, placebocontrolled study of the effect of 3-dimensional, VR gameplay on visual acuity (VA) and stereopsis in subjects with amblyopia. Approximately 50 participants between the ages of 15 and 45 with moderate vision loss from anisometropic and/or strabismic amblyopia are being enrolled. Subjects are randomized into three arms, comparing at-home dichoptic gameplay to monocular patching or binocular non-dichoptic gameplay. After an initial three-week period of patching or gameplay at home, all subjects receive the dichoptic intervention for an additional three weeks. Office-based testing is supplemented with novel in-game at-home diagnostic testing and compliance monitoring. Durability of treatment will be evaluated six months after enrollment. Primary study outcomes are VA in the amblyopic eye and stereopsis. Secondary outcomes include quality of life (AS-20 questionnaire), binocular Sloan low contrast acuity, and safety. Results: Pilot data supports a beneficial effect in amblyopic patients, with reduced suppression after 3 hours of gameplay. More than 300 users have trialed this system without reporting persistent diplopia or other bothersome side effects. In control subjects with varied levels of vision, measures of acuity and stereopsis from clinical examinations correlate with in-game testing metrics. Conclusions: Dichoptic VR treatment may be safe and effective in reducing suppression in young adults with amblyopia. Our randomized-controlled study will formally test the effects of dichoptic VR therapy on VA and stereopsis. Home-based VR systems also enable remote diagnostics and monitoring and should encourage compliance. Our initial results also support a role for remote testing in rigorous studies of candidate vision therapies. Commercial Relationships: Christopher M. Aderman, None; Michael Deiner, None; Manish Gupta, Apollo VR (I); James Blaha, Apollo VR (I); Marc H. Levin, None Clinical Trial: NCT02246556 Program Number: 2192 Poster Board Number: B0045 Presentation Time: 3:45 PM–5:30 PM Effect of monocular perceptual learning on binocular combination in anisometropic amblyopia Zidong Chen, Jinrong Li, Junpeng Yuan, Daming Deng, Minbin Yu. Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. Purpose: Perceptual learning of contrast detection can improve monocular visual function in adult amblyopes (Huang, 2008, PNAS). The effect of such training paradigm on binocular combination condition remains unknown. This study aimed to assess the binocular combination outcome after monocular perceptual learning in anisometropic amblyopes beyond critical period. Methods: Ten young participants with anisometropic amblyopia (age: 8-20) performed 2AFC grating contrast detection task near cut-off spatial frequency in the amblyopic eye for 7-12 days. Contrast sensitivity function (CSF), binocular function measurement using (1) binocular phase combination, (2) global dichoptic motion coherence, visual acuity (VA), and randot stereo acuity were assessed before and after training. Another ten subjects with anisometropic amblyopia (age: 7-16) prescribed patching for 4h/d and followed up in 2 weeks served as control. Results: Monocular perceptual learning significantly improved visual acuity in the amblyopic eye (1.68±0.08 lines, P=0.0002) and contrast sensitivity (CS) at trained spatial frequency (8.83±3.04 dB, P=0.0001). Change of binocular combination was observed by measuring effective contrast ratio (ECR) in (1) binocular phase combination task at spatial frequency of 0.3 cycle per degree (P=0.015; N=10), and (2) dichoptic motion coherence task (P=0.013; N=8). Area under log CSF (AULCSF) was calculated. Improvement of AULCSF in the amblyopic eye was found to be correlated with the improvement of ECR in binocular phase combination task (R=0.733, P=0.016) and VA (R=0.71,P=0.021). Change of binocularly perceived phase after training was observed only when low contrast stimuli was presented to the non-amblyopic eye, but not when higher contrast stimuli was used. Patching group didn’t show significant improvement in either visual acuity or binocular combination in 2 weeks. Conclusions: Monocular perceptual learning in anisometropic amblyopia could improve visual acuity in amblyopic eyes and change binocular combination condition. Improvement of CSF may be the underlying mechanism. However, such training paradigm was not sufficient to establish normal binocular vision in amblyopes when images of identical contrast were presented to both eyes. Commercial Relationships: Zidong Chen, None; Jinrong Li, None; Junpeng Yuan, None; Daming Deng, None; Minbin Yu, None Support: National Natural Science Foundation of China Grant (81200715) and Fundamental Research Funds of State Key Laboratory of Ophthalmology to Jinrong Li Program Number: 2193 Poster Board Number: B0046 Presentation Time: 3:45 PM–5:30 PM Improving visual functions in adult amblyopia with combined perceptual training and transcranial random noise stimulation (tRNS): a pilot study Antonella Veronese1, Giuseppe Lo Giudice1, Gianluca Campana2, Rebecca Camilleri2, Andrea Pavan3, Alessandro Galan1. 1 Ophthalmology, San Antonio Hospital, Padova, Italy; 2General Psychology, University of Padova, Padova, Italy; 3Institut fur Experimentelle Psychologie, University of Regensburg, Regensburg, Germany. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Purpose: to assess whether a much shorter perceptual training regime, in association with high-frequency transcranial electrical stimulation (hf-tRNS), was able to improve visual functions in a group of adult participants with amblyopia. Methods: Seven participants with anisometric amblyopia were recruited at the San Paolo Ophthalmic Center of San Antonio Hospital (Padova, Italy). The participants were enrolled in a 2-week (8 sessions) behavioural training programme using a contrast detection task under lateral masking conditions combined with online high frequency tRNS (hftRNS). All pre/post tests were administered monocularly on either eye and with the best optical correction. Perceptual training was also administered monocularly on the amblyopic eye with the best optical correction. Exclusion criteria included any other ocular condition or cause for reduced VA other than amblyopia, myopia, presbyopia, hypermetropia and/or astigmatism; these include diabetes mellitus, pregnancy, presence of myopia-related ocular complications and any previous ocular surgery. Exclusion criteria also included incompatibility with transcranial electrical stimulation, as assessed with a questionnaire (e.g. history of seizures, skin problems, migraine, etc.). This study has been approved by the local Ethics Committee. Results: VA and CS data were analysed with a repeated measures ANOVA with Time (pre- vs. post-test), and Spatial Frequency (only for CS: 0.8, 2.9, 5.8, 9.7, and 14.5 cpd) as within-subjects factors, and Eye (amblyopic/trained vs. non-amblyopic/untrained) as a between-subjects factor. Following eight sessions of a contrast detection training with lateral masking, VA significantly improved in both trained and untrained eye (F1,12=35.4, p=.0001, η2p=0.75). The VA in the trained and untrained eye was also significantly different (F1,8=22.12, p=.001, η2p=0.65). CS significantly improved after training (F1,12=11.7, p=.005, η2p=0.49), regardless the eye (interaction Time by Eye: F1,12=.03, p=.87, η2p=0.02) Conclusions: In our small sample of participants, a short (8 sessions) contrast detection training under lateral masking conditions and concurrent hf-tRNS was able to increase mean VA by 0.18 LogMAR (53% improvement, ranging from 25% to 111%) in the trained amblyopic eye. The CSF also resulted in strong improvements following training. Commercial Relationships: Antonella Veronese, None; Giuseppe Lo Giudice, None; Gianluca Campana, None; Rebecca Camilleri, None; Andrea Pavan, None; Alessandro Galan, None Program Number: 2194 Poster Board Number: B0047 Presentation Time: 3:45 PM–5:30 PM A personalized approach to occlusion therapy for amblyopia Laura Smith1, Catherine Stewart1, Alistair R. Fielder1, Merrick J. Moseley1, Michael Wallace2. 1Optometry and Visual Science, City University London, London, United Kingdom; 2Biostatistics, McGill University, Montreal, QC, Canada. Purpose: To use data of previous research in to the treatment of amblyopia to generate a computerised model for patching strategies to treat childhood amblyopia. Methods: Statistical modelling analysis was undertaken on a combined data set based on MOTAS (Stewart et al., 2004) and ROTAS (Stewart et al., 2007) studies. We considered an approach that aimed to prescribe a patient’s total effective occlusion dose (TED) to be converted to a daily patching for a fixed follow-up period. We assumed that every patient has an optimal visual outcome, and total effective dose of occlusion which they must undertake to achieve it. Results: In MOTAS and ROTAS there were occlusion data for 149 participants; amblyopia associated with anisometropia in 50, strabismus in 43, and mixed in 56 participants. Median time to optimized visual acuity was 63 days (25% and 75% quartiles of 28 and 91 days respectively). Median visual acuity in the amblyopic eye at start of occlusion was 0.40 logMAR (quartiles 0.22 and 0.68 logMAR). Median residual visual acuity (interocular difference) was 0.34 logMAR (quartiles 0.23 and 0.64 logMAR). Median lower estimate of total effective dose was 120 hours (quartiles 34 and 242 hours), median upper estimate was 176 hours (quartiles 84 and 316 hours). Exploratory plots depict a piecewise linear relationship (p = 0.008) with breakpoint estimated at 2.16 (standard error 0.51) hours/ day. The 2-part model is characterized by a steep gradient from 0 to 2.16 hours a day, followed by a shallower gradient for dose rates above this (figure 1). Our first model highlighted age, sex, gender, amblyopia type and residual amblyopia as possible predictors of total effective dose. Those with worse amblyopia at start of occlusion tended to have a larger total effective dose. Patients who were older at start of occlusion tended to have a lower total effective dose. Conclusions: We have presented a new approach to the prescription of occlusion therapy for the treatment of amblyopia in children. We have introduced the concept of total effective dose of occlusion: the total dose a patient requires of occlusion before it stops being effective. Total effective dose depends on the patient’s residual amblyopia, amblyopia type, and age at the start of occlusion therapy. Dose-rates prescribed range from 2.5 to 12 hours/ day. Figure 1: Average daily dose rate and (transformed) total effective dose Commercial Relationships: Laura Smith, None; Catherine Stewart, None; Alistair R. Fielder, None; Merrick J. Moseley, None; Michael Wallace, None Support: NIHR RFPB Grant PB-PG-0808-16087 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2195 Poster Board Number: B0048 Presentation Time: 3:45 PM–5:30 PM A new anti-suppression approach to treating anisometropic amblyopia Ying Yuan1, MIN LI1, Jiangnan He2, Bilian Ke1. 1Ophthalmology, Shanghai First People’s Hospital of Shanghai Jiaotong University, Shanghai, China; 2Shanghai Eye Diseases Prevention & Treatment Center, Shanghai, China. Purpose: To evaluate the efficacy of Eyetronix Flicker Glass therapy in treating anisometropic amblyopia by breaking interocular suppression and promoting binocular fusion. Methods: Thirty subjects with anisometropic amblyopia, ages 7 to 13, were enrolled in this study. A novel stimulus of Eyetronix Flicker Glass, a lightweight spectacle frame with liquid crystal lenses that provide direct square-wave alternating occlusion, was used at a pre-programmed temporal frequency of 7 Hz. Visual acuity, contrast sensitivity (CSV-1000E charts) of 3, 6, 12 and 18 cycles per degree spatial frequencies and binocular function were measured at baseline and follow-up visits at weeks 1, 3, 6, 9 and 12 to assess improvement of amblyopia. In addition, pattern-reversal visual evoked potential (RETIport32) was used to record visual cortex activity before and after treatment. Results: After Eyetronix Flicker Glass therapy, visual acuity significantly improved from 0.45±0.23logMAR to 0.27±0.22logMAR. Thirteen children (48%) had two lines or more visual acuity improvement. Contrast sensitivity of 3, 6, 12 and 18 cycles per degree spatial frequencies showed significant improvement at the visits of 3, 6, 9 and 12 weeks. Mean stereoacuity (Titmus test) improved from 241 seconds to 80 seconds. Stereoacuity in 11/30 children recovered to 60 seconds. In addition, there was a decreased P100 latency and increased N75-P100 amplitude of visual evoked potential after treatment. Conclusions: EyeTronix Flicker Glass showed promise as an alternative method for amblyopia treatment. It was effective in improving both monocular and binocular function, likely by reducing suppression and stimulating recovery of the visual cortex. Commercial Relationships: Ying Yuan, Eyetronix.Inc (F); MIN LI, Eyetronix.Inc (F); Jiangnan He, None; Bilian Ke, Eyetronix.Inc (F) Support: Grant No.81200713;Grant No.12RC06;Grant No.070339 Clinical Trial: 2013-010 Program Number: 2196 Poster Board Number: B0049 Presentation Time: 3:45 PM–5:30 PM The relationship between fusion, suppression, and diplopia in amblyopia Daniel P. Spiegel1, Alex S. Baldwin1, Mark A. Georgeson2, Reza P. Farivar1, Robert F. Hess1. 1Ophthalmology, McGill University, Montreal, QC, Canada; 2Vision Sciences, Aston University, Birmingham, United Kingdom. Purpose: Traditionally, it has been thought that no binocular combination occurs in amblyopia. However, there is a growing body of evidence that there are intact binocular mechanisms in amblyopia rendered inactive under normal viewing conditions due to imbalanced monocular inputs. Georgeson and Wallis (2014) recently introduced a novel method to investigate fusion, suppression and diplopia in normal population. We have modified this method to assess binocular interactions in amblyopia. Methods: Ten amblyopic and ten control subjects viewed brieflypresented (200 ms) pairs of dichoptically separated horizontal Gaussian blurred edges. Subjects reported one central edge, one offset edge, or a double edge as the vertical disparity was manipulated. The experiment was conducted at a range of spatial scales (blur widths of 4, 8, 16, and 32 arc min) and contrasts. Our model, based Georgeson and Wallis (2014), converted subjects’ responses into probabilities of fusion, suppression, and diplopia. Results: When the normal participants were presented equal contrast to each eye the probability of fusion gradually decreased with increasing disparity, as the probability of diplopia gradually increased. In only a small proportion of the trials, normal participants experienced suppression. The pattern was consistent across all edge blurs. Interestingly, the majority of amblyopes had a comparable pattern of fusion, i.e. decreasing probability with increasing disparity. However, with increasing disparity the amblyopes tended to suppress the amblyopic eye, experiencing diplopia only in a small proportion of trials particularly at large blurs. Increasing the interocular contrast offset favouring the amblyopic eye normalized the pattern of data in a way similar to normal participants. There were some interesting exceptions: strong suppressors for which our contrast range was inadequate and one case in which diplopia dominated. Conclusions: This task is suitable for assessing binocular interactions in amblyopic participants and providing a way to quantify the relationship between fusion, suppression and diplopia. In agreement with previous studies, our data indicate the presence of binocular mechanisms in amblyopia. A contrast offset favouring the amblyopic eye normalizes the measured binocular interactions in the amblyopic visual system. Commercial Relationships: Daniel P. Spiegel, None; Alex S. Baldwin, None; Mark A. Georgeson, None; Reza P. Farivar, None; Robert F. Hess, None Support: CIHR MOP-53346 Program Number: 2197 Poster Board Number: B0050 Presentation Time: 3:45 PM–5:30 PM Interocular Suppression and Treatment of Childhood Amblyopia Sarah E. Morale1, Simone L. Li1, Reed M. Jost1, Angie De La Cruz1, David Stager3, Lori Dao3, Eileen E. Birch1, 2. 1Retina Foundation of the Southwest, Dallas, TX; 2Dept. of Ophthalmology, UT Southwestern Medical Center, Dallas, TX; 3Pediatric Ophthalmology & Adult Strabismus, Plano, TX. Purpose: New techniques for measuring depth of interocular suppression make it possible to quantify the relationship between suppression and monocular visual deficits in amblyopia. Here, we investigate the effects of treatment on interocular suppression and its relationship to changes in visual acuity in amblyopic children. Methods: 121 children (5-12y) with strabismus, anisometropia, or both were tested; 71 were amblyopic, 24 were never amblyopic, 26 had recovered from amblyopia with treatment. Depth of interocular suppression was measured with a dichoptic motion coherence task. The amblyopic eye viewed high contrast coherent moving dots while the fellow eye viewed randomly moving dots with adjustable contrast. Dichoptic threshold (DT) was defined as the maximum fellow eye percent contrast (%C) that allowed reliable motion direction discrimination determined using a 2-down-1-up staircase protocol. Higher DT values indicate less interocular suppression. Best-corrected visual acuity (BCVA) was measured with ATS-HOTV (5-6y) or e-ETDRS (7-12y). Results: Mean (± se) DT for strabismic and/or anisometropic children who were never amblyopic was 84±3 %C and for those who had recovered was 69±6 %C. There was no significant difference in DT between strabismic and anisometropic amblyopia (49±5 vs 55±4 %C; p=0.36). DTs for amblyopic children being treated with glasses (45±4 %C) and those being treated with patching + glasses (35±5 %C; p<0.0001) were significantly lower than both nonamblyopic groups (p<0.001). DT for amblyopic children participating in binocular treatment (Li et al Eye 2014; Birch et al JAAPOS in press) was not significantly different from the recovered group (68±6 %C; ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology p=0.90) but was significantly higher than the patching + glasses group (p<0.0001). For 30 children who had 2 visits, including 3 with recurrent amblyopia, 17 with stable BCVA, and 10 with BCVA improvement, the change in DT was correlated with the change in BCVA (r=-0.47; p=0.009). Conclusions: The success of amblyopia treatment may rely on the remediation of interocular suppression, which plays a key role in strabismic and anisometropic amblyopia. Binocular treatment appears to be more effective than patching in reducing interocular suppression. Commercial Relationships: Sarah E. Morale, None; Simone L. Li, None; Reed M. Jost, None; Angie De La Cruz, None; David Stager, None; Lori Dao, None; Eileen E. Birch, None Support: NEI Grant EY022313 Program Number: 2198 Poster Board Number: B0051 Presentation Time: 3:45 PM–5:30 PM Short-term monocular deprivation reveals rapid shifts in interocular balance and gain in adult macaque visual cortex Momotaz Begum1, 2, Daniel Y. Tso1, 2. 1Neurosurgery, SUNY Upstate Medical University, Syracuse, NY; 2SUNY Eye Institute, Syracuse, NY. Purpose: Short-term monocular deprivation (STMD, patching one eye for 2.5 hours) markedly alters interocular balance in adult humans, as measured psychophysically (Lunghi et al 2011; Zhou et al 2013). In those studies, the relative contribution of the patched eye was elevated for more than an hour after patch removal. Now using intrinsic optical imaging in anesthetized macaque primary visual cortex (V1), we sought a parallel impact of STMD on interocular balance as measured by the strength of the V1 ocular dominance columns (ODC). Single-unit recordings in V1 with STMD, explored the neural correlates of these changes interocular balance at the neuronal level. Methods: Optical imaging of V1 provided an initial ODC map for the imaging studies, and to guide the placement of single-unit electrodes. After measuring the baseline monocular and binocular responses, one eye was “deprived” by viewing a mean gray screen while the other eye continued to view the same stimuli and imaging or electrophysiological recordings proceeded. This MD phase lasted 2 hours, then visual stimuli and imaging or recordings continued another 2 hours. Results: The imaging data were analyzed for ODC maps and for ODC signal strength (fractional reflectance change). Single cell responses to monocular and binocular stimuli were plotted before, during and after STMD. During STMD, the imaging data showed a steady decrease in the non-deprived eye strength, which dramatically shifted course (increased) after STMD even though stimulus in this eye was unaltered. The single-unit recordings revealed several different types of cell responses, including cells that showed unremarkable shifts in responses due to the STMD, other cells that exhibited an apparent strengthening of the non-deprived eye during STMD, and cells where the non-deprived eye showed dramatic drops in responsivity during STMD, consistent with the observed imaging (and psychophysical) results. Conclusions: The weakened response for the non-deprived eye during and immediately after patching was striking. It cannot be explained by adaptation in the eye or cortex. We have now also observed electrophysiologically a corresponding alteration of interocular balance at the single cell level. These results matches the previous psychophysical studies and suggests a dynamic mechanism for regulating interocular balance and gain, one that is likely cortical in origin. Commercial Relationships: Momotaz Begum, None; Daniel Y. Tso, None Program Number: 2199 Poster Board Number: B0052 Presentation Time: 3:45 PM–5:30 PM Dynamic regulation of synapsin phosphorylation by monucular deprivaiton in mice Tao Fu1, Qing Su1, Jing Wang1, Song Han2, Junfa Li2. 1Beijing TongRen Eye Center, Capital Medical University affiliated Beijing TongRen Hospital, Beijing, China; 2Department of Neurobiology and Beijing Institute for Brain Disorders Capital Medical University, Beijing, China. Purpose: To investigate the dynamic changes of isoform-specific protein expression and phosphorylation of synapsins in visual cortex of the postnatal mice with monocular deprivation (MD). Methods: Forty-two clean neonatal C57BL/6J mice were divided into seven groups randomly and six for each group. The mice were sacrificed to obtain the tissue samples at postnatal 7, 14, 21, 28, 35, 42, 60 days respectively. Similarly, Thirty neonatal healthy C57BL/6J mice were divided into five groups randomly (Monocular Deprivation groups, MD groups) and six for each group. The right eyelids of MD groups were sutured at postnatal 14, 21, 28, 35, 60 days respectively, and sacrificed after 7 days to obtain the tissue samples. Western blot were applied to quantitatively analyze the level of Synapsin phosphorylation and protein expression in the visual cortex. Results: The results showed that the total (T-) protein levels of synapsins including the isoform of Ia/b, IIa/b and IIIa were about 21-26% of adult level in visual cortex of mice at postnatal 7 days (P7), and then the T-synapsin Ia/b and IIb could quickly reach adult level at P35. However, the T-synapsin IIa and IIIa increased more slowly (71-74% at P35), and then kept increasing in the visual cortex of mice at P60. Unlike to the changes of T-synapsins, the level of phosphorylated (P-) synapsin Ia/b (not IIa/b and IIIa) at site 1 increased with development to the highest level (286.0±16.7%) at P21, and then decreased rapidly to a low level in visual cortex of mice at P35-60. In addition, we found that the levels of P-synapsin Ia/b increased significantly (p<0.05, n=6 per group) in left visual cortex of P28 and P35 (not P21 and P42) mice with one-week MD of right eye; and no significant changes of T-synapsins were observed in both left and right sides of visual cortex in P21-42 mice with MD treatment. Conclusions: These results suggested that the isoform-specific protein expression and site-1 phosphorylation of synapsins might play a different role in the synaptic plasticity of visual cortex, and monocular deprivation delays the dynamic changes of phosphorylated synapsin Ia/b at site-1 in contralateral visual cortex of juvenile mice. Commercial Relationships: Tao Fu, None; Qing Su, None; Jing Wang, None; Song Han, None; Junfa Li, None Support: NNSF of China 30600688; BNSF 7132057 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2200 Poster Board Number: B0053 Presentation Time: 3:45 PM–5:30 PM Effects of abnormal binocular vision due to amblyopia on early stages of somatosensory processing Ewa Niechwiej-Szwedo, Christina Popovich, Jessica Chin, W. Richard Staines. Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada. Purpose: Abnormal visual experience during development results in amblyopia and/or strabismus and affects neural activity in the striate and extrastriate visual areas; however, no studies to date examined the effect of amblyopia on neurophysiological processing beyond the primary visual areas. Previous work with healthy adults has shown that crossmodal stimuli can modulate neural excitability at very early stages of information processing. For example, the amplitude of the early somatosensory event-related potential (ERP), P50, is significantly enhanced when a tactile stimulus is presented concurrently with a relevant visual stimulus.1 We hypothesised that altered neural excitability in the primary visual areas in amblyopia will alter crossmodal interactions in other brain regions. Methods: Participants were three patients with amblyopia and five visually-normal adults. Crossmodal interaction was investigated during binocular viewing using EEG. Specifically, the P50 somatosensory ERP was recorded as participants engaged in a task which required discrimination of the amplitude of a tactile and visual stimulus. Tactile stimuli were discrete vibrations presented to the left index finger and visual stimuli were presented as a central horizontal bar on a computer screen. Participants executed a graded motor response with the right hand indicating the summation of the amplitude of the sensory inputs. Three experimental conditions were tested: unimodal (tactile only), bimodal concurrent (tactile and visual presented simultaneously), and bimodal priming (visual presented 100 ms prior to tactile). Results: As hypothesized, patients showed no enhancement of the P50 amplitude in the bimodal conditions (unimodal: 2.97±0.40μV; bimodal concurrent: 1.86±0.84μV; bimodal priming: 1.94±0.81μV). In contrast, visually normal participants showed a significant enhancement of the P50 amplitude in the bimodal condition (unimodal: 2.07±0.33μV; bimodal concurrent: 2.46±0.34μV; bimodal priming: 3.22±0.50μV), which is consistent with the previous study1. Conclusions: Preliminary results indicate that early crossmodal facilitation is affected by abnormal visual experience during development. Thus, this study offers the first evidence that the consequences of amblyopia on neurophysiological processing extend beyond the primary visual areas. 1 Popovich & Staines (2014) Brain Behav 4:247-60 Commercial Relationships: Ewa Niechwiej-Szwedo, None; Christina Popovich, None; Jessica Chin, None; W. Richard Staines, None Support: Canadian Foundation for Innovation and Ontario Research Fund Purpose: The current gold standard of a successful amblyopia treatment is the full recovery of visual acuity in the amblyopic eye. Although anecdotal evidence suggests that other visual functions such as contrast sensitivity might still be deficient after full acuity recovery, there has been no systematic study on how the previously amblyopic eye (pAE) will behave in binocular vision. In this study, we aimed to quantify sensory dominance of the pAE in a group of treated amblyopia. Methods: Eight treated amblyopes with very similar acuity in the two eyes (logMAR: .03 vs .00) participated in this study. Stereoacuity, monocular and binocular contrast sensitivity functions (CSF) with the quick CSF method (Lesmes et al., 2010), perceived phase of binocularly combined sinewave grating as a function of interocular contrast ratio (Huang et al., 2009), and pAE dominance in viewing dichoptically presented incompatible images of equal contrasts were measured. To quantify sensory eye dominance, we derived three different indices: (1) binocular contrast summation ratio: the ratio of the areas under binocular and previously fellow eye (pFE) CSFs, (2) balance point in binocular combination: the interocular contrast ratio at which the two eyes contribute equally to binocular phase combination, and (3) percentage of pAE dominance. The lower the binocular summation ratio and balance point, the weaker the pAE relative to the pFE is; a less than 0.5 eye dominance percentage indicates weaker pAE than pFE. Results: Near stereo acuity (31.38”±6.93”) and pAE dominance percentage (.5 at 1 c/d and .43 at 8 c/d) of the treated amblyopes were largely comparable to those of normal subjects. Contrast sensitivity remained deficient in high spatial frequencies, consistent with Huang et al. (2007), although their binocular contrast summation ratio (1.26±0.16) is only slightly less than that of normal subjects (Baker et al. 2007). However, the average balance point in binocular combination was only 0.41—-the effective contrast of images in the pAE is equal to about 41% of the same contrast presented to the pFE in binocular phase combination. Conclusions: Although near stereoacuity, binocular contrast summation ratio, and eye dominance in treated amblyopia were normal or nearly normal, the pAE remained “lazy” in binocular phase combination. Our results suggest that structured monocular and binocular training are necessary to fully recover deficient functions in amblyopia. Commercial Relationships: Wuli Jia, None; WUXIAO ZHAO, None; Chang-Bing Huang, None; Zhong-Lin Lu, Adaptive Sensory Technology, LLC. (I), The Ohio State University (P) Support: Supported by National Natural Science Foundation of China (NSFC 31230032 and 31470983), the Knowledge Innovation Program of the Chinese Academy of Sciences (Y3CX102003), Institute of Psychology, CAS to Chang-Bing Huang, and NEI (EY021553) to Zhong-Lin Lu. ZLL owns intellectual property rights on quick CSF technology and has equity interest in Adaptive Sensory Technology, LLC. Program Number: 2201 Poster Board Number: B0054 Presentation Time: 3:45 PM–5:30 PM Ocular Imbalance in Clinically Treated Amblyopia Wuli Jia1, 2, WUXIAO ZHAO3, Chang-Bing Huang1, Zhong-Lin Lu4. 1 Institute of Psychology, Chinese Academy of Sciences, Beijing, China; 2Institute of Psychology, University of Chinese Academy of Sciences, Beijing, China; 3Center for Optometry and Visual Science, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; 4Laboratory of Brain Processes (LOBES), Departments of Psychology, The Ohio State University, Columbus, OH. Program Number: 2202 Poster Board Number: B0055 Presentation Time: 3:45 PM–5:30 PM Detection of Amblyopia using sweep VEP grating and vernier acuity Chuan Hou1, William V. Good1, Anthony Norcia2. 1The SmithKettlewell Eye Research Institute, San Francisco, CA; 2Department of Psychology, Stanford University, Stanford, CA. Purpose: Grating and vernier displacement thresholds can be measured with swept-parameter visual evoked potentials (sVEP) and may therefore be useful in pre- or nonverbal subjects. Psychophysical studies indicate that while both grating and vernier acuity are correlated with letter acuity, grating acuity underestimates the full- ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology line letter acuity loss in amblyopia. This study was conducted to determine whether sVEP vernier acuity is better estimate of letter acuity than is sVEP grating acuity in patients with amblyopia. Methods: 18 adults with amblyopia (8 anisometroic and 10 strabismic) and 28 age-matched normal vision observers participated the study. In the patient group, letter acuity was between 20/32 and 20/250 in the amblyopic eye and 20/20 or better in the fellow eye when measured with a constant LogMar chart (Bailey-Lovie). In the normal vision group, letter acuity was 20/20 or better in each eye. sVEP vernier acuity was measured using square-wave gratings containing vernier displacements modulated at 3.76 Hz. sVEP grating acuity was measured using sine-wave gratings reversal at 7.5 Hz. Results: As has previously been reported for psychophysical measurements of vernier and grating acuity, sVEP vernier acuity in both normal vision observers and amblyopic observers faithfully reflected the absolute magnitude of the Letter acuity, while sVEP grating acuity systematically over-estimated letter acuity in the amblyopic eye. Conclusions: Because sVEP venier acuity is a better estimate of the full letter acuity loss and can be measured without the need for instruction or behavioral responses, it may be useful in assessing visual function in pre- and nonverbal patients. Commercial Relationships: Chuan Hou, None; William V. Good, None; Anthony Norcia, None Support: The Smith-Kettlewell Eye Research Institute Program Number: 2203 Poster Board Number: B0056 Presentation Time: 3:45 PM–5:30 PM Normative Pediatric Data for Three Tests of Functional Vision James R. Drover1, Shelley Cornick2, Ashley Drover2, Deanne Mayo3, Nadine Kielly3. 1Psychology and Pediatrics, Memorial University of Newfoundland, St. John’s, NF, Canada; 2Psychology, Memorial University of Newfoundland, St. John’s, NF, Canada; 3Private Practice Optometrist, St. John’s, NF, Canada. Purpose: Tests of visual acuity, stereoacuity, and refractive error are common components of preschool vision screening programs. An increasing number of these tests are becoming commercially available. The purpose of the present study is to provide the first normative pediatric data for three such tests, namely, the Precision Vision Visual Acuity Testing (PVVAT) system, the Pass Test 3 Stereo Test, and the PlusoptiX S09 Vision Screener. Methods: The participants included 267 children between the ages of 3 and 5 years (Mean=4.2±0.8years) participating in a preschool vision screening study. The children completed monocular testing with the PVVAT system, a computerized test of visual acuity. The optotypes used were isolated Patti Pics symbols surrounded by crowding bars. Stereoacuity was assessed using the Pass Test 3 Stereo Test, a random-dot test similar to the Random Dot E Stereo Test. Refractive error was measured using the Plusoptix S09 Vision Screener, which provides automatic, noncycloplegic estimates of refractive error. The mean and 95% tolerance limits were determined for each test. Results: Visual acuity improved significantly from 0.32 logMAR at 3 years to 0.18 logMAR at 5 years (p<0.0001). The lower tolerance limit improved from 0.59 logMAR at 3 years to 0.38 logMAR at 5 years. Stereoacuity also improved, decreasing from 120 arcsec (lower tolerance limit = 294 arcsec) at 3 years to 87 arcsec (lower tolerance limit = 220 arcsec) at 5 years (p=0.0015). Spherical refractive error remained stable at 0.27D (lower tolerance limit at 3 years = 1.33D; lower tolerance limit at 5 years = 0.91D; p=0.81), while cylindrical refractive error was also relatively stable, measuring 0.39D (lower tolerance limit = 1.00D) at 3 years and 0.37D (lower tolerance limit = 0.93D) at 5 years (p=0.90). Conclusions: Both visual acuity and stereoacuity improved significantly from 3 to 5 years of age. Note however, the norms obtained using the PVVAT system were somewhat lower than those reported in previous studies using different tests. The stability of spherical refractive error is unusual to some extent in that these children are undergoing emmetropization, but it does agree with a previous study providing noncycloplegic estimates of refractive error in children. Commercial Relationships: James R. Drover, None; Shelley Cornick, None; Ashley Drover, None; Deanne Mayo, None; Nadine Kielly, None Support: Canadian National Institute for the Blind New Researcher Award; Janeway Foundation Grant Program Number: 2204 Poster Board Number: B0057 Presentation Time: 3:45 PM–5:30 PM Identification of young children for participation in studies of spectacle correction through pediatric primary care clinics: A pilot study Irene Campus1, Kimberly Gerhart2, Jordana M. Smith1, Amy Davis1, Joseph M. Miller1, Erin M. Harvey1. 1Ophthal & Vision Science, University of Arizona, Tucson, AZ; 2Pediatrics, University of Arizona, Tucson, AZ. Purpose: To determine the true positive rate for children referred for eye examinations based on SPOT (Welch Allyn, Inc) photoscreening in pediatric primary care clinics. Methods: Children were screened at well-child checks with the SPOT photoscreener at one of three pediatric clinics. Screening failures were referred to the University of Arizona Visual Development Laboratory for follow-up eye examinations which included cycloplegic refraction and assessment of ocular alignment. Screening results were considered true positives if examination results met American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) amblyopia risk factor referral criteria for children age 12 months and older. Results: The final sample included 31 children ranging in age from 12 to 70 months who failed a SPOT screening conducted at their pediatric primary care clinic and completed an eye examination at the Visual Development Lab. Children failed the SPOT screening due to suspected astigmatism (24/31, 77%), anisometropia (5/31, 16%), hyperopia (2/31, 6%), and gaze asymmetry (2/31, 6%) (one child met criteria for astigmatism, hyperopia and anisometropia). Of the 31 children, 16 met AAPOS referral criteria based on eye examination results indicating a true positive rate of 52%. False positive rates were 10/24 (42%) for astigmatism, 1/2 (50%) for hyperopia, 4/5 (80%) for anisometropia, and 2/2 (100%) for gaze asymmetry. Conclusions: Results indicate that approximately half of the children referred had significant refractive error. True positive referrals may be improved if primary care clinics repeat screenings to verify results before referring children. These preliminary data suggest that this method may be an efficient way to recruit subjects for clinical trials on refractive correction of young children. The primary care recruitment base will produce a study sample of previously untreated children that is more generalizable than samples recruited through ophthalmology/optometry clinics. Commercial Relationships: Irene Campus, None; Kimberly Gerhart, None; Jordana M. Smith, None; Amy Davis, None; Joseph M. Miller, None; Erin M. Harvey, None Support: NIH/NEI EY13153 (EMH), Research to Prevent Blindness ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2205 Poster Board Number: B0058 Presentation Time: 3:45 PM–5:30 PM Refractive Change in Children with Accommodative Esotropia Lucas Bonafede1, Lloyd Bender1, James Shaffer2, Gui-Shuang Ying2, Gil Binenbaum1, 2. 1Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, PA; 2The Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Purpose: There is debate regarding the degree of change in refractive error over time in children with accommodative esotropia. We conducted a retrospective cohort study to determine whether there is a measurable change in hypermetropia in children with accommodative esotropia as they age. Methods: We identified children with accommodative or partially accommodative esotropia diagnosed prior to age 7 years, followed to age 10 or older, and with at least two full cycloplegic refractions, one performed prior to age 7 years and one after age 10 years. Subjects who lacked refractive or orthoptic data, or had a concurrent ocular, motility, or systemic abnormality were excluded. The primary outcome was annual change in spherical equivalent refractive error calculated from linear mixed effect models with assessment for breakpoints based upon the annual changes. The annual change was further calculated during two periods (ages 3 to 7 years and ages 7 to 15 years) with subgroup analysis by baseline refractive error less than or greater than 4 diopters (D) of hypermetropia. Results: 405 subjects met inclusion criteria. Mean age at first and last visit was 3.2 (SD 1.6) and 12.1 (SD 1.9) years, respectively, with the mean number of cycloplegic refractions being 7.6 (SD 2.5). Between ages 3 and 7, refractive error among children with baseline hypermetropia <4 D (n=176) increased by 0.14 D/year (95% CI +0.10 to +0.18), while refractive error was stable among children with baseline 4D or greater (n=229) whose annual change was 0.0 D/year (95% CI -0.03 to +0.04); the difference among groups was significant (p<0.001). Hypermetropia decreased from age 7 to 15 years in both subgroups: <4D subgroup -0.18 D/year (-0.21 to -0.16), 4D+ subgroup -0.20 D/year (-0.22 to -0.17)(comparison between subgroups p=0.527). There were no significant differences in refractive change between fully (n=274) and partially (n=131) accommodative esotropia (p>0.10). Conclusions: Hypermetropia in children with accommodative esotropia is stable or increases up to age 7 years. Hypermetropia then decreases gradually between ages 7 and 15 years. However, the decrease in refractive error is not large for the great majority of children and is similar regardless of baseline refractive error. Commercial Relationships: Lucas Bonafede, None; Lloyd Bender, None; James Shaffer, None; Gui-Shuang Ying, None; Gil Binenbaum, None Support: NIH grants P30 EY01583-26, 5T35DK060441-10, and UL1RR02499 Program Number: 2206 Poster Board Number: B0059 Presentation Time: 3:45 PM–5:30 PM Vision In Preschoolers - Hyperopia In Preschoolers (VIP - HIP) Study: Visual function differences between Hyperopes and Emmetropes Elise Ciner. Salus University, Elkins Park, PA. Purpose: To compare the visual function of uncorrected hyperopic(≥3 to ≤6 diopters [D]) and emmetropic children without strabismus or amblyopia who were enrolled in the Vision in Preschoolers – Hyperopia in Preschoolers study. Methods: Participants were children 4 to 5 years old attending preschool or kindergarten, who had never received refractive correction. Data collection included threshold monocular visual acuity (VA) at distance and binocular VA at near with crowded HOTV, accommodative response by Monocular Estimation Method (MEM) and Grand Seiko autorefraction at 33cm, and stereoacuity (up to 30 sec arc) by Preschool Assessment of Stereopsis with a Smile (PASS). Cycloplegic autorefraction was performed using Retinomax to confirm the presence of either hyperopia (≥3.0D to ≤6.0D in the most hyperopic meridian of at least one eye; astigmatism ≤1.5D and anisometropia ≤1.0D) or emmetropia (hyperopia <1.0D; myopia, astigmatism and anisometropia <1.0D). Cover test at distance and near and VA were used to rule out strabismus or amblyopia. Results: 492 children (244 hyperopes and 248 emmetropes) participated (mean age 58 months; mean [+SD] spherical equivalent refractive error +3.47D+0.81 in hyperopes and +0.37D+0.50 in emmetropes). Mean logMAR distance VA was better for emmetropes than hyperopes (0.10±0.11 vs. 0.19±0.10, p<.001) and more emmetropes than hyperopes were able to achieve VA of at least 20/20 in the better seeing eye (53.6% vs. 21.4%, p<0.001). The mean logMAR VA at near in emmetropes was better than hyperopes (0.13±0.11 vs. 0.21±0.11, p<.001), with 20/20 VA attained by 23.8% of emmetropes vs. 5.3% of hyperopes (p<0.001). Mean accommodative lag in emmetropes was smaller than in hyperopes for both MEM (1.0±0.5 vs. 2.0±1.0, p<0.001) and Grand Seiko (0.9±0.6 vs. 1.8±1.1, p<0.001). More emmetropes (59.3%) than hyperopes (16.4%) were able to achieve one of the two best tested stereoacuity levels (30 or 40 sec arc, p<0.001). Mean stereoacuity was better in emmetropes than hyperopes (67±60 sec arc vs.166±137 sec arc, p<.001). Conclusions: Visual function as measured with VA, accommodative response and stereoacuity was significantly better in emmetropes compared to uncorrected hyperopes in this group of 4 to 5 year old children without strabismus or amblyopia. It is not known if correction of the hyperopia at this age improves these visual skills. Commercial Relationships: Elise Ciner, None Support: NIH/NEI R01EY021141 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2207 Poster Board Number: B0060 Presentation Time: 3:45 PM–5:30 PM The Clinical Profile of Moderate Hyperopia in Children Three to Five Years of Age Donny W. Suh1, Marjean T. Kulp2, Trevano W. Dean3, Raymond T. Kraker3, Sergul A. Erzurum4, 5, David K. Wallace6, Yi Pang7, Caroline J. Shea8, John M. Avallone9. 1Department of Ophthlamology, University of Nebraska, West Des Moines, IA; 2College of Optometry, The Ohio State University, Columbus, OH; 3Jaeb Center for Health Research, Tampa, FL; 4Eye Care Associates, Youngstown, OH; 5Northeast Ohio Medical University, Rootstown, OH; 6Duke Eye Center, Durham, NC; 7Illinois College of Optometry, Chicago, IL; 8Providence Sacred Heart Medical Center, Spokane, WA; 9 Ophthalmology Associates of Greater Annapolis, Arnold, MD. Purpose: To describe relationships among baseline clinical findings in a cohort of children 3 to 5 years of age with moderate hyperopia participating in a 3-year randomized trial comparing glasses versus observation for development of amblyopia and strabismus. Methods: 117 children 3 to 5 years of age with hyperopia in at least one eye between +3.00D and +6.00D spherical equivalent (SE), astigmatism ≤+1.50D in both eyes, and anisometropia ≤+1.50D SE based on cycloplegic refraction were enrolled. To be eligible, children had to have no measurable heterotropia, and could not have received previous treatment for refractive error, amblyopia, or strabismus. In addition, children had to 1) demonstrate age-normal monocular visual acuity (VA) uncorrected at distance in both eyes measured without cycloplegia, using the ATS-HOTV© VA testing protocol; 2) have ≤1 line of interocular difference; and 3) demonstrate age-normal stereoacuity on the Randot Preschool Stereotest. Binocular near VA and monocular estimate method (MEM) dynamic retinoscopy were measured in a subset of subjects. Pearson correlation and partial correlation coefficients and 95% confidence intervals (CI) were calculated to evaluate relationships. Results: The mean age was 4.42 years, and mean SE refractive error was +3.95D in the more hyperopic eye and +3.61D in the less hyperopic eye. Greater hyperopia at baseline was associated with greater accommodative lag as measured by MEM retinoscopy (R=0.31, 95% CI= 0.05 to 0.53). Higher hyperopia at baseline was associated with worse distance VA, controlling for age (R=0.24, 95% CI= 0.06 to 0.41). Better binocular near VA was associated with better monocular distance VA controlling for age (the correlation of near VA with distance VA was 0.35 (95% CI= 0.16 to 0.51) in the better seeing eye and was 0.34 (95% CI= 0.15 to 0.51) in the worse seeing eye). Better binocular near VA was also associated with better stereoacuity (R=0.24, 95% CI = 0.04 to 0.42) controlling for age and anisometropia. Conclusions: Weak to moderate associations exist among children enrolled with moderate hyperopia (+3.00D to +6.00D) and agenormal VA and stereoacuity. As expected, greater hyperopia is moderately associated with greater accommodative lag and weakly associated with worse distance VA. Better binocular near VA is moderately associated with better monocular distance VA and weakly associated with better stereoacuity. Commercial Relationships: Donny W. Suh, None; Marjean T. Kulp, None; Trevano W. Dean, None; Raymond T. Kraker, None; Sergul A. Erzurum, None; David K. Wallace, None; Yi Pang, None; Caroline J. Shea, None; John M. Avallone, None Support: NIH Grants EY018810, EY023198, and EY011751 Clinical Trial: NCT01515475 Program Number: 2208 Poster Board Number: B0061 Presentation Time: 3:45 PM–5:30 PM Refractive errors in a rural population of Argentine Patagonia Julio A. Urrets-Zavalia1, Leandro Correa1, Evangelina Esposito1, M. E. Gonzalez-Castellanos1, Dana Martinez1, fernanda Suarez2, Horacio M. Serra2. 1University Clinic R Fabiola/Ophthalmol, Universidad Catolica de Cordoba, Cordoba, Argentina; 2CIBICICONICET, Faculty of Chemical Sciences, Universidad Nacional de Cordoba, Cordoba, Argentina. Purpose: Information of refractive errors prevalence in rural populations in Argentina is lacking. The purpose of our study was to assess the prevalence of refractive errors in an adult rural population living in an area of the Argentine Patagonia. Methods: An observational, descriptive and retrospective study was performed to assess the frequency of myopia, hyperopia, astigmatism and anisometropia in 144 consecutive adult patients, 76 men and 68 women, of mapuche etnia from a rural region of the Argentine Patagonia. All patients received a comprehensive eye examination, including visual acuity with Snellen chart, and refraction was obtained under cycloplegia. Refractive errors were evaluated in spherical equivalent (SE). Myopia and hyperopia were defined as spherical equivalent (SE) ± 0.50. All patients with SE less than ± 0.50D were considered as emmetropic. Astigmatism was defined as a cylinder equal or greater than 0.50D. Anisometropia was defined as the difference in spherical equivalent of > 1.00D between the two eyes. Each refractive error was separated into three different groups: low (less than 1d), moderate (1-3D) and severe (> 3d) astigmatism; low (<+2D), moderate (+2.25 to +5D) and severe (more than+5D) hyperopia; low (less than -3D), moderate (-3 to -6D) and severe (more than -6D) myopia . As the Spearman correlation coefficient for the SE and the cylinder between the right and left eye was high (r = 0.86, P <0.0001), only data from the right eye were used for analysis. Anisometropia was analyzed with SE data of both eyes. Variables with a p<0.05 were considered as significant. Results: Median age was 55.5 years (r= 20-84 years). The prevalence for emmetropia was 34% (95% CI = -0.38, 0.38); myopia 18% (95% CI = -21.25, -0.50), being more prevalent in women (p<0.001), much more frequently involved in near work tasks; hyperopia was 46.5% (95% CI = 0.5; 4.38); and astigmatism 63.2% (95% CI = 0.5; 5.5). Low (30.6%) and moderate (26.4%) astigmatism were more prevalent. 86,6% of hyperopic patients had low hyperopia, 11,9% moderate and the 1,5% had severe hyperopia. Among myopic patients 73.1% had low, 11.5% moderate and 15.4% severe myopia. Anisometropia prevalence was 14.6% (95% CI = 1; 20.5). Conclusions: Astigmatism, in particular low and moderate, was found to be highly prevalent among this rural population. Environmental factors and type of activity might contribute to astigmatism and myopia, respectively. Commercial Relationships: Julio A. Urrets-Zavalia, None; Leandro Correa, None; Evangelina Esposito, None; M. E. Gonzalez-Castellanos, None; Dana Martinez, None; fernanda Suarez, None; Horacio M. Serra, None Program Number: 2209 Poster Board Number: B0062 Presentation Time: 3:45 PM–5:30 PM Comparison of non-cycloplegic refraction with the PlusOptix A09 distance refraction and cycloplegic refraction. Arnaud Payerols1, Claudie Malrieu-Eliaou1, Max Villain1, 2, Vincent Daien1, 2. 1Ophthalmology, Gui de Chauliac Hospital, Montpellier, Montpellier, France; 2Montpellier 1 University, Montpellier, France. Purpose: ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Accurate measurement of refraction in paediatric ophthalmology is mandatory. Cycloplegic refraction is the gold standard before first spectacle and during strabismus or amblyopia management. In this study we aimed to identify the distance refraction values as compared with non-cycloplegic refraction and cycloplegic refraction. Methods: A total of 32 children (corresponding to 64 eyes) ranging from 7 to 139 months of age where prospectively included. Before cycloplegic administration of 1% cyclopentolate hydrochloride, each child underwent refraction with the PlusOptix A09 and with the Retinomax hand-held or the Nidek autorefractor when possible. Same measurements were performed after cycloplegia. Paired t-tests were used to compare spherical equivalent between each refraction. Pearson coefficients were used to correlate refraction values. The Bland-Altman method was used to assess the difference in refraction between distance PlusOptix A09 and cycloplegic refraction. Right eye was considered for all comparisons. Results: We observed significant differences of mean (interquartile range) spherical equivalent between classic refraction (-0.70 [-2.0;1.1] D) and PlusOptix A09 (+0.54 [-0.8;1.9] D), p=0.008 and between spherical equivalent from PlusOptix A09 (+0.54 [-0.8;1.9] D) and cycloplegic refraction (+1.06 [-0.4;2.0] D), p=0.02. The refraction value with the PlusOptix A09 was positively and significantly correlated to cycloplegic refraction (r =+0.81, p<0.001). The mean difference between PlusOptix A09 and cycloplegic refraction was +0.52 (IC95: 0.10 - 0.93) and the limit of agreement range from 1.55 D to +3.15 D. Conclusions: This study documented the spherical equivalent value of non cycloplegic refraction performed with PlusOptix A09 that give closer value to cycloplegic refraction than classic refraction. Distance refraction can constitute a tool for screening or follow up that have higher value than classical non-cycloplegic refraction. However it cannot replace the cycloplegic refraction for first spectacle correction and during strabismus or amblyopia management. Commercial Relationships: Arnaud Payerols, None; Claudie Malrieu-Eliaou, None; Max Villain, None; Vincent Daien, None Program Number: 2210 Poster Board Number: B0063 Presentation Time: 3:45 PM–5:30 PM Infrared photorefraction is more sensitive in the detection of visually significant refractive errors in school children when compared to visual acuity measurement Minal P. Patil1, Ashwin C. Mallipatna1, Swathi Baliga1, Vasudha Kemmanu1, Bhujang Shetty2. 1Peadiatric Ophthalmology, Narayana Nethralaya, Bangalore, India; 2Narayana Nethralaya Foundation, Bangalore, India. Purpose: Refractive error is major cause of visual impairment in school children. We intend to determine the accuracy of visual acuity and infrared photorefraction testing in school, by comparing it to visual acuity and cycloplegic autorefraction done in the hospital. Methods: Retrospective data was collected from 4 schools with 1241 children (5 to 18 years) screened with visual acuity and infrared photorefraction using the Plusoptix Autorefractor A09 (Plusoptix GmbH, Nuremberg, Germany). Children referred for further examination met at least one of these criteria: 1. Vision worse than 6/12; 2. Refractive spherical equivalent lesser than -0.5D (myopia) or greater than +3.0D (hypermetropia); 3. Cylindrical error greater than 2.5D; 4.Any complaint or obvious eye pathology. Of the children who were referred for further examination, the following was done in clinic:1. Visual acuity; 2. Cycloplegic autorefraction. Results: Of the 1241 children listed in the schools 133 were absent. Visual acuity was recorded in 2071 eyes of which 92 eyes were worse than 6/12. Visual acuity was rechecked in clinic for 73 eyes and 28 were found to have vision of 6/12 or better .Of the 1108 children screened, 17 children were referred for vision complaints. Of the 2216 eyes screened, refraction was recorded using the photorefractor in 1892 eyes. The device was not able to get readings in 197 eyes. Myopia worse than -0.50D was seen in 100 eyes, hypermetropia worse than +3.00D was seen in 22 eyes and a cylindrical refractive error greater than 2.5D was seen in 46 eyes. Sensitivity and specificity data was calculated using the limits of our screening criteria. Visual acuity measurements alone in school screening were 42% sensitive and 93% specific. The photo refractor prediction of myopia worse than -0.5D was 62% sensitive and 84% specific, that for hypermetropia worse than +3.0D was 100% sensitive and 95% specific, and that for cylinder worse than 2.5D was 100% sensitive and 93% specific. Conclusions: During school screening, visual acuity measurement alone may not be sensitive enough to detect poor vision. Photorefraction can help detect significant refractive errors with reasonable accuracy. However, careful selection of screening criteria is important to be most sensitive and specific for the population screened. Commercial Relationships: Minal P. Patil, None; Ashwin C. Mallipatna, None; Swathi Baliga, None; Vasudha Kemmanu, None; Bhujang Shetty, None Program Number: 2211 Poster Board Number: B0064 Presentation Time: 3:45 PM–5:30 PM Validation of Confidence Levels for a Cell Phone-Based Refractor (NETRA-G) Vitor F. Pamplona1, Steven Turpin2, Jorge Cuadros2, Rahul Modi1. 1 EyeNetra Inc, Somerville, MA; 2University of California, Berkeley, Berkeley, MA. Purpose: To assess the performance of a cell phone based refracting device (NET). We identify the efficacy of NET confidence values by comparing refractive differences between NET and subjective refraction (SR). Methods: NET retrofits a high-resolution mobile phone (Samsung S4) by adding a pinhole mask and a lens onto the display. The device is bi-ocular and both eyes are constantly fogged (+6D). The subject aligns red and green lines with the translation on the screen proportional to refractive error. Besides refraction, the device computes a confidence value (from 0, poor, to 1, good). The hypothesis is that results under 0.4 require a retest. 89 subjects (mean + SD age 28.41 +/- 6.95) underwent SR and NET refraction. Auto-Refractor (AR) was used as a starting point for SR. Subjects were split according to NET’s confidence value and compared. Group A (n=70) included high confidence readings (>0.4) and Group B (n=19) low confidence readings (<0.4). Subject’s refractive error ranged from +1.50 to -8.25D (mean + SD refraction -1.37 +/- 1.90D). Exclusion criteria included: amblyopia, non-refractory pathologies, and 4 subjects in which NET yielded a better refraction than SR. Results: For all 89 subjects, the mean + SD Vector Power Difference (VDD) of NET-SR is 1.20 +/- 1.24D. Group A’s mean + SD VDD is 0.95 +/- 0.60D (corr=95%). In comparison, the mean + SD VDD of AR-SR is 0.51 +/- 0.45D (note: SR is biased towards AR). NET, AR and SR yielded 20/25 or better vision on 92%, 96% and 98% respectively. Mean + SD visual acuity difference of NET-SR is -0.07 +/- 0.08 logMar. Group B’s mean + SD VDD of NET-SR is 2.12 +/2.18D (corr=65%). NET, AR and SR yielded 20/25 or better for 61%, 72% and 89% respectively. Linear regression of spherical equivalent ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology presented a slope of 0.86 and a y-intercept of -0.63D. Mean + SD of PD difference of NET-AR is -0.76 +/- 1.88mm. Conclusions: NET’s confidence value can be used as a predictor for insufficient accuracy, triggering a retest or a discarding method. The low confidence group included the only 2 subjects with highorder aberrations and 5 subjects that required translation (a known language barrier for NET, since subjects need to understand the procedures). Group A included all subjects that could not reach 20/20 vision on the SR. The results show that NET has potential to be a used as an effective tool for rapidly estimating refractive errors and interpupillary distance measurements. Commercial Relationships: Vitor F. Pamplona, EyeNetra Inc (E); Steven Turpin, None; Jorge Cuadros, None; Rahul Modi, EyeNetra Inc (E) Program Number: 2212 Poster Board Number: B0065 Presentation Time: 3:45 PM–5:30 PM Spatial summation of perimetric stimuli across the visual field in anisometropic and strabismic amblyopia Shindy Je, Fergal A. Ennis, James E. Morgan, Tony Redmond. School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom. Purpose: To investigate differences in the area of complete spatial summation (Ricco’s area) for standard perimetric stimuli, between amblyopic eyes and their fellow non-amblyopic eye, and to compare any such inter-ocular differences to those in observers with normal binocular vision. Methods: Achromatic contrast detection thresholds were measured with circular incremental stimuli of different area (Goldmann I-V; 0.02°–1.7° diameter) at 12 visual field locations (9°, 15° and 21° eccentricity; 4 locations each) in observers with strabismic amblyopia (n=2; age: 19, 23 years), anisometropic amblyopia (n=3; age:18, 19, 20 years), and normal binocular vision (n=5; mean age: 25.8 years, range: 20, 31). Background luminance was 10cd/m2. Experiments were performed on an Octopus 900 perimeter (Haag Streit, Koeniz, Switzerland), with the Open Perimetry Interface. Thresholds were averaged by eccentricity and three spatial summation curves were constructed for each eye. Ricco’s area was estimated from each by two-phase regression analysis. Estimates were compared between amblyopic and fellow non-amblyopic eyes at each eccentricity. Inter-ocular differences at each eccentricity were compared between observers with and without amblyopia. Results: Ricco’s area was significantly larger (mean: 0.3 log deg2) in amblyopic eyes than in fellow non-amblyopic eyes at all eccentricities (p=0.01, paired t-test, Holm-Bonferroni correction). Inter-ocular differences in control subjects (mean: 0.03 log deg2) were not statistically significant (p>0.05, paired t-test, Holm-Bonferroni correction). Compared with control eyes, mean Ricco’s area was larger in amblyopic eyes but smaller in non-amblyopic eyes (Figure). Conclusions: Given that changes in receptive fields of retinal ganglion cells in amblyopia are not marked, our findings likely point to a difference in representation of each eye at the cortical level. Greater convergence of signals from retinal ganglion cells in amblyopic eyes to thinner ocular dominance (OD) columns in V1, and less convergence from those in the fellow non-amblyopic eye to thicker OD columns, may explain these results. These findings also support the concept that the physiological basis for Ricco’s area reflects processing along the entire visual pathway, and is not confined to the retina. Mean Ricco’s area as a function of eccentricity in amblyopic, nonamblyopic and control eyes. (Error bars: SEM) Commercial Relationships: Shindy Je, None; Fergal A. Ennis, None; James E. Morgan, None; Tony Redmond, Heidelberg Engineering (F) Support: College of Optometrists Research Fellowship Program Number: 2213 Poster Board Number: B0066 Presentation Time: 3:45 PM–5:30 PM Do different mechanisms mediate contour interaction and crowding in the fovea and visual periphery? Stephanie M. Marten-Ellis, Harold E. Bedell. College of Optometry, University of Houston, Houston, TX. Purpose: To compare the influence of nearby flanking lines (contour interaction) and flanking letters (crowding) on the identification of foveal and peripheral letters at different luminances. Methods: Single Sloan letters were presented at the fovea or at 5 deg in the inferior visual field, with and without 4 flanking bars or flanking letters placed symmetrically to the right, left, above and below the target letter. Background luminance was either 200 or 0.5 cd/sq.m. For each combination of eccentricity and background luminance, letter size was adjusted to produce 80 – 90% correct identification when the flanking targets were absent. Percent correct letter identification was then determined for 5 to 8 edge-to-edge separations between the flankers and Sloan letters in 2 normal observers. The bar flankers subtended 1 x 5 letter-stroke widths and the letter flankers had the same dimensions as the letter targets. Results: At the fovea, the extent of interaction (the maximum target-to-flanker separation that influenced performance) was approximately 3 – 4 min arc for both bar and letter flankers. The magnitude of interaction (the maximum reduction of percent correct letter identification) also was similar for both types of flankers, but decreased dramatically at low compared to high background luminance. At 5 deg in the inferior field, the extent of contour interaction for bar flankers was approximately 4 times smaller than the extent of crowding for letter flankers. Reducing background luminance had no effect on either the extent or the magnitude of peripheral contour interaction or crowding. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: At the fovea, bar and letter flanking targets interfere with letter recognition based on the same luminance-dependent mechanism. In the periphery, contour interaction and crowding are independent of background luminance but flanking bars impair identification much less strongly than flanking letters. The results suggest that flanking targets influence foveal and peripheral letter identification by different mechanisms. Commercial Relationships: Stephanie M. Marten-Ellis, None; Harold E. Bedell, None Support: NEI Grant T35 EY007088 Program Number: 2214 Poster Board Number: B0067 Presentation Time: 3:45 PM–5:30 PM Crowding in simulated monovision Zuopao Zhuo1, 2, Hua Bi2, Bin Zhang2, Ziming Liu3, 2, Zheyi Chen1, Binbin Su1, Jun Jiang1, Fan Lv1. 1Optometry Department, The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China; 2College of Optometry, NOVA Southeastern University, Davie, FL; 3Shenyang He Eye Hospital, Shenyang, China. Purpose: Monovision is the presbyopic vision correction practice of prescribing distance vision in one eye and near vision in the other eye. With blurred image in one eye and clear image in the other, the visual system experiences more binocular masking/suppression/ rivalry. About 20%-30% patients with monovision have reported discomfort, indicating certain impairment in visual function. The largely normal visual acuity, which represents the foveal visual function, indicates periphery visual disturbance in those patients. Crowding refers to the reduced object identification ability in the periphery when the target object is flanked by distracters. It is a binocular process and other binocular processes that are ongoing simultaneously could interfere to amplify the impairment to object identification. In this study, we tested whether crowding is much more severe in simulated monovision condition. Methods: 20 subjects participated in this study. Cycloplegia was induced by instillation of one drop of 1% tropicamide and an artificial pupil with 3mm diameter was applied. Monovision was simulated by full correction in one eye and correction with +2.5 D defocus in the other eye. The crowding effect was quantified by reduction in accuracy when identifying letters (5° eccentricity from the fixation) with flankers at 5 different spacing (0.44°, 0.88°, 1.32°, 1.76°, 2.4°) as compared with no flanker. For each subject, the crowding effect was measured both in normal and simulated monovision condition. Accuracy of letter identification and area of error identification were calculated. Z-test was applied to test if the accuracy of letter identification and area of error identification changed significantly in simulated monovision condition. Results: The accuracy of letter identification, when tested without flankers, was similar in normal and simulated monovision condition. However, with flankers, the accuracy of letter identification was significantly lower in simulated monovision condition at all spacing (P < 0.05), and the changes of accuracy between them at 5 different spacing were significantly different. (P < 0.05) The area of error identification was significantly higher in simulated monovision condition (3.32 ± 0.47) as compared with normal condition (2.31 ± 0.59). (P < 0.05) Conclusions: The crowding was much more severe in simulated monovision condition than normal viewing condition, and the difference was dependent of the spacing between the target and flankers. Commercial Relationships: Zuopao Zhuo, None; Hua Bi, None; Bin Zhang, None; Ziming Liu, None; Zheyi Chen, None; Binbin Su, None; Jun Jiang, None; Fan Lv, None Support: NSU Health Professions Division Grant Program Number: 2215 Poster Board Number: B0068 Presentation Time: 3:45 PM–5:30 PM Digital self-assessment application for identifying ADHD symptoms Oren Yehezkel, Anna Sterkin, Maria Lev, Uri Polat. Scientific, Eyekon E.R.D Ltd, Ramat-Gan, Israel. Purpose: ADHD is a common neurobehavioral disorder. ADHD is diagnosed by clinicians using subjective tools, sometimes supported by a computerized test. However, since this diagnosis requires visiting a clinic and is affected by external factors such as intelligence and fatigue, many cases remain undiagnosed through adulthood. There is a societal burden associated with undiagnosed ADHD, creating a need for objective tools for ADHD preliminary self-assessment, prompting seeking professional clinical diagnosis if relevant. Here we aimed at testing whether we can manipulate spatial and temporal stimulation to identify ADHD symptoms in adults. To this end, we used a short, self-administered tool based on dynamic crowded visual stimulation to identify ADHD symptoms. Various studies demonstrated the usefulness of crowded conditions for measuring visual performance in aging adults and children. Methods: Measurements using a prototype dynamic digital assessment tool, currently developed by GlassesOff™, on smartphones, which reliably measure functional near visual acuity (VA), were compared between diagnosed-ADHD and control groups: 24 ADHD subjects (aged 16-28 years, with an ADHD diagnosis performed by a neurologist or psychiatrist) and 18 controls (aged 20-30 years), all corrected to normal vision (worst binocular VA 0.04 logMAR). Stimuli consisted of matrices composed of 25 letters “E” (5×5), each with a randomly chosen orientation having 4 options. Two variations of inter-letter-spacing within the matrix were used (0.4 and 1 letter size). Participants were requested to identify the orientation of the central letter. VA thresholds were determined using a staircase measuring the minimal detectable letter size, under crowding conditions and the stimulus presentation ranged from 34 to 120 msec. Results: Despite normal VA on the clinical static ETDRS chart, our self-administered test showed a large and significant VA reduction in ADHD subjects compared with controls: 62, 79, and 64% for 34, 60, and 120 msec, respectively, equivalent to about 2 ETDRS lines. Similar results were obtained for 0.4-letter spacing. Conclusions: Our self-administered dynamic digital tool may be used for objective assessment of ADHD symptoms. We suggest that under-development of visual functions, which is present in children under regular conditions, persist in adults with ADHD symptoms and that this becomes apparent under spatial and temporal loading conditions. Commercial Relationships: Oren Yehezkel, Eyekon ERD (E); Anna Sterkin, Eyekon ERD Ltd (E); Maria Lev, Eyekon ERD Ltd (E); Uri Polat, Eyekon ERD Ltd (P) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 278 Idiopathic intracranial hypertension and papilledema Monday, May 04, 2015 3:45 PM–5:30 PM Exhibit Hall Poster Session Program #/Board # Range: 2228–2239/B0081–B0092 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Multidisciplinary Ophthalmic Imaging Program Number: 2228 Poster Board Number: B0081 Presentation Time: 3:45 PM–5:30 PM The relationship between the levonorgestrel-releasing intrauterine system and idiopathic intracranial hypertension Ruju Rai1, Brian Kirk1, Jessica Sanders2, Reuben Valenzuela1, Subhashree Sundar1, Judith Warner1, Kathleen B. Digre1, Balamurali Ambati1, Alison V. Crum1, Bradley J. Katz1. 1Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; 2Obstetrics and Gynecology, University of Utah, Salt Lake City, UT. Purpose: Unconfirmed reports have linked the levonorgestrelreleasing intrauterine system (LNG-IUS), a long-acting contraceptive, to idiopathic intracranial hypertension (IIH). In this pilot case-control study, we compared LNG-IUS exposure between a cohort of patients with IIH and an analogous cohort of patients without IIH. Methods: A retrospective series of 473 patients with ICD-9 codes for pseudotumor cerebri (PTC) was screened for female gender, age at onset of 18-55, diagnosis from 2008-2013, and non-idiopathic etiologies. Of 176 eligible participants, 59 completed telephone birth control histories of the 3 month timeframe preceding IIH onset. Records were then queried for CPT codes for LNG-IUS insertion in 220,904 women without ICD-9 codes for PTC who were aged 18-55 and had at least one clinical encounter from 2008-2013. Descriptive statistics and significance tests were performed, and odds ratios were calculated. Results: Exposure to an LNG-IUS was significantly associated with the development of IIH (OR 7.7, 95% CI 3.2-16.4, p<0.001); the prevalence of IIH was 0.18% in the LNG-IUS population (8/4408, 95% CI 0.07-0.35) versus 0.02% in the non-LNG-IUS population (51/216555, 95% CI 0.01-0.03). Of those IIH patients not on an LNG-IUS, 9 (15%) were on another contraceptive and 42 (71%) were not on any contraceptives. All LNG-IUS users who developed IIH manifested symptoms while the device was still in situ. There were no significant differences between LNG-IUS users and non-users in terms of age, body mass index, recent weight gain, or presenting signs and symptoms. Conclusions: Our findings suggest that LNG-IUS exposure does not alter the clinical features of IIH; however, it is disproportionately more common among IIH patients than non-IIH patients. Therefore, although a causative role for LNG-IUS has not yet been established, we recommend augmenting the routine evaluation of IIH with a birth control history. IIH patients who are considering options for birth control should be counseled about the possible connection between LNG-IUS and IIH. While the preliminary evidence does not warrant the removal of an LNG-IUS in a typical IIH patient, atypical IIH patients (i.e. non-obese, having no other risk factors) with an LNGIUS may wish to switch to an alternative contraceptive. Commercial Relationships: Ruju Rai, None; Brian Kirk, None; Jessica Sanders, None; Reuben Valenzuela, None; Subhashree Sundar, None; Judith Warner, None; Kathleen B. Digre, None; Balamurali Ambati, None; Alison V. Crum, None; Bradley J. Katz, None Support: Supported in part by grants from the Center for Clinical and Translational Sciences (8UL1TR000105) and the Research to Prevent Blindness, Inc., New York, NY. Program Number: 2229 Poster Board Number: B0082 Presentation Time: 3:45 PM–5:30 PM Sixth nerve palsy in pediatric idiopathic or secondary intracranial hypertension Julia E. Reid1, Rachel E. Reem2, Shawn Aylward2, David Rogers2. 1 The Ohio State University, Columbus, OH; 2Nationwide Children’s Hospital, Columbus, OH. Purpose: To report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in pediatric patients with intracranial hypertension (IH). Methods: A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic intracranial hypertension (IIH), while IH with identifiable pathologic etiology was deemed secondary intracranial hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, etiology of SIH, ophthalmic exam, lumbar puncture results, neuroimaging results, and response to treatment. Results: Seventy-nine children with intracranial hypertension were included in the study. Ten (13%) children (4 males, 6 females; median age 15, range 3-18) were found to have a unilateral (n=3) or bilateral (n=7) CN VI palsy. Six children had IIH; the remaining four had SIH from cerebral venous sinus thrombosis (n=3) and rocky mountain spotted fever (n=1). The mean opening pressure for these patients was 40 cm H20 (range: 21-65 cm H20). Papilledema was present in 9/10 (90%) patients. One patient required a lumboperitoneal shunt and two required optic nerve sheath fenestrations in addition to medical management. All cases of CN VI palsy resolved with treatment. Conclusions: In our primary service area, the incidence of CN VI palsy is 13% amongst pediatric IIH and SIH patients. The majority of cases of CN VI palsy occur concurrently with papilledema and commonly resolve with treatment of intracranial hypertension. Commercial Relationships: Julia E. Reid, None; Rachel E. Reem, None; Shawn Aylward, None; David Rogers, None Support: The Ohio Lions Eye Research Foundation Program Number: 2230 Poster Board Number: B0083 Presentation Time: 3:45 PM–5:30 PM Structure function relationships in idiopathic intracranial hypertension Heather Moss, J Jason McAnany, Jason C. Park. Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL. Purpose: To establish the relationships between measures of visual function (standard automated perimetry (SAP)), ganglion cell function (the photopic negative response (PhNR)), ganglion cell structure and optic nerve structure in idiopathic intracranial hypertension (IIH). Methods: Visual function was assessed using SAP mean deviation (SAP-MD) scores in 10 subjects with IIH (3 untreated, 4 active, 3 treated). The PhNR of the photopic full-field, brief flash electroretinogram, was recorded using standard stimulation and recording techniques. Ganglion cell structure was assessed using ganglion cell complex volume (GCCV) in a 3mm diameter region centered on the macula, which was semi-automatically segmented from OCT B-scans (Spectralis). Optic nerve structure was categorized according to Frisén papilledema grading scale (FPG). Associations within and between functional markers (SAP-MD, PhNR) and structural markers (GCCV, FPG) were studied with multiple linear regression (LR). Results: Log PhNR amplitude and SAP-MD were modestly correlated (Pearson correlation, r = 0.78, p= 0.008, LR). GCCV ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology and FPG were not associated (p=0.10, mann-whitney rank sum). SAP-MD was associated with GCCV (r=0.72, p=0.019, LR). Addition of FPG did not improve the LR model for SAP-MD. Log PhNR amplitude was also associated with GCCV (r=0.77, p=0.009, LR). Addition of FPG improved the LR model for PhNR (r=0.94, p<0.0001, p(GCCV)<0.0001, p(FPG)=0.003, LR). Conclusions: Though visual and ganglion cell functional markers are modestly correlated, we find their individual correlations with structural markers to differ. Both SAP-MD and PhNR are related to ganglion cell atrophy, but only PhNR is also associated with degree of acute optic nerve pathology. The observation that high-grade papilledema is associated with PhNR decrease but not SAP-MD severity supports literature implicating PhNR association with preperimetric optic nerve injury. Further studies are needed to determine the clinical utility of PhNR as a marker for diagnosis and monitoring of IIH. Support: Unrestricted departmental grant from Research to Prevent Blindness, Illinois Society for the Prevention of Blindness, NIH K23 EY-024345, NIH P30 EY-001792, R00 EY019510, K12 EY021475 Program Number: 2231 Poster Board Number: B0084 Presentation Time: 3:45 PM–5:30 PM Correlation of opening pressure and Frisén grade of papilledema in pediatric patients with intracranial hypertension Laura L. Scott1, Shawn Aylward2, 3, David Rogers4, 5, Rachel E. Reem4, 5 1 . The Ohio State College of Medicine, Columbus, OH; 2Neurology, Nationwide Children’s Hospital, Columbus, OH; 3Neurology, The Ohio State University Wexner Medical Center, Columbus, OH; 4 Ophthalmology, Nationwide Children’s Hospital, Columbus, OH; 5 Ophthalmology, The Ohio State University Wexner Medical Center, Columbus, OH. Purpose: While clinicians are diagnosing idiopathic and secondary intracranial hypertension in pediatric patients with increasing frequency, a paucity of research regarding the diagnosis and clinical features of these conditions exists. We performed a retrospective chart review of pediatric patients with intracranial hypertension in order to examine the relationship between lumbar puncture opening pressure (LPOP) and the severity of papilledema grade utilizing the Modified Frisén Scale (MFS). Methods: 130 patients presenting between 2007 and 2013 with lumbar puncture-confirmed intracranial hypertension were included in the study. Demographic data and exam findings from initial exam with an ophthalmologist were collected. The worse papilledema grade between the two eyes on initial exam was compared to LPOP using Spearman’s Rank Correlation Coefficient, “r.” A second reader rated the subjects’ fundus photos and the inter-rater reliability was calculated using Cohen’s chance-corrected kappa statistic, “k.” Results: Of the 130 included patients, 78 were female and 52 were male. The mean age of patients evaluated was 12.3 years old (range 3-18). 39 subjects were diagnosed with secondary intracranial hypertension. Seventy four patients had their lumbar puncture performed on the same day as their eye exam. A statistically significant moderately positive correlation was found between LPOP and Frisén grade of papilledema (r=0.426, p-value=0.000153). Even including those whose LP and eye exam were performed on different days, there was a weakly positive correlation between the LPOP and papilledema grade (r=0.255, p-value of 0.003371). In addition, 236 optic disc photos of 119 patients were reviewed. The linear weighted kappa value indicating inter-rater reliability indicated a good strength of agreement (k=0.669). Conclusions: In pediatric patients with intracranial hypertension, the severity of papilledema correlates positively with lumbar puncture opening pressure. This result confirms the findings of a recent study in adult patients1 and may be helpful in guiding the clinical management of patients afflicted with intracranial hypertension. References 1. Kupersmith M. Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial: Part II. Correlations and Relationship to Clinical Features. Investigative ophthalmology & visual science. 2014-11-04. Commercial Relationships: Laura L. Scott, None; Shawn Aylward, None; David Rogers, None; Rachel E. Reem, None Support: Ohio Lions Eye Research Foundation Visual function (top) and Photopic negative response (bottom) as a function of ganglion cell complex volume (line) and papilledema grade (markers) in IIH subjects Commercial Relationships: Heather Moss, None; J Jason McAnany, None; Jason C. Park, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2232 Poster Board Number: B0085 Presentation Time: 3:45 PM–5:30 PM Changes in basement membrane opening displacement within 1 hour following intracranial pressure lowering in subjects with and without idiopathic intracranial hypertension Gautam Vangipuram, Heather Moss. University of Illinois, Chicago, IL. Purpose: Changes in basement membrane(BM) contour in the region of the optic nerve head are a promising marker for intracranial pressure(ICP) changes in idiopathic intracranial hypertension(IIH) based on studies showing change following surgical and medical treatment for elevated ICP. Rapid changes in BM configuration associated with ICP lowering have yet to be studied. This study tests the hypothesis that changes in BM opening(BMO) displacement, a surrogate for BM contour, occur rapidly following ICP lowering via lumbar puncture (LP). Methods: Within 1 hour prior to and following LP in seven (27-60 yrs old, 11-24mL CSF drained) prospectively recruited subjects, 20o OCT B-scan images centered on the right optic nerve head along the nasal/temporal axis were acquired. The BM and inner limiting membrane(ILM) were automatically segmented and manually corrected. Optic nerve head maximum nasal, temporal and cup thicknesses were calculated as the distance between the BM and ILM. BMO displacement was calculated at the nasal and temporal margins of the BMO referenced to a straight line between the outer nuclear layer-inner segment junction 3 mm nasally and temporally from the optic nerve head(fig.). Based on LP opening pressure(OP), subjects were grouped as IIH (n=3, OP 28-55cm H2O, all with papilledema) or non-IIH (n=4, OP 10-20cm H2O, none with papilledema). Results: Across all subjects, BM displaced posteriorly following LP (p=0.018 nasal, 0.063 temporal, Wilcoxan signed ranks(WSR)). Optic nerve thicknesses and cup depth did not change following LP (p=0.15, 0.87, 0.18, WSR). IIH subjects had greater optic nerve thicknesses, shallower cup depth, and a more anterior BMO prior to LP than non-IIH subjects (p=0.034 for all, Mann Whitney Rank Sum). IIH and non-IIH subjects did not differ in the pre-post LP change in BM displacement, optic nerve thickness or cup depth. Groups did not differ by age or amount of CSF drained. Conclusions: Changes in BMO displacement occur within 1 hour of ICP lowering via LP in subjects with and without IIH. Changes in optic nerve head contour do not occur within 1 hour of ICP lowering in subjects with or without IIH. These observations align with reports of BMO changes preceding optic nerve changes in treated IIH and support the candidacy of BMO displacement as a non-invasive rapid marker of ICP changes. Program Number: 2233 Poster Board Number: B0086 Presentation Time: 3:45 PM–5:30 PM Change in the Deflection of the Neural Canal Opening Over Time with Acetazolamide Treatment in Idiopathic Intracranial Hypertension Jui-Kai Wang1, Patrick A. Sibony2, Randy H. Kardon4, 5, Mark J. Kupersmith3, Mona K. Garvin5, 1. 1Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA; 2Department of Ophthalmology, State University of NY at Stony Brook/UHMC, Stony Brook, NY; 3Department of NeuroOphthalmology, Roosevelt Hospital and NYEE, New York, NY; 4 Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA; 5Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA. Purpose: In papilledema, Bruch’s membrane (BM) bordering the neural canal opening is often deflected inward toward the vitreous in contrast to normal eyes (Sibony et al., IOVS, 2011, 2014). We prospectively compared OCT-derived changes in the BM shape with acetazolamide (ACZ) plus diet compared to placebo plus diet in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). A novel semi-automated method for quantifying the BM shape was developed for this purpose. Methods: For each of the 126 subjects enrolled in the OCT substudy of the IIHTT (OCT Sub-Study Committee, IOVS, 2014), the central slice from the Cirrus OCT high-definition (HD) 5-line raster scan at baseline, 3 months, and 6 months (as available) was used to perform the statistical shape analysis. After manually marking the two Bruch’s membrane opening points in each slice, 9 landmark points were automatically placed along Bruch’s membrane on each side of the neural canal border, extending out radially for 2500 microns (Fig. 1). Principal component analysis was used to create a shape model using the landmark points at baseline. The second principal component coefficient, reflecting the angle and direction of the neural canal border, was then computed at each time point for study eyes in the two treatment groups. Results: In this analysis, 73 out of 126 subjects in IIHTT OCT substudy had 5-line raster data available at all time points for the study eye. In the ACZ plus diet group (n=39), the neural canal shape measure became more positive (deflecting away from the vitreous cavity, Fig. 2 left) over time and was significantly greater (p < 0.01) than in the placebo plus diet group (n=34), as shown in Fig. 2. The mean neural canal shape measure changes from baseline to 3 months were 0.64 ± 1.10 in the ACZ group vs. -0.04 ± 0.93 in the placebo group; from baseline to 6 months, the changes were 0.87 ± 1.26 in the ACZ group vs. 0.03 ± 0.83 in the placebo group. Conclusions: Displacement of the neural canal border at the optic nerve head reflects the translaminar pressure differential between the retrolaminar and intraocular fluid compartments and appears to be a biomarker of successful treatment of raised intracranial pressure. Commercial Relationships: Gautam Vangipuram, None; Heather Moss, None Support: Unrestricted departmental grant from Research to Prevent Blindness, Illinois Society for the Prevention of Blindness, NIH K23 EY-024345, NIH P30 EY-001792 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Fig. 1. Semi-automated landmark placement Fig. 2. Left: Neural canal shape model variations; Right: Shape measure in ACZ/placebo group at baseline, 3 months and 6 months Commercial Relationships: Jui-Kai Wang, None; Patrick A. Sibony, None; Randy H. Kardon, Acorda (C), Department of Veterans Affairs Research Foundation, Iowa City, IA (S), Fight for Sight Inc (S), Novartis (C); Mark J. Kupersmith, None; Mona K. Garvin, The University of Iowa (P) Support: U10 EY017281-01A1, U10 EY017387-01A1, 3U10EY017281-01A1S1, R01 EY023279 Clinical Trial: NCT01003639 Program Number: 2234 Poster Board Number: B0087 Presentation Time: 3:45 PM–5:30 PM Pointwise Visual Field Change in the Idiopathic Intracranial Hypertension Treatment Trial Michael Wall1, Gideon Zamba2. 1Neurology & Ophthalmology, Univ of Iowa, Carver Coll of Med, Iowa City, IA; 2Biostatistics, University of Iowa, Iowa City, IA. Purpose: The Idiopathic Intracranial Hypertension Trial (IIHTT) showed acetazolamide provided a modest but significant improvement in global visual field function using mean deviation. Here, we aim to further analyze 1) the rate and 2) the magnitude of individual visual field test location change in the treatment groups from baseline to primary end point (six months). Methods: We evaluated 121 of the enrolled IIH subjects who had visual field testing at baseline, six months and 3 of 4 interim visits. At entry the SITA Standard 24-2 mean deviation was between -2 dB and -7 dB in the worst eye (study eye). Subjects from multiple study sites were randomized in a placebo-controlled trial of acetazolamide with both treatment groups receiving a weight reduction program. We used pointwise linear regression to classify each of the 52 visual field test locations in the study eye as improving or not using the criterion of a positive slope. In a separate analysis, differences in magnitude in dB from baseline to final visit for the groups were computed and ANOVA was used to determine the significance of differences at each location. Results: On average, subjects had 36 of 52 test locations with improving visual thresholds over six months in the study eye. While slopes of both groups improved, there were no significant differences in slopes between the treatment groups. Thresholds improved across the visual field with the magnitude of the change from baseline to final visit in dB greatest and statistically significant around the blind spot and the nasal area especially in the acetazolamide group. The figure shows the difference in dB between the groups (effect size of acetazolamide point by point). Conclusions: While there were significant positive trends (slopes) in visual thresholds over time for most participants there were no significant differences between the groups. However, acetazolamide treatment resulted in significant improvement in visual field function with the magnitude of the changes greatest in the nasal and pericecal areas; the latter is likely due to reduction in blind spot size related to improvement in papilledema. Point by point effect size in dB of acetazolamide found by subtracting the average change from baseline of the placebo group from the acetazolamide group. Commercial Relationships: Michael Wall, None; Gideon Zamba, None Support: NORDIC 1U10EY017281-01A1 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Clinical Trial: NCT01003639 Program Number: 2235 Poster Board Number: B0088 Presentation Time: 3:45 PM–5:30 PM Papilledema Outcome Evaluation in the OCT Substudy of the Idiopathic Intracranial Hypertension Treatment Trial Mark J. Kupersmith. 1Neuro-Ophthalmology, Roosevelt Hospital and NYEE, New York, NY; 2Icahn School of Medicine at Mount Sinai, New York City, NY. Purpose: To demonstrate the effect of therapy on quantitative imaging of papilledema in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). The IIHTT showed that acetazolamide (ACZ) was efficacious in improving mild visual field loss in patients with IIH. We showed that spectral domain optical coherence tomography (SD-OCT) combined with custom 3-segmentation analysis provides reliable continuous measurements of structural changes in the optic nerve head and retina due to papilledema (OCT Sub-Study Committee, IOVS in press). Methods: Eighty-nine (43 ACZ, 46 placebo treated) IIHTT subjects were evaluated at study entry and at 3 and 6 months with standard automated perimetry, Frisén grading of photos, high and low contrast visual acuity, and OCT imaging using the Cirrus SD-OCT. OCT data were analyzed using custom 3-D segmentation algorithms to calculate retinal nerve fiber layer (RNFL), total retinal thickness (TRT), optic nerve volume (ONHV), and retinal ganglion cell layer (GCL) measurements. Results for ‘study eyes’ (with worse perimetric mean deviation, PMD, at baseline) were used for most analyses. Results: At study entry, distributions of OCT measures were similar in both treatment groups. At 6 months, ACZ group eyes showed greater mean reductions in RNFL (175 mm vs. 89 mm, p=0.001), TRT (220 mm vs. 113 mm, p=0.001), and ONHV (4.9 mm3 vs. 2.1 mm3, p=0.001) than placebo group eyes. For both treatment groups, subjects with weight loss > 6% had greater mean reductions in RNFL (156 mm vs. 103 mm, p=0.01), TRT (201 mm vs 127 mm, p=0.003), and ONHV (4.3 mm3 vs. 2.6 mm3, p=0.002) than those with less weight loss. GCL thinning was minor in the ACZ (3.6 mm) and placebo (2.1 mm) groups. Interocular correlations were > 0.8 for all 3-D segmentation derived measurements. At 6 months, RNFL, TRT, and ONHV correlated with Frisén grade (r=0.48-0.59, p<0.0001). At 6 months, the 21 eyes with GCL thickness <5th percentile of controls had worse PMD (p=0.01) and both high (p=0.05) and low (p=0.01) contrast acuity than for eyes with GCL > 5th percentile. Conclusions: OCT measures of swelling due to papilledema in IIH are effectively improved with ACZ and weight loss. In contrast to the strong correlation at baseline (IOVS in press), 6 month RNFL, TRT, and ONHV show only moderate correlations with papilledema grade. Commercial Relationships: Mark J. Kupersmith, None Support: U10 EY017281-01A1, U10 EY017387-01A1, 3U10EY017281-01A1S1 Clinical Trial: NCT01003639 Program Number: 2236 Poster Board Number: B0089 Presentation Time: 3:45 PM–5:30 PM Ultramicroscopic study of the Optic Nerve Sheath in Patients with Severe Vision Loss from Idiopathic Intracranial Hypertension - Results Marla Davis1, Joshua W. Evans1, Sachin Kedar2, Deepta Ghate3, Peter Timoney1, Richard Kielar1, Bruce Maley5, William O’Connor4. 1 Ophthalmology, University of Kentucky, Lexington, KY; 2 Neurology, University of Nebraska, Omaha, NE; 3Ophthalmology, University of Nebraska, Omaha, NE; 4Pathology, University of Kentucky, Lexington, KY; 5Anatomy, University of Kentucky, Lexington, KY. Purpose: The objective of our study is to describe microscopic changes in the optic nerve sheath (ONS) of patients with severe and/ or progressive vision loss from IIH. Methods: ONS specimens were obtained at ONS fenestration in IIH (cases) and enucleation for painful blind eye (controls). Both procedures were performed by a single surgeon. After fixation and staining, specimens were examined by masked experts using light (LM), transmission electron (TEM) and polarization (PM) microscopy for specimen quality and tissue anatomy (cellularity and collagen structure). Results: Of 12 specimens, 7 (6 cases, 1 control) met diagnostic and quality criteria. For cases: Mean age was 31.25y; mean disease duration 57 days; Mean CSF OP 40.25cm water. Papilledema grades were II (3 eyes); III (1 eye); IV (2 eyes). 5/6 patients showed severe visual field loss (MD> 15 dB); 3/6 had acuity worse than 20/40 and 2/6 had RAPD. All had normal CSF contents. Control ONS was obtained from an enucleated eye of a 18y with childhood ocular trauma.Collagen abnormalities on TEM: irregular arrangement (all cases), collagen disruption and increased extracellular fluid (5/6 cases) while control ONS showed regular, compact, normal collagen. PM showed marked decrease in green yellow birefringence (<20% in all cases with <5% in 4 cases) compared to control ONS (75% birefringence) which confirmed abnormal collagen content and arrangement in cases. All 6 cases showed increased cellularity on LM and/or TEM with active fibroblasts (3/6 cases) and chronic inflammatory cells (lymphocytes) in all 6 cases. Conclusions: Disruption and disorganization of dural collagen in the ONS from IIH points to significant shear forces on distal ONS from raised ICP while increased cellularity indicates tissue repair. These mechanical and inflammatory components could contribute to visual loss in IIH. Early aggressive medical and/or surgical treatment may be beneficial in IIH. Commercial Relationships: Marla Davis, None; Joshua W. Evans, None; Sachin Kedar, None; Deepta Ghate, None; Peter Timoney, None; Richard Kielar, None; Bruce Maley, None; William O’Connor, None Support: Research to Prevent Blindness Program Number: 2237 Poster Board Number: B0090 Presentation Time: 3:45 PM–5:30 PM Ultramicroscopic study of the Optic Nerve Sheath in Patients with Severe Vision Loss from Idiopathic Intracranial Hypertension- Methodology Joshua W. Evans1, Marla Davis1, Sachin Kedar2, Deepta Ghate3, Peter Timoney1, Richard Kielar1, Bruce Maley4, William O’Connor5. 1Ophthalmology, University of Kentucky, Lexington, KY; 2Neurology, University of Nebraska Medical Center, Omaha, NE; 3Ophthalmology, University of Nebraska Medical Center, Omaha, NE; 4Anatomy and Neurobiology, University of Kentucky, Lexington, KY; 5Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY. Purpose: Very little is known about the anatomy and pathology of the optic nerve sheath (ONS) in normal and diseased states. The objective of our study is to explore microscopic changes in the ONS in patients with severe and/or progressive vision loss from IIH. Methods: ONS specimens were obtained from patients with IIH after ONS fenestration (cases) and painful blind eye after enucleation (controls). Both procedures were performed by a single surgeon. A 2 x 1 mm ONS window was obtained, divided into 2 parts, fixed and stained per following protocol.Light Microscopy (LM): All specimens were formalin fixed, stained using HematoxylinEosin and examined at 10x and 40x magnification.Transmission electron microscopy (TEM): All specimens were immediately ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology fixed (in Operating room) using 4% paraformaldehyde and 3.5% glutaraldehyde on ice; washed in Cacodylate buffer; postfixed using Osmium tetroxide/buffer mixture; dehydrated through graded concentrations of ethanol washes; and resin embedded. Ultrathin sections were obtained, stained and examined in Philips Tecnai Biotwin 12 TEM at 2900X magnification.Polarization microscopy (PM): All specimens were stained using Picrosirius red and examined under polarization microscope using previously published methods. (Junqueira et al., 1979) Masked experts in LM, TEM and PM performed evaluations for specimen quality (desiccation, trauma and staining) and tissue anatomy (cellularity and collagen arrangement). Results: Of 13 subjects and 16 eyes enrolled, 7 specimens (6 cases and 1 control) met inclusion and quality control criteria for analysis. Tissue was not obtained in 4 eyes at surgery. 2 specimens were excluded due to alternative diagnosis (meningioma, panophthalmitis). 3 specimens were excluded due to tissue desiccation resulting from increased time interval from resection to tissue fixation. Conclusions: Adequate quantity and quality ONS specimens were obtained in patients undergoing ONS fenestration and enucleation. Since ONS is susceptible to desiccation, tissue should be fixed immediately in the operating room. Commercial Relationships: Joshua W. Evans, None; Marla Davis, None; Sachin Kedar, None; Deepta Ghate, None; Peter Timoney, None; Richard Kielar, None; Bruce Maley, None; William O’Connor, None Support: Research to Prevent Blindness Program Number: 2238 Poster Board Number: B0091 Presentation Time: 3:45 PM–5:30 PM Multicolor imaging in the assessment and diagnosis of optic disc swelling Andy Malem, Stephanie West, Gabriella De Salvo. Southampton General Hospital, Southampton, United Kingdom. Purpose: To examine the use of the recently developed Multicolor imaging (Heidelberg Spectralis) as an adjunct to traditional imaging modalities in the assessment of patients with suspected optic disc swelling, and to determine whether Multicolour (MC) can help in the differential diagnosis between true optic disc swelling and pseusopapilloedema. Methods: Prospective consecutive study of 19 patients who presented to our clinic with suspected bilateral optic disc swelling. MC was performed on all patients in addition to fundoscopy, retinal nerve fiber layer optical coherence tomography (OCT) and fundus autofluorescence (FAF). MC combines three different wavelengths to enhance different retinal layers: 488nm (blue), 536nm (green) and 786nm near infrared (NIR). All images were analyzed by a medical retinal specialist. Results: Of the 19 cases, 12 (63%) were female and 7 (37%) were male, with an average age of 19. Diagnosis of true papilloedema versus pseudopapilloedema was confirmed in all patients with a multidisciplinary approach. In fact 17 (89%) patients had raised intracranial pressure (ICP) confirmed by lumbar puncture opening pressure or brain imaging, and 2 (11%) had optic disc drusen. In those with true optic disc swelling secondary to raised ICP, MC illustrated a green shift correlating to the thickened retinal nerve fiber layer (RNFL) seen both clinically and on the optic disc OCT. The disc margins were indistinguishable at the green reflectance and a double ‘shadow’ was seen on the NIR reflectance. Unlike those with raised ICP, the patients with optic disc drusen did not present a green shift on the MC image and the disc margins were well delineated by a ring of hyperreflectance seen at the green reflectance; no thickening of the RNFL was detected. Conclusions: Our results show that MC is a useful additional imaging modality in the diagnosis of true swollen optic discs and can provide additional information to help determine the underlying diagnosis in true and pseudopapilloedema. Commercial Relationships: Andy Malem, None; Stephanie West, None; Gabriella De Salvo, None Program Number: 2239 Poster Board Number: B0092 Presentation Time: 3:45 PM–5:30 PM Papilledema Associated with Infantile Hypophosphatasia and Craniosynostosis Constance E. West2, 1, Robert B. Hufnagel3, 4, Howard M. Saal3, 4. 1 Department of Ophthalmology, University of Cincinnati, Cincinnati, OH; 2Division of Pediatric Ophthalmology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 3Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 4Department of Pediatrics, University of Cincinnati, Cincinnati, OH. Purpose: Hypophosphatasia (HPP) is a rare disease caused by reduced activity of alkaline phosphatase (ALP), and is secondary to mutations in ALPL, the gene encoding tissue-nonspecific ALP (TNSALP). There are at least six clinical forms and the spectrum of disease is wide, ranging from stillbirth to pathologic fractures in adulthood. Craniosynostosis and papilledema may accompany the infantile and childhood forms. There are six reported cases of craniosynostosis and papilledema in HPP; however, none contain ophthalmic follow-up. We report our experience with three patients with infantile HPP, craniosynostosis, and papilledema. Methods: Patients received comprehensive ophthalmic examination and follow-up while receiving treatment for complications of infantile HPP. Results: A 5.5 month old girl was diagnosed with HPP (compound heterozygote: c.1327G>T, p.Ala443Ser; c.1471G>A, p.Gly491Arg), and with craniosynostosis at six months of age. On ophthalmic examination, 3+ papilledema was found. Two and a half months after cranial vault expansion, papilledema worsened, and a second cranial vault expansion was performed. Four months after the second procedure, the papilledema had resolved and the nerves were pink and healthy with normal visual behavior for age. There has been no recurrence 7 months postoperatively. A 27 month old male was referred for management of complications of HPP (homozygous c.293C>T, p.S98F). Craniosynostosis was found on clinical and radiologic examination and ophthalmologic consultation showed 2+ disc swelling bilaterally; cranial vault expansion was performed. Disc swelling resolved after 4.5 months, and 14 months after cranial vault expansion, the nerves remain pink and healthy with normal visual behavior. His sister (same mutation) was referred at 5.5 years. Infantile HPP was diagnosed at 8 months and nystagmus was noted at 3.5 years. On examination, she had craniosynostosis, bilateral optic atrophy, roving nystagmus, and left exotropia. A cranial vault expansion was performed. At 6.5 years old, acuity was 20/250 OD and hand motions OS, a red green color vision defect, and constricted fields. The nerves remain atrophic. Conclusions: Untreated papilledema resulted in visual impairment, but prompt treatment of elevated intracranial pressure associated with craniosynostosis in HPP leads to resolution of papilledema over several months’ time. Commercial Relationships: Constance E. West, None; Robert B. Hufnagel, None; Howard M. Saal, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 308 Optic nerve Tuesday, May 05, 2015 8:30 AM–10:15 AM 4CD Mile High Blrm Paper Session Program #/Board # Range: 2603–2609 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2603 Presentation Time: 8:30 AM–8:45 AM TSH/M22 induces TNFα production in human fibrocytes: mechanistic aspects Shannon J. Shan, Tong Wu, Tunde Mester, Raymond Douglas. Ophthalmology, University of Michigan, Ann Arbor, MI. Purpose: Fibrocytes (FC) are bone marrow-derived progenitor cells implicated in various conditions of inflammation and fibrosis. In Graves disease (GD) and Graves orbitopathy (GO), circulating FCs become more abundant and can infiltrate the thyroid and orbit. FCs express high levels of thyrotropin receptor (TSHR) and insulin growth factor-1 receptor (IGF-1R), two putative pathogenic autoantigens in GO. The role of the FCs and these receptors in the pathogenesis of GO remains to be fully delineated. Treatment of FCs with thyroid stimulating hormone (TSH) or M22 (activating TSHR antibody) induces the production of a multitude of cytokines, including the key pro-inflammatory cytokine, tumor necrosis factor α (TNFα). This study aims to characterize the molecular mechanisms underlying TSH/M22-induced TNFα production in FCs. Methods: Circulating and cultured FCs from healthy and GD patients were treated with various combinations of TSH, M22, MG132 and AKTi (inhibitors of NF-kB and Akt, respectively), and teprotumumab (TMB, a human monoclonal IGF-1R blocking antibody). Extracellular and intracellular TNFα protein production was measured by Luminex and flow cytometry, respectively. Messenger RNA expression was quantified by real time PCR. Results: Treatment with TSH or M22 induced significant TNFα protein and mRNA production by FCs. TSH-induced TNFα protein production in cultured FCs was reduced by 53% and 81% when pretreated with MG132 and AKTi, respectively (p<0.0001). Similarly, TSH-induced TNFα mRNA expression was reduced from 93-fold to 16-fold expression with MG132 (p<0.001), and from 23fold to 1.3-fold expression with AKTi (p<0.0001). TMB decreased TSH-induced TNFα protein production in circulating FCs from mean fluorescent index (MFI) value of 2.92 to 1.91, and mRNA expression in cultured FCs from 141- to 52-fold expression (p<0.0001). TMB also decreased M22-induced TNFα protein production from MFI of 1.67 to 1.12, and mRNA expression from 6- to 3-fold expression (p<0.0001). Conclusions: TSH/M22 stimulates FCs to produce TNFα. Both steady state mRNA and protein levels are increased. This process involves the transcription factor NF-kB and its regulator Akt. TMB attenuates this activating effect of TSH/M22, suggesting that TSHR downstream signaling may be partially dependent on IGF-1R signaling. By modulating the proinflammatory properties of FC such as TNFα production, TMB may be a promising therapeutic agent for GO. Commercial Relationships: Shannon J. Shan, None; Tong Wu, None; Tunde Mester, None; Raymond Douglas, None Support: EY008976, EY011708, DK063121, EY016339, EY021197, EY007003 Eye Core Grant, an unrestricted grant from Research to Prevent Blindness, a Research to Prevent Blindness Career Development Award, Research to Prevent Blindness Lew Wasserman Merit Award, and the Bell Charitable Foundation Program Number: 2604 Presentation Time: 8:45 AM–9:00 AM Mitochondrial DNA instability and dysregulated mitochondrial quality control contribute to progressive retinal ganglion cell loss in dominant optic atrophy Patrick Yu-Wai-Man1, 2, Chunyan Liao3, 4, Neil Ashley3, 4, Padraig J. Flannery1, Massimo Zeviani6, Anna K. Simon5, Patrick F. Chinnery1, Joanna Poulton3, 4. 1Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom; 2UCL Institute of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; 3Nuffield Department of Obstetrics and Gynaecology, The Women’s Centre, University of Oxford, Oxford, United Kingdom; 4 Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom; 5NIHR Translational Immunology Laboratory, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; 6MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, United Kingdom. Purpose: Autosomal dominant optic atrophy (DOA) is a mitochondrial optic neuropathy caused by pathogenic mutations within the OPA1 gene (3q28-q29), which encodes for an inner mitochondrial membrane protein. The neuronal loss observed in DOA represents an attractive monogenic disease model to dissect the overlapping pathological pathways in more complex adult-onset neurodegenerative disorders. However, the fundamental mechanisms by which OPA1 mutations ultimately precipitate retinal ganglion cell (RGC) loss have still not been clarified. Methods: We made use of a comprehensive OPA1 tissue biobank comprised of muscle biopsy specimens (n=30) and primary fibroblast cell lines (n=40) established from patients with both isolated optic atrophy and the more severe syndromic “DOA plus” phenotypes. By using a series of validated experimental assays, the following cellular parameters were assessed: (i) mitochondrial respiratory chain integrity; (ii) mitochondrial DNA (mtDNA) instability with real-time PCR and ultra-deep next generation sequencing; (iii) the kinetics of mitochondrial genome replication following a period of mtDNA depletion induced with ethidium bromide; and (iv) mitochondrial quality control (mitophagy) using a high-throughput flow cytometry protocol that allows rapid co-localisation of autophagosomes and quantification of LC3-positive puncta. Results: OPA1 mutations result in a significant mitochondrial biochemical defect in both skeletal muscle and fibroblasts, and a clear correlation was observed with clinical disease severity. An accumulation of secondary mtDNA abnormalities was also observed, implicating marked mitochondrial genome instability secondary to an imbalance between mitochondrial fusion and fission. This impairment in the cell’s mtDNA replication machinery was further exacerbated following a period of mtDNA depletion induced with ethidium bromide treatment. Importantly, there was a dramatic reduction in the cell’s ability to handle exogenous pro-apoptotic stress due to the inappropriate activation of mitophagic pathways in a compensatory effort to eliminate dysfunctional mitochondria. Conclusions: MtDNA instability and impaired mitochondrial quality control are important synergistic mechanisms that contribute to neuronal loss in DOA, and they represent attractive disease pathways amenable to therapeutic intervention. Commercial Relationships: Patrick Yu-Wai-Man, None; Chunyan Liao, None; Neil Ashley, None; Padraig J. Flannery, None; Massimo Zeviani, None; Anna K. Simon, None; Patrick F. Chinnery, None; Joanna Poulton, None Support: Medical Research Council (MRC, UK) Clinician Scientist Fellowship (G1002570) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2605 Presentation Time: 9:00 AM–9:15 AM Cecocentral Scotoma: A Neuro-Ophthalmic Revisionist Approach Steven A. Newman. Ophthalmology, University of Virginia, Charlottesville, VA. Purpose: Although homonymous hemianopsia, bitemporal, and arcuate visual field defects are by far the most common, the most classic visual field defect in neuro-ophthalmology has been the central scotoma. Literature from the mid-20th century emphasized the unique nature of cecocentral scotomas seen in patients with toxic and nutritional pathology. The fact that macular pathology can produce central scotomas has also been recognized and the distinction between retinal and neuro-ophthalmic disease has proved to be a major clinical distinction. Methods: A retrospective study of 193 patients referred to the NeuroOphthalmology Division at the University of Virginia and coded for central and cecocentral scotomas. Patterns were analyzed. Foveal sensitivity was available on all fields. Most patients were studied with a 10-2 program as well as a 24-2 program. Some patients were studied with a V size test object (dense defects or poor central vision). Results: Twenty-nine charts were excluded for either transient central scotomas, or what appeared to be arcuate or paracentral defects. Fourteen charts were classified as unknown etiology. Of the remaining 150 patients, 80 had evidence of macular pathology, (67 having clear maculopathy and 13 with retinal vascular disease). Of those with primary optic nerve pathology, optic neuritis and compressive optic neuropathies (24 each) were the most common. This was followed by anterior ischemic optic neuropathy (17 cases), 2 patients with neuroretinitis, 2 patients with neuromyelitis optica, and 1 patient with traumatic optic neuropathy. The classical finding of central scotomas was seen in 2 cases of Leber’s, 1 case of dominant optic atrophy, 2 cases of nutritional optic neuropathy, and 1 case of toxic optic neuropathy. Conclusions: In spite of a selective referral bias, retinal disease was the most common pathophysiology causing central and cecocentral scotomas. The addition of OCT and anatomic studies helped to distinguish these, although even when the macula looked normal, functional studies such as multifocal ERG may be necessary. The use of the 10-2 program and a V size test object is often necessary to recognize the pattern of field defect. Even classical, toxic, metabolic, and hereditary optic neuropathies may involve central fixation without extension to the blind spot. Commercial Relationships: Steven A. Newman, None Program Number: 2606 Presentation Time: 9:15 AM–9:30 AM Leber’s Hereditary Optic Neuropathy (LHON) Open Label Clinical Study for EPI-743: 2015 update Rustum Karanjia4, 1, Edward R. Chu1, Shellee Rockwell4, Matthew Klein2, Guy Miller2, Fillipe Chicani3, Fred N. Ross-Cisneros1, Alfredo A. Sadun4, 1. 1Doheny Eye Institute, Los Angeles, CA; 2Edison Pharmaceuticals, Mountain View, CA; 3Ophthalmology, Universidade Federal de São Paulo,, São Paulo,, Brazil; 4Ophthalmology, University of California at Los Angeles, Los Angeles, CA. Purpose: LHON is a maternally inherited disease characterized by sudden and profound loss of central vision in both eyes. The purpose of this study is to describe the 4 year results of treating LHON with a novel experimental quinone, EPI-743, in 7 consecutively enrolled patients all with the 11778 LHON mutation. Methods: Seven of 11 affected LHON patients treated with EPI-743 as part of this clinical study have been on continuous therapy for 4 years. Outcome measurements of efficacy include visual acuity (VA) (improvement if 2 or more lines of change or off to on chart), visual fields (VF) (improvement if >5dB of changes in mean deviation), OCT, and color vision (improvement if ≥ 2 plates in Ishihara plates, or from 0 to 2 plate). Thirteen eyes of 7 patients were included (one patient had retinal detachment in one eye) and two time points were compared, 6 months post onset and their most recent visit between 36-48 months into therapy. After six months, the natural history for affected patient with the 11778 LHON mutation is for vision to either stabilize or slowly deteriorate. This information is presented and discussed in a separate abstract submission. Results: VA: Nine of 13 eyes improved (70%), one to 20/20 level (from 20/300) and 8 from off chart to on chart. 4 eyes (30%) of 2 patients remained off chart. VF: 4 (30%) eyes improved, 8 (62%) were unchanged and 1 (8%) was worse than the 6 month VF. Color: 3 eyes (24%) improved (one 3/14 to 7/14, rest 0/14 to 2/14), 5 eyes (38%) were able to see only 1 color plate, and 5 eyes (38%) remained unable to see any color plates. OCT: All patients presented with progressive loss of fibers over time (25 to 50% of the normal values). These improvements were favorable in comparison to the natural history of 11778 LHON. Conclusions: EPI-743 treatment improved vision by these criteria in 56% of treated eyes. Visual improvement was noted up to 4 years following initiation of therapy suggesting that there is a large therapeutic window for recovery with EPI-743. There were no significant drug-related adverse events or clinical laboratory abnormalities. EPI-743 is a safe and effective treatment for LHON for most patients. This data is part of an ongoing compassionate use study. Commercial Relationships: Rustum Karanjia, None; Edward R. Chu, Edison Pharmaceuticals (C), Edison Pharmaceuticals (F); Shellee Rockwell, None; Matthew Klein, Edison Pharmaceuticals (E); Guy Miller, Edison Pharmaceuticals (E); Fillipe Chicani, Edison Pharmaceuticals (C); Fred N. Ross-Cisneros, Edison Pharmaceuticals (F); Alfredo A. Sadun, Edison Pharmaceuticals (F) Clinical Trial: NCT02300753 Program Number: 2607 Presentation Time: 9:30 AM–9:45 AM Macular Retinal Sublayer Thickness Changes in Patients and Carriers in the Natural History Phase of the Leber Hereditary Optic Neuropathy G11778A Gene Therapy Clinical Trial Byron L. Lam, Samuel P. Burke, Mindy X. Wang, Gloria A. Nadayil, Giovanni Gregori, William J. Feuer, Potyra R. Rosa, Sophia Cuprill-Nilson, Ruth Vandenbroucke, John Guy. Bascom Palmer Eye Institute, University of Miami, Miami, FL. Purpose: We determined macular retinal sublayer thickness changes of patients and carriers with G11778A Leber hereditary optic neuropathy (LHON) by utilizing data from the natural history phase of the gene therapy trial where subjects underwent visual examination every 6 months from 2008 to 2013. Methods: Spectral-domain Cirrus OCT 512x128 macular cube scans were segmented for the baseline examination. Segmented retinal sublayers were the RNFL, GCL-IPL, INL-OPL, ONL-IS, and OS. Poor quality scans that cannot be segmented accurately were excluded. The thickness of the retinal sublayers of the LHON affected subjects and asymptomatic carriers were compared to a normal group. Results: Segmented macular OCT data were available from 20 LHON affected subjects (age 31+14 years, range 10-61), 31 asymptomatic LHON carriers (age 38+18, 9-65), and 14 normal subjects (age 39+13, 23-61). In general, parameters were not significantly correlated with age in any of the groups. There were no differences between carriers and normals for any sublayers but some layers were thinner or thicker in LHON subjects. Layers showing ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology the most striking differences between LHON and the other two groups included the RNFL, GCL-IPL, and OS (p-values from 0.046 to <0.001). LHON RNFL and GCL-IPL were thinner than carriers and normals while LHON OS was thicker than carriers and normals. Differences between groups were not significant in the INL+OPL. The ONL+IS layer of the temporal and inferior quadrants (inner and outer macular annular rings) was thicker in LHON (0.041≥p≥0.009). Conclusions: LHON affected patients, compared to normal subjects, have thickened photoreceptor outer segment layer and some thickening of the ONL-IS in spite of having thinner RNFL and GCL-IPL layers. Asymptomatic LHON carriers have retinal sublayer thickness similar to normal subjects. The findings indicate optic nerve degeneration in LHON also has an effect on the morphology of the outer retinal layers of the macula. Commercial Relationships: Byron L. Lam, None; Samuel P. Burke, None; Mindy X. Wang, None; Gloria A. Nadayil, None; Giovanni Gregori, None; William J. Feuer, None; Potyra R. Rosa, None; Sophia Cuprill-Nilson, None; Ruth Vandenbroucke, None; John Guy, None Support: 1U10EY023558-01A1 Program Number: 2608 Presentation Time: 9:45 AM–10:00 AM Leber Hereditary Optic Neuropathy Gene Therapy (LHON) Clinical Trial: Initial Results John Guy1, William J. Feuer1, Vittorio Porciatti1, William W. Hauswirth2, Janet L. Davis1, Byron L. Lam1, Rajeshwari D. Koilkonda1, Huijun Yuan1, Phillip Gonzalez1, Anil Lalwani1. 1Bascom Palmer Eye Institute, Miami, FL; 2Ophthalmology, University of Florida, Gainesville, FL. Purpose: To determine the safety and tolerability of AAV2(Y444,500,703F)-P1ND4v2 (a nuclear encoded version wildtype ND4 imported into the mitochondria with the addition of a targeting sequence) in patients with LHON. Methods: After obtaining informed consent for participation in this open-label, unilateral single-dose, intravitreal injection of AAV2(Y444,500,703F)-P1ND4v2 per subject in a dose-escalation study designed to investigate the safety of three vector doses (5x109 vg, 2.46x1010 vg and 1x1011 vg) in subjects with molecularly confirmed G11778A-mutated mitochondrial DNA; two patients with long-standing (>12 months) and bilateral acuity loss down to ≤ 35 ETDRS letters (20/200) received intravitreal injections of low dose study drug (5x109 vg) into the eye with worse acuity. Clinical testing included ETDRS visual acuity, Humphrey visual fields (30-2), OCT, pattern ERG (PERG) and neuro-ophthalmic examinations. Blood samples were screened for neutralizing antibodies (Nabs) to AAV2 prior and after intravitreal injection. Postinjection evaluations thus far are 1 month in the first patient and one week in the second patient. Results: Visual acuity of patient 1 was hand movements prior to injection and remained at that level one day, one week and 1-2 months after injection. No haze, cells or inflammation was detected in the vitreous or anterior chamber and retinal examination remained normal showing only optic atrophy . RNFL was 54 mm prior to injection and 56 mm after injection. HVF MD remained -32.8. PERG amplitudes were 0.17 mV, within noise levels, prior to injection and 0.27 mV after injection . Visual acuity of patient 2 was counting fingers prior to and one week after injection. PERG amplitudes were 0.45 -0.48 mV prior to injection and 0.57 mV 1 week postinjection. Both patients had NAb titers of 1:20,480 prior to injection that did not change after injection. Vector genomes were not detected in the blood. Conclusions: Thus far study drug appears to be safe and welltolerated. After the 3rd patient is injected we will evaluate the higher doses in this chronic cohort then evaluate safety in subjects with a) acute (<12 months) bilateral loss of visual acuity to < 35 ETDRS letters and b) with acute (<12 months) unilateral loss of acuity to <35 ETDRS letters, but who have “good acuity” ≥ 70 letters (20/40) in the contralateral eye with better acuity selected for injection. Commercial Relationships: John Guy, None; William J. Feuer, None; Vittorio Porciatti, None; William W. Hauswirth, AGTC (F); Janet L. Davis, None; Byron L. Lam, None; Rajeshwari D. Koilkonda, None; Huijun Yuan, None; Phillip Gonzalez, None; Anil Lalwani, None Support: 1U10EY023558-01A1 Clinical Trial: NCT02161380 Program Number: 2609 Presentation Time: 10:00 AM–10:15 AM Chronic Optic Neuropathy Causes Decreases in both Inner Retinal Blood Flow and Prelaminar Optic Nerve Blood Flow Randy H. Kardon1, 2, Enrique Rivera1, Susan C. Anderson2, 1, Jan M. Full2, 1, Michael Wall1, 2, Robert Mallery1, Matthew Thurtell1, 2. 1 Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA; 2Research, Veterans Affairs Medical Center, Iowa City, IA. Purpose: Our purpose was to determine in a prospective, observational clinical study if optic neuropathy results in an obligatory decrease in blood flow to the inner retina and optic nerve due to decreased metabolic demand from non-functioning neurons. Visual stimulation causes transient hyperemia, but it is unknown if decreases in neuron activity cause reduced blood flow. Methods: Laser speckle blood flowgraphy imaging (LSFG-NAVI; Softcare Ltd, Fukuoka, Japan) was performed on a 25x20 degree area of the fundus incorporating the optic nerve head. Blurring of the laser speckle pattern by moving particles in the image plane was used to simultaneously measure blood flow in the major circumpapillary retinal arteries and veins, and below the surface of the optic nerve head. Blood flow was determined in each eye of 19 patients with unilateral optic neuropathy (ischemic=13, compressive=5, inflammatory=1) in the chronic state. Inner retinal blood flow and optic nerve head blood flow were compared between affected and unaffected eyes. Retinal nerve fiber layer (RNFL) and retinal ganglion cell layer complex (GCL) were compared to retinal and optic nerve blood flow. Results: There was a significant decrease in inner retinal blood flow (supplied by branches of the central retinal artery) in eyes with optic neuropathy compared to the fellow normal eye (P=0.002; mean=69±17% of fellow eye). A significant decrease in optic nerve head blood flow deep to the superficial retinal capillaries overlying the optic nerve was also present (P<0.001; mean=65±22% of fellow eye). There was also significant decrease in both RNFL (P=0.02; mean=83±32% of fellow eye) and GCL thickness (P<0.001; mean=71±11% of fellow eye), but no significant correlation between the inter-ocular asymmetry of retinal or optic nerve blood flow and RNFL or GCL thickness. Conclusions: Chronic optic neuropathy results in decreased retinal and optic nerve head blood flow, likely due to reduced metabolic demand. Laser speckle blood flowgraphy allows non-invasive simultaneous measurement of retinal, choroidal, and optic nerve head blood flow, which may be proportional to metabolism and neurovascular coupling. Commercial Relationships: Randy H. Kardon, Department of Veterans Affairs Research Foundation (S), Fight for Sight (S), Novartis (F); Enrique Rivera, None; Susan C. Anderson, None; Jan M. Full, None; Michael Wall, None; Robert Mallery, None; Matthew Thurtell, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Support: NEI R009040554; R01 EY018853, VA Rehabilitation Research and Development; C9251-C; 1I01RX000889-01A1, Department of Defense; TATRC; W81XWH-10-1-0736; W18XWH-10-1-0561, Novartis steering committee OCTiMS 318 Eye movements / Nystagmus / Central field loss Tuesday, May 05, 2015 8:30 AM–10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 2902–2929/D0001–D0028 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Visual Psychophysics/Physiological Optics, Visual Neuroscience Program Number: 2902 Poster Board Number: D0001 Presentation Time: 8:30 AM–10:15 AM Eye-hand reference frames misalign after central field loss Terence L. Tyson1, Laura Walker1, 2, Anna Ma-Wyatt3, Donald C. Fletcher4, 1. 1The Smith-Kettlewell Eye Research Institute, Daly City, CA; 2Envision Inc., Wichita, KS; 3University of Adelaide, Adelaide, SA, Australia; 4Frank Stein and Paul S. May Center for Low Vision Rehabilitation, San Francisco, CA. Purpose: When central vision is lost and a preferred retinal locus (PRL) develops in the periphery, typical eye-hand coordination may be disrupted. In cases of AMD, reach initiation is delayed (Timberlake et al., 2011) and saccades can be misdirected (Renninger et al., 2012). This work examines the degree to which the reach trajectory is affected by central field loss (CFL). Methods: Subjects with CFL and age-matched controls performed a rapid reach to a high contrast dot on a touch sensitive screen. The dot can occur in 1 of 8 locations surrounding fixation at varying distances. Subjects received negative feedback if reach time or touch endpoint error criteria was violated. Reach time limits were determined for each subject during practice trials, and defined as the critical reach duration in which accuracy began to decline. Eye and hand movement trajectories were tracked (SR Eyelink 1000 and Polhemus Liberty Motion Tracker) and touch endpoints were collected (ELO Touchscreen). Viewing was binocular, with tracking of the dominant/better eye. Monocular scotoma and PRL locations were measured with microperimetry. The foveal pit was localized relative to the scotoma and PRL utilizing optical coherence tomography (OCT/SLO by Optos). Reach trajectories were analyzed for initiation time, peak velocity, total duration, tortuosity and directional bias. Accuracy and precision of endpoint errors were also analyzed. Results: Reach initiation was delayed relative to age-matched healthy controls, yet overall trajectories were smooth and exhibited ageappropriate dynamics. Eye movements tended to bring the fixational PRL close to the target before onset of reach initiation. Directionality of the reach toward the target exhibited more variability in CFL subjects, yet endpoint precision was not worse than predicted given PRL eccentricity (i.e., visual acuity). In several cases, PRL landing was notably biased off of the target in a direction that pulled the non-functioning fovea closer to the target, suggesting incomplete rereferencing of eye-hand coordination to the PRL. Conclusions: In many cases of CFL, fixation is re-referenced to the PRL. This “remapping” does not always extend completely to the hand, resulting in an offset between PRL and reach endpoints. The misalignment between the eye and hand may pose a problem for dexterity, especially when moving under time pressure. Rehabilitation that targets eye-hand realignment may provide a benefit. Commercial Relationships: Terence L. Tyson, None; Laura Walker, None; Anna Ma-Wyatt, None; Donald C. Fletcher, None Support: NEI R01 Grant EY022156 Program Number: 2903 Poster Board Number: D0002 Presentation Time: 8:30 AM–10:15 AM Characteristics of Monocular Smooth Pursuit in Central Field Loss Natela M. Shanidze, Elena Potapchuk, Giovanni Fusco, Stephen Heinen, Preeti Verghese. Smith-Kettlewell Eye Research Institute, San Francisco, CA. Purpose: Currently, it is not well known how people with central field loss (CFL) pursue moving targets, a behavior that has been attributed to the fovea (Krauzlis 2003). Optimizing pursuit behavior may be especially important for this population, as it can afford additional time to visualize a moving object of interest. As the position of the target changes during the task, it is important to assess pursuit characteristics in the context of the target’s location relative to a subject’s scotoma and preferred retinal loci (PRL). Here, we present results describing monocular smooth pursuit in CFL patients using a novel approach employing a scanning laser ophthalmoscope (SLO) that allows for a direct visualization of the target on the damaged retina. Methods: Six (5 AMD, 1 JMD) individuals with differing degrees of CFL were recruited. Monocular scotomas were assessed using standard microperimetry in an SLO. Subsequent to mapping each scotoma, observers pursued in a step ramp (Rashbass 1961) paradigm. They first fixated a central target (1°) for 1 second. The target then disappeared, and reappeared 6° away, moving at a constant speed (~5°/s), in one of 8 possible directions (in 45° increments), selected at random. Participants were asked to follow the target with their eyes. Results: CFL patients demonstrated reasonable pursuit of moving targets, with pursuit velocity gain (0.16-1.79) dependent on whether the target moved into or out of the scotoma. Gains were lowest for targets moving toward the scotoma and highest for those moving out of and away from it. Pursuit latencies mirrored gains. Fig 1 shows pursuit of a target moving out of the scotoma for one observer. A computed gain modulation index (MI) that characterized the difference between maximum and minimum gains across target trajectories correlated with scotoma size (Fig 2). Conclusions: Despite absence of the fovea, CFL patients could smoothly pursue moving targets during the majority of trials. Pursuit gains were highest for targets moving out of the scotoma, suggesting subjects were trying to catch up with the target. For targets starting opposite the scotoma and moving towards it, our results are contrary to the expectation that patients would pursue the target to avoid having it disappear into the scotoma. One potential explanation is that individuals have some knowledge of the scotoma and are unwilling to pursue a target if it means obscuring the center of the visual field. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Natela M. Shanidze, None; Elena Potapchuk, None; Giovanni Fusco, None; Stephen Heinen, None; Preeti Verghese, None Support: R01 EY022394, NIH; Rachel C. Atkinson & C.V. Starr Postdoctoral Fellowship, Smith-Kettlewell Eye Research Institute Program Number: 2904 Poster Board Number: D0003 Presentation Time: 8:30 AM–10:15 AM Compensatory strategies for independent binocular scotomas in simulated CFL Concetta F. Alberti1, Peter J. Bex2. 1Schepens Eye Research Institute, Boston, MA; 2Department of Psychology, Northeastern University, Boston, MA. Purpose: People with central field loss (CFL) can learn to use a Preferred Retinal Locus (PRL) in peripheral vision as a substitute fovea. The location of the PRL is generally measured monocularly, however people with CFL typically have asymmetric monocular scotomata forming a compound binocular scotoma. We simulate CFL with independent monocular scotomata in each eye of normally sighted observers to examine binocular visual function and oculomotor control with asymmetric vision loss. Methods: Gaze contingent binocular scotomata were simulated in 11 normally sighted participants using an Eyelink 1000Hz eye tracker and 3D stereoscopic shutter glasses. A Gaussian (σ=1°, 2°, 4° or 8° ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology in different sessions) windowed patch of 100% contrast pink noise was positioned at the point of gaze of each eye on a 144Hz computer display (Lmean=25 cd/m2). In each session, observers were instructed to freely-view the screen and to identify a sequence of 50 black (0.1 cd/m2) SLOAN letters presented at the screen centre. Each letter was presented until the observer responded and its size was under control of an adaptive staircase. Binocular eye positions were recorded throughout each session so that retinal position of the target, fixation stability and vergence could be determined. Results: As the scotoma size increased, fixation shifted to a greater eccentricity (p<0.05) and fixation instability increased (p<0.05), in line with previous studies of monocular PRL behaviour, however visual acuity did not significantly worsen with scotoma size (p=0.07). In addition, spontaneous binocular fixation patterns differed for different scotoma sizes: for the 2 smaller scotomata, observers made vergence eye movements that brought the target onto a ‘disjunctive PRL’ (p<0.05); for the 2 larger scotomata, observers made conjugate eye movements that brought the target onto a ‘conjunctive PRL’. Conclusions: Simulation of independent binocular CFL reveals strategic oculomotor behaviour that cannot be predicted from studies of real or simulated monocular CFL. Observers spontaneously adopt a PRL that under some conditions is in a correlated location in each eye – conjunctive PRL. However, for small scotomata the PRL may be in uncorrelated locations in each eye – disjunctive PRL – which suggests that they may use binocular vergence eye movements to bring a target into a sighted area of their 3D visual field. Commercial Relationships: Concetta F. Alberti, None; Peter J. Bex, None Program Number: 2905 Poster Board Number: D0004 Presentation Time: 8:30 AM–10:15 AM Adaptation to optically induced simultaneous bifocal vision Aiswaryah Radhakrishnan, Carlos Dorronsoro, Susana Marcos. Instituto de Optica, CSIC, Madrid, Spain. Purpose: To evaluate in subjects neural adaptation to optically induced simultaneous vision corrections in presence of their natural aberrations. Methods: A modified Simultaneous Vision simulator was used to produce pure bifocal images. The shift in Perceived Best Focus (PBF, i.e. amount of blur that is perceived as neutral) following adaptation to bifocal images was measured in four normal subjects. Adapting images were real bifocal images of different additions (achieved by combining two Badal channels focused for distance and near: 0.5D, 1.5D, and 3D) and proportions of near/far energy (produced by a spatial light modulator: 100%Blur (B)/0%Sharp (S), 75B/25S, 50B/50S, 25B/75S, 0B/100S). A total of 9 bifocal blur patterns, 3 pure defocus, 1 sharp, and 1 gray adaptation conditions were tested. Test images were 301 pure defocus images, simulated by convolution with 0 to 3D spherical blur of a face (subtending 2 deg at retina). The PBF was obtained with a blur detection task in a QUEST paradigm (subject responded for each test image whether it was sharp or blurred). The PBF shift was calculated as the difference between the PBF following every adapting image and the PBF following gray adaptation. All measurements were performed under paralyzed accommodation and a 5-mm pupil diameter artificial pupil. Results: The average PBF across subjects was 0.63±0.17D following gray adaptation and 0.51±0.1D following sharp adaptation (natural viewing), with no statistically significant differences (p=0.08) between these conditions. A high statistical significant correlation between the blur level of the adapting images and the shift in PBF (r=0.77, p=0.003). The largest shift in PBF occurred following adaptation to pure defocus (100B/0S: 0.32D±0.02D) and to the bifocal pattern with the largest blur component (75B/25S: 0.19D± 0.05D) for 3 D addition. Adaptation to a 50B/50S bifocal pattern produced the largest PBF shift (0.13D± 0.05D) for a 1.5 D addition. None except one subject experienced significant after-effects following adaptation to25B/75S bifocal pattern. Conclusions: Our results suggest that subjects can adapt, to a certain extent, to the image degradation produced by simultaneous vision pattern, particularly to patterns with 50%Near/50%Far or 75%/25%Near or Far. A simultaneous vision simulator is a useful tool to assess potential adaptation effects to bifocal corrections. Figure 1: Adaptation to optical simultaneous vision blur Commercial Relationships: Aiswaryah Radhakrishnan, None; Carlos Dorronsoro, OEPM P201331436 (P); Susana Marcos, OEPM P201331436 (P) Support: FIS2011-25637; ERC-2011-AdG-294099; EU Marie Curie FP7-PEOPLE-2010-ITN #26405 Program Number: 2906 Poster Board Number: D0005 Presentation Time: 8:30 AM–10:15 AM Eye movements in children with delayed reading skills Valldeflors Vinuela-Navarro1, Cathy Williams2, Jonathan T. Erichsen1, Joy Margaret Woodhouse1. 1School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom; 2School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. Purpose: Vision can be considered the primary sensory input for development and learning, and any condition that impairs vision, including eye movement anomalies, may reduce performance in learning and recreational environments. The purpose of this study is to evaluate differences in oculomotor behaviour between children who are good/average readers and children with delayed reading skills. Methods: Binocular eye movement recordings were obtained from 163 children (4-11 years) using a Tobii TX300 eye tracker. A 2° customised animated stimulus moving horizontally and vertically at 6°/s and 12°/s was used to study smooth pursuit. A 2° cartoon character was presented horizontally from -20° to +20° in steps of 5° to study saccades. Velocity and position gains, the number of saccades throughout the smooth pursuit, and the saccadic main sequence were obtained for each participant. The children who had delayed reading skills (n=43) were unmasked after data collection was completed. Means and standard deviations were calculated for children with and without delayed reading skills in each age group. Confidence intervals for the parameters measured were obtained from the good/average readers. Contingency tables were produced showing the proportion of children with and without delayed reading skills with eye movement parameters outside the established confidence intervals. Results: Paired t-tests showed no significant differences in the means of any eye movement parameter studied between good/average readers and those with delayed reading skills for any age group (p>0.05). In contrast, the eye movement parameters of children with ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology delayed readings skills were more frequently outside the confidence intervals for their age (smooth pursuit: 23.2%; saccades: 34.9%) than was the case for good/average readers (8.3% and 18.3%, respectively). Chi-square tests revealed an association between delayed reading and parameters for horizontal smooth pursuit (x2=6.55; p=0.01) and saccades (x2=4.94, p=0.02) that were outside the confidence intervals. Conclusions: Children with delayed reading skills have a two-fold increased risk of having their eye movement properties outside the confidence intervals for their age. Hence, there is evidence to support an association between delayed reading and eye movements, suggesting that some of these children may have significantly different eye movements or their eye movements have not developed at the same rate as typical children. Commercial Relationships: Valldeflors Vinuela-Navarro, None; Cathy Williams, None; Jonathan T. Erichsen, None; Joy Margaret Woodhouse, None Support: The College of Optometrists Postgraduate Scholarship Program Number: 2907 Poster Board Number: D0006 Presentation Time: 8:30 AM–10:15 AM The effect of anisometropic amblyopia on initiation of smooth pursuit eye movements Ivy Ziqian Liu1, Rana Arham Raashid1, Alan Blakeman3, Agnes M. Wong2, 3. 1Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada; 2Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON, Canada; 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. Purpose: Amblyopia is a spatiotemporal visual impairment caused by abnormal visual experience early in development. Recent studies have shown that amblyopia affects visuomotor behaviors in addition to impairing sensory functions. Here we investigate the effects of anisometropic amblyopia on smooth pursuit eye movements responsible for maintaining visual acuity and stabilizing the image of moving objects on the fovea. We hypothesized that given the visual processing delays in amblyopia, there will be a significant delay in the initiation of pursuit in patients during amblyopic eye viewing Methods: Fourteen visually normal controls and 9 people with anisometropic amblyopia were instructed to follow a red laser dot moving at ±15/s horizontally for approximately one second for a total of 40 trials. The experiment was repeated for each participant under three viewing conditions in the given order: 1) amblyopic/ nondominant eye, 2) binocular, and 3) fellow/dominant eye viewing. Outcome measures were pursuit initiation latency, open-loop gain (eye/target velocity ratio 100 ms post-onset), and steady state gain (eye/target velocity ratio throughout movement). Results: As predicted, when viewing monocularly with the amblyopic eye, participants with anisometropic amblyopia took longer to initiate pursuit movements (203±20 ms) compared to controls viewing with their nondominant eye (183±17 ms, p=0.004). The pursuit latency in patients during binocular (168±17 ms) and monocular fellow eye (176±22 ms) viewings was comparable to controls (binocular: 172±19 ms; dominant eye: 169±15 ms respectively). Mean open-loop gains and steady state gains did not differ significantly between the two groups. Conclusions: This study provides novel evidence of delayed pursuit initiation in people with anisometropic amblyopia with the amblyopic eye viewing. A comparable observation was made previously in a study involving saccadic eye movements in anisometropic amblyopia. Our findings suggest that longer initiation latencies may be due to a delay in visual processing of target motion in amblyopia. However, after smooth pursuit has been initiated, pursuit accuracy in amblyopia was equivalent to that seen in visually normal participants. Commercial Relationships: Ivy Ziqian Liu, None; Rana Arham Raashid, None; Alan Blakeman, None; Agnes M. Wong, None Support: CIHR MOP 106663, Leaders Opportunity Fund from the Canada Foundation for Innovation (CFI), the John and Melinda Thompson Endowment Fund in Vision Neurosciences, and the Department of Ophthalmology and Vision Sciences at The Hospital for Sick Children. Program Number: 2908 Poster Board Number: D0007 Presentation Time: 8:30 AM–10:15 AM Eye movement reaction times and visual task performance in congenital nystagmus in the presence of mental load Marzieh Salehi Fadardi, Larry A. Abel. Optometry and Vision Science, University of Melbourne, Melbourne, VIC, Australia. Purpose: Longer visual recognition time and latencies of target acquisition (Lt) and saccades (Ls) have been measured in congenital nystagmus (CN). Visually demanding tasks in the presence of stress have been said to make CN worse. We have investigated task performance, Lt and Ls in saccade tasks with low and high mental load in CN and controls. Methods: Eye movements and heart rate (HR) were recorded in 15 CN and 25 normal subjects who were required to respond manually to saccade targets randomly presented. The task was done with low mental load (by itself) and high mental load (with time restriction and mental arithmetic). We compared manual response time (RT), HR, Lt and Ls within subjects and across groups using 2-way mixed ANOVA. Results: High mental load was evidenced by significantly increased in HR at both groups. The percentage of the trials with saccades towards target did not change across tasks in CN. Eye movement reaction times were significantly longer in CN than normals (Ls: f(1,38)=26.3, p<.001, Lt: f(1,38)=23.12, p<.001) and also at the task with high mental load Ls:f(1,38)=34.7, p<.001, Lt: f(1,38)=7.20, p=.011). The interaction between task and group was not significant for Ls (Mean ± SEM for CN: 254.6±9.9 ms at low and 221±7.4 at high load; for normals: 216.2±6.1 at low and 180.8±4.2 at high load). Similarly, no significant interaction was found between task and group for Lt for CN: 539.7±47.4 at low and 489.8±20.6 at high load; for normal: 375.6±5.8 at low and 413.1±9.3 at high load). There was a significant main effect on manual RT only for group (f(1,38)=9.9, p=.003). The interaction between task and group was significant for RT; CN subjects showed longer RT than normals with high load (for CN: 873.3±47.3 at low and 968.7±32.7 at high load; for normals: 770±25 at low and 801.1±36.6 at high load, f(1,38)=5.02, p=.03). Conclusions: Both Ls and Lt are prolonged in CN. Task performance degraded in CN with mental load. Possible interactions between task demands and internal state may have affected CN and may have changed the exposure time required to see a target. Further studies are required to investigate the underlying motor and sensory mechanisms involved in both being slow to get on the target and slow to recognize it. Commercial Relationships: Marzieh Salehi Fadardi, None; Larry A. Abel, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2909 Poster Board Number: D0008 Presentation Time: 8:30 AM–10:15 AM Saccadic and optocollic head movements in homing pigeon (Columba livia) Jonathan T. Erichsen1, Christopher M. Dillingham1, John A. Barnes1, Turgut Meydan2, Tomasz Kutrowski2, Noor Aldoumani2. 1Optom and Vis Sciences, Cardiff University, Cardiff, United Kingdom; 2Wolfson Centre for Magnetics, Cardiff University, Cardiff, United Kingdom. Purpose: Quantitative measurement of the dynamical properties of visuomotor movements provides useful information about the interrelationship between the sensory capabilities of the visual system and the control of motor responses in people and other animals. The purposes of this study in pigeon were: 1) to define the main sequence of saccadic head movements, and 2) characterise the nature and thresholds of the reflexive optocollic response to an OKN stimulus. Methods: To investigate saccadic head movements, 17 birds were placed in a Perspex box with a transparent lid, and the angular position of their heads was recorded with a high-speed video camera (500fps). Both spontaneous movements and those in response to a non-localisable auditory stimulus were measured. A second group of birds (n=9) were gently restrained and placed in the centre of an arena comprising 6 LCD monitors on which could be displayed a vertical square wave (0.16 cycles/°) OKN stimulus moving at different velocities. Head position was recorded with a digital camera (60fps). In both experiments, horizontal head angle was determined frame by frame with purpose-designed software using LabView. The OKN stimuli were presented either: a) using stepped increases (2, 4, 6, 8 or 10°/s) of velocity from 2 to 60°/s with each step lasting 10 or 20s, or b) at randomly chosen velocities (1-100°/s) that lasted 60s. Results: The slope of the approximately linear relationship between the peak velocity and amplitude of the pigeons’ head movements was considerably higher for movements in response to an auditory stimulus. Similar to humans, the duration of head movements over a range of 7° to 70° is relatively constant and shorter in response to sound (110ms vs 150ms). In response to the stepped OKN stimulus, slow phases of the pigeons’ head responses had a gain close to 1 up to a velocity of 50-60°/s, above which the gain decreased to below 0.5. In contrast, random presentation resulted in a drop in gain above 30°/s. Responses were only recruited above a velocity threshold of 5°/s. At higher velocities, attaining a gain of 1 took progressively longer. Conclusions: Saccadic head movements in pigeons reveal a main sequence similar to that of head movements in humans. Ramping up the speed of the OKN stimulus at least doubles the velocity at which the bird achieves a gain of 1, suggesting only a limited range of visual velocities are capable of recruiting the optocollic response. Commercial Relationships: Jonathan T. Erichsen, None; Christopher M. Dillingham, None; John A. Barnes, None; Turgut Meydan, None; Tomasz Kutrowski, None; Noor Aldoumani, None Support: Leverhulme Trust (UK) Program Number: 2910 Poster Board Number: D0009 Presentation Time: 8:30 AM–10:15 AM “Face” stimulus eliminates pro and anti saccade differences Ari Z. Zivotofsky, Liran Zeligman. Brain Science, Bar Ilan University, Ramat Gan, Israel. Purpose: Two classic ocular motor paradigms are the pro- and anti-saccade tasks. In the former, the subject is required to make a saccade towards an appearing target while in the later he looks in the opposite direction. Classically, anti-saccades result in more erroneous saccades and longer latency saccades. We hypothesize that if the standard symbolic cue is replaced with a “smiley” like face-drawing rather than a typical symbolic icon it will increase the difficulty in disengaging from fixation and eliminate those differences. Methods: Subjects provided written, informed consent. Trials began with a 2000 ms fixation target in the center of the screen that also serves to indicate the saccade type: a plus sign for pro and a circle for anti. The cue then appears (with equal probability) left or right for 600 ms. Participants are required to direct their gaze, as quickly as possible, ‘‘TOWARDS’’ the cue (pro-saccade task) or ‘‘AWAY’’ from the cue (anti-saccade task). Pro and anti saccades were run either in blocks or randomly interleaved. In the drawn-face variation the symbolic stimulus is replaced with a “smiley” like face-drawing that signals task type and target direction. Monocular eye movements were recorded at 120 Hz using the ISCAN ETL-400 (ISCAN Inc., Woburn, MA) video system. Results: 21 right-handed undergraduate students between the ages of 20 and 22 (8 males) participated in this experiment. Mean error rates were significantly lower for pro than anti in both block (0.05 vs 0.22) and random (0.12 vs 0.42) in symbolic conditions. No such difference was found in face trials. A similar result was found for saccadic latency. Mean latencies were significantly lower (p<.001) for pro than anti in both block (249 ms vs 329) and random (260 vs 320) in symbolic conditions. No such difference was found in face trials. Conclusions: The seemingly ubiquitous difference between pro and anti saccades is usually attributed to the “difficulty” inherent in suppressing a reflexive saccade and then producing the anti saccade. Our data, in which the pro advantage disappears in the face-type trials points not to a typical handicap in anti- but a speeding up in pro. When presented with face stimuli subjects have more trouble disengaging resulting in the pro- trials showing results similar to a typical anti- trial. Commercial Relationships: Ari Z. Zivotofsky, None; Liran Zeligman, None Program Number: 2911 Poster Board Number: D0010 Presentation Time: 8:30 AM–10:15 AM Anti-saccades in early stages of multiple sclerosis Antonio F. Macedo5, Marisa B. Ferreira5, 3, Marta G. Parreira3, Inês Sousa6, José Figueiredo4, João J. Cerqueira1, 2, Paulo S. Pereira6. 1 Neurosciences Domain; Life and Health Sciences Research Institute, School of Health Sciences and ICVS/3B’s Associate Laboratory, University of Minho, Braga, Portugal; 2Clinical Academic Centre (CCA), Hospital de Braga, Braga, Portugal; 3TEM-All with the Mutiple Sclerosis, Braga, Portugal; 4Department of Neurology, Private Hospital of Braga, Braga, Portugal; 5Vision Rehabilitation Lab.; Centre/Department of Physics and Optometry, Universty of Minho, Braga, Portugal; 6Department of Mathematics and Applications, University of Minho, Braga, Portugal. Purpose: Eye movements disability is common finding in multiple sclerosis (MS) but the exact stage at which changes are visible is not clear. The aim of study was to assess if anti-saccade (AS) planning and execution are altered at early stages of the disease. Methods: A total of 48 participants with MS selected by a neurologist (JJC) at Hospital de Braga and 52 controls participated in this study. Inclusion criteria: relapsing-remitting course, EDSS≤3, 1 month or more without MS crisis, and normal or corrected visual acuity. Exclusion criteria (MS and Control): cognitive impairment, traumatic brain injury or stroke. The mean age in the MS group was 37y and 33y in the control group. Eye movements were monitored using a binocular infrared eyetracker running at 250Hz(RED250, SMI Gmb Germany), precision <0.4deg, stimuli were presented in a 22 monitor (Dell P2210). Code for running the experiment and data analysis was written using the Matlab (Mathworks Inc). Participants were seated in a room dim light at 74cm from the monitor and head ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology movements were minimized by a headband. The task was to fixate, after a variable period between steady fixation and the stimulus of 1250ms or 1600ms, participants looked as quickly as possible for the opposite direction where the target (a 30x30mm cross) was presented (anti-saccade movement). Each subject performed 40 trails. Results: The main results were the proportion of the directional errors (wherein the participant voluntarily looked for the wrong side), and latencies for: i) anti-saccades, ii) pro-saccades (movement in the same direction of the stimulus) and iii) correction (reaction time that the participant takes from the error fixation until to start the movement). The mean number of errors was 28%(SD=19) in MS group and 16%(SD=11) in the control group, mean difference 12%, t(74)=3.83, p<.001. Anti-saccades latency was 330msec (SD=61) in the MS group and 294ms(SD=59) in the control group, mean difference 36ms, F(1,98)=10.99, p<.05. The mean of the correction latency value was 178ms(SD=111) in the MS group and 129ms(SD=107) in the control group with a mean difference of 49ms, F(1,98)=6, p<.05. No statistically significant differences were found in accuracy and pro-saccade latency between groups. Conclusions: This study shows that anti-saccades latency and errors are increased at early stages of multiple sclerosis. Anti-saccades might be a sensitive tool to assess functional status in people with this condition. Commercial Relationships: Antonio F. Macedo, None; Marisa B. Ferreira, None; Marta G. Parreira, None; Inês Sousa, None; José Figueiredo, None; João J. Cerqueira, None; Paulo S. Pereira, None Support: This study was supported by the Multiple sclerosis Association “Todos com a Esclerose Multipla (TEM)”. The Lab. of Vision Reabilitation receives support from Shamir Portugal, FCT and APLO Program Number: 2912 Poster Board Number: D0011 Presentation Time: 8:30 AM–10:15 AM Objective optokinetic nystagmus measurement in children from consumer grade video Jason Turuwhenua1, Mehrdad Sangi1, Benjamin Thompson2. 1 Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; 2Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand. Purpose: Accurate clinical assessment of visual function in young children is challenging. Optokinetic Nystagmus (OKN) may allow for objective measurement of visual function in children if appropriate child-friendly eye tracking techniques are available. Methods: We developed software tools to analyze video footage of children (n = 5 children, n = 20 individual trials) freely viewing dynamic random dot stimuli designed to elicit OKN (250 dots, 0.5° diameter, drifting at 8°/second). The videos were recorded using an off-the-shelf video recorder (SONY digital high definition camera HDRCX7EK, Sony Corporation, Tokyo, Japan). A novel head stabilization technique based on tracking random features of the face was applied to the videos to obtain a stable visualization of the head area. This was followed by extraction of the eye velocity in the stabilized eye region. Finally, the presence of OKN was detected using a method in which quick phases fitting heuristic criteria were averaged and thresholded. The outputs of our technique were compared with the observations of two observers masked to the results of the method. Firstly, the quick phases observed by an experienced observer were compared to those detected by the automated method. Secondly, the overall computer determined assessment as to the presence of OKN in each trial was compared with judgements made by a clinical assessor. Results: The sensitivity and specificity of our eye movement detection was 89.1% and 98.9% respectively across all trials, with an experienced observer as a baseline. The positive predictive and negative predictive values were 72.6% and 99.5% respectively. Our OKN detection method predicted the clinical assesor’s results in 17 of 20 (85%) of the trials. Conclusions: We developed tools that improved the visualization of the eye, and facilitated the measurement of OKN related eye movements from videos of children. The results suggest that consumer grade equipment can be used for the assessment of eye movements in children, which may help in the diagnosis of visual disorders. The workflow we implemented for the semi-automated detection of optokinetic nystagmus Commercial Relationships: Jason Turuwhenua, #60259 (P); Mehrdad Sangi, #60259 (P); Benjamin Thompson, #60259 (P) Support: University of Auckland Faculty Research Development Fund Program Number: 2913 Poster Board Number: D0012 Presentation Time: 8:30 AM–10:15 AM Infantile Nystagmus and Abnormalities of Conjugate Eye Movements in Down Syndrome: A Corollary of Cerebellar Maldevelopment Avery H. Weiss1, 2, James O. Phillips1, 3, John P. Kelly1, 2. 1Ophthal, Roger Johnson Vis Lab, Seattle Children’s Hosp/W-7729, Seattle, WA; 2Ophthalmology, University of Washington, Seattle, WA; 3 Otolaryngology, University of Washington, Seattle, WA. Purpose: Anatomic and neuroimaging evidence of abnormal cerebellar development in humans and a mouse model of DS prompted us to study the eye movements of DS patients with CN. Methods: Gaze-holding in primary gaze and at eccentricities of 15 degrees, saccades to horizontal or vertical target steps ranging from 5 to 25 deg, smooth pursuit of targets drifted at 10, 20 & 30s/s and optokinetic nystagmus(OKN) in response to horizontally-oriented square wave gratings (0.1cpd) drifted at 15,30 and 45s/s were recorded with binocular video-oculography (SMI, Interacoustics). Results: All patients demonstrated one or a combination of the following gaze holding instabilities: 1) Conjugate, horizontal, constant velocity, jerk nystagmus; 2) Conjugate, horizontal symmetric or asymmetric pendular nystagmus; 3) Intermittent saccadic oscillations that could be larger in one eye, or symmetric in both eye; 4) saccadic oscilations superimposed upon nystagmus types 1 or 2. Gains for horizontal saccades to target steps of more than 5 deg were uniformly hypometric (Gains = 0.50-0.78 compared to >0.80 for age-matched norms). The relationship between peak ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology saccadic velocity and saccade amplitude followed the main sequence. Gains for vertical OKN were asymmetric in a subset of children. Conclusions: The nystagmus and abnormalities of conjugate eye movements observed in children with DS are consistent with functional abnormalities of the cerebellum. The findings of dysmetric saccades that follow the main sequence localize the underlying abnormality to the cerebellum and exclude brainstem structures. Sonic Hedgehog has been shown to mediate the proliferation and anatomical organization of cerebellar granule neuronal precursor cells. Deregulation of Sonic Hedgehog in DS may account for the cerebellar abnormalities that underlie the congenital nystagmus and ocular motor abnormalities. Commercial Relationships: Avery H. Weiss, None; James O. Phillips, None; John P. Kelly, None Support: upported by an unrestricted grant from grant from the Peter LeHaye, Barbara Anderson, and William O. Rogers Endowment Funds Program Number: 2914 Poster Board Number: D0013 Presentation Time: 8:30 AM–10:15 AM Two dimensional analysis of horizontal and vertical pursuit performance in infantile nystagmus Lee Mcilreavy1, Tom C. Freeman2, Jonathan T. Erichsen1. 1School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom; 2School of Psychology, Cardiff University, Cardiff, United Kingdom. Purpose: Previous studies of pursuit in infantile nystagmus (IN) have generally overlooked the ability to pursue targets moving vertically, presumably because the oscillation accompanying IN is predominantly horizontal. We compared horizontal and vertical pursuit in IN and controls, in each case analysing both the horizontal and vertical components of the eye movements in order to obtain 2D performance measures. Methods: Fifteen adult participants with IN completed a monocular pursuit task, with normally sighted age-matched participants as a control. Horizontal and vertical pursuit was to a 0.2° green dot moving through primary position with a total excursion of 16° or 32° at velocities of either 8°/s or 16°/s. Eye movements were recorded at 1000Hz (EyeLink 1000) and analysed offline. After removing saccades and fast phases (IN), eye velocity relative to the pursuit target was used to obtain 2D probability density functions. Isocontours bounding 68% of the highest probability densities estimated velocity matching. Accuracy was defined as isocontour centre of mass, while precision was defined as isocontour area. Principal component analysis of isocontour bounded data yielded major and minor axes of the area and its shape. Results: Results to date indicate pursuit precision was significantly lower along both orientations for IN compared to controls (vertical p<0.001, horizontal p<0.001). While the IN group showed large variation, especially for accuracy, horizontal pursuit precision was significantly greater than vertical (p<0.001) for IN, with no significant difference in controls. Isocontour area was significantly more circular for vertical than horizontal pursuit (p<0.001) for both IN and controls. Further analyses of IN data may reveal the influence of the null zone, if any, on velocity matching during pursuit as well as the role of fast phases in re-establishing pursuit. Conclusions: We present a novel method for investigating IN slow phase velocity matching to a pursuit target. Our results suggest that pursuit performance in IN is neither accurate nor precise when compared with controls, with significant impairment for vertical pursuit compared with horizontal. Instantaneous eye velocities, relative to the pursuit target, for a participant with IN. Superimposed upon the 2D scatter plot is the corresponding probability density function of eye velocity, with colour coding of the velocity probabilities. Commercial Relationships: Lee Mcilreavy, None; Tom C. Freeman, None; Jonathan T. Erichsen, None Support: BBSRC (UK) Program Number: 2915 Poster Board Number: D0014 Presentation Time: 8:30 AM–10:15 AM Onset of low-frequency, upgaze-evoked and high-frequency, horizontal nystagmus in infant with night-blindness associated, transient, tonic downgaze (NATTD) Huibert J. Simonsz1, 2, M. Kooiker3, J. J. Pel3, M. M. van Genderen4, Ralf Florijn2, L.S. Smit5, Maarten Kamermans2, J. van der Steen3. 1 Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands; 2 Netherlands Institute for Neuroscience, Amsterdam, Netherlands; 3 Neuroscience, Erasmus Medical Center, Rotterdam, Netherlands; 4 Bartiméus Institute for the Visually Impaired, Zeist, Netherlands; 5 Pediatric Neurology, Erasmus Medical Center, Rotterdam, Netherlands. Purpose: In 1994 we described infants who presented at age 2-4 months with tonic downgaze, chin-up head posture and lowfrequency, upgaze-evoked nystagmus that disappeared at age 2, accompanied by high-frequency, horizontal nystagmus that persisted. In most of these, abnormal ERGs and CACNA1F, NYX or GPR179 mutations confirming CSNB were found. As the proteins affected by these mutations reside on either side of the rod-ON-bipolar synapse, and this pathway carries a motion signal, this specific combination of horizontal and vertical nystagmus may have a retinal cause. Early diagnosis of NATTD now permits longitudinal recording of the onset of upgaze-evoked and horizontal nystagmus. Methods: A 4-months-old male infant, born prematurely (34 weeks, 2100g) presented with tonic downgaze and chin-up head posture. Eye movements were recorded with a Tobii X60 video eye tracker. Recording was repeated every 2 weeks from onset, later every 4-6 weeks. ERG was made in the months after. Results: A hemizygote mutation c.1784G>A; p.(Arg595His) was found in the CACNA1F gene. At 4 months (corrected age 11 weeks) the eyes were continuously in downgaze. Upper eyelid retraction occurred periodically without upward saccades. Slow horizontal pendular eye movements, disjugate and more pronounced in the right eye (Fig. 1), were accompanied by convergence spasms. At 4,5 months (corrected age 13 weeks) the horizontal pendular nystagmus ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology had become more rapid with less convergence spasms. At 5,5 months (corrected age 17 weeks) horizontal eye movements had become more conjugate (Fig. 2); convergence spasms were rare. The infant occasionally tried to look ahead resulting in upward jerks with subsequent slow phases with deceleration back to downgaze, and eyelid retraction. Conclusions: Tonic downgaze, accompanied by chin-up head posture, occurred as the primary event. The horizontal pendular nystagmus started with a minimal, hardly noticeable, pendular eye movement. A few weeks later upgaze-evoked nystagmus started when the infant tried to look ahead. In previous NATTD cases the upgaze-evoked nystagmus disappeared at around 2 years, in one case before 8 months. Interestingly, two of these were operated at age 10 for chin-down head posture, with the nulzone of the rapid horizontal nystagmus in upgaze. Eye movements at 11 weeks corrected age Eye movements at 17 weeks corrected age Commercial Relationships: Huibert J. Simonsz, None; M. Kooiker, None; J. J. Pel, None; M. M. van Genderen, None; Ralf Florijn, None; L.S. Smit, None; Maarten Kamermans, None; J. van der Steen, None Support: Foundation ODAS Program Number: 2916 Poster Board Number: D0015 Presentation Time: 8:30 AM–10:15 AM Dramatic Fixation Instability in Peripheral Vestibulopathies without Visual Feedback Compared with Central Vestibulopathies Jaclyn Hwang, Yaping J. Liao. Ophthalmology, Stanford, Stanford, CA. Purpose: Eye movement abnormalities are common in central and peripheral vestibulopathies, and characterization of eye movements can help teach us important ways to localize the lesion. Eye movement characterization has also been used to triage dizzy patients in the acute setting to determine if this may be an emergency requiring brain imaging (Kattah, Stroke, 2009). In this study, we compared and contrasted eye movement findings during a simple fixation task in patients with central and peripheral vestibulopathies. Methods: We performed detailed neuro-ophthalmic examination in 10 patients with peripheral and 10 patients with central vestibulopathies. We assessed visual fixation with and without visual feedback using 60-Hz binocular 3D infrared oculography. Fixation target at distance in the light was displayed using a custom-made LED board. Fixation target in the dark was displayed within the infrared recording goggle and turned on and off to assess rapid changes in eye position. Results: In patients with peripheral vestibulopathies, such as acoustic neuromas or vestibular neuronitis, visual fixation of a distant target was typically good, with rare, small amplitude square wave jerks that were also found in normals. Once fixation target was removed, however, patients’ fixation often rapidly decompensated, exhibiting deviations of eye positions, often in square wave jerk waveform that may be accompanied by a torsional nystagmus. The fixation instability pattern was different in patients with central vestibulopathies, such as Wallenberg syndrome or brainstem cavernous malformations. With visual feedback, patients typically exhibited uni- or multi-directional oscillations initiated by a slow phase. Once fixation target was removed, patients exhibited relatively less change in eye movement waveforms during fixation. Conclusions: We confirmed previously reported unmasking of fixation instability in the dark without visual feedback in peripheral vestibulopathies (Hirvonen, Eur Arch Otorhinolaryngol, 2012) and showed that fixation in central vestibulopathies was less affected by visual feedback, consistent with failure of fixation suppression in central causes. We propose that a useful test to distinguish peripheral and central vestibulopathies is to observe patient eye movement behavior during fixation with and without visual feedback, ideally in the dark. Commercial Relationships: Jaclyn Hwang, None; Yaping J. Liao, None Support: Burroughs Wellcome Foundation Program Number: 2917 Poster Board Number: D0016 Presentation Time: 8:30 AM–10:15 AM Study of fusional convergence using eye tracking: preliminary results on subjects with normal binocular vision Michela Fresina1, Laura Cercenelli2, Cecilia Benedetti1, Emilio C. Campos1, Barbara Bortolani2, Brunella Merante2, Piera Versura1, Emanuela Marcelli2. 1DIMES, Ophthalmology Service, Bologna, Italy; 2DIMES, Laboratory of Bioengineering, Bologna, Italy. Purpose: In the field of ophthalmology, vision researchers use eye tracking to study oculomotor behavior, cognitive visual function and vision deficiencies. Fusional vergence is a disjunctive movement of the eyes that is made in order to obtain single vision with two eyes. Fusional vergence disorders are often associated with the most common forms of strabismus. The aim of the study was to ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology characterize fusional convergence response in subjects with normal binocular viewing by using an eye tracking system. Methods: Base-out horizontal prisms of 4 and 6 diopters were used to elicit fusional convergence of the right eye in 11 subjects with normal binocular vision. Eye movements were continuously recorded using the Viewpoint infrared video eye tracker (Arrington Research, Scottsdale, AZ, USA) and custom software was developed to automatically analyze off-line the saccadic response (gaze angle and angular velocity). The Fusional Convergence Amplitude (FCA) was calculated by subtracting the baseline position of the right eye (i.e. before the introduction of the prism) from the maximum saccadic excursion of the right eye during the disconjugate eye movements in the vergence phase (Figure 1.a). Results: The typical eye-movement response in subjects achieving the fusional convergence was a preliminary saccadic movement of both eyes (version phase) followed by a convergence movement with the eyes moving towards each other to achieve single vision (vergence phase) (Figure 1). Eye tracking recordings showed that 2 patients were not able to achieve fusion with neither 4 nor 6 diopters prisms. Fusion was achieved in 8 subjects when using the 4 diopters prism and only in 6 subjects when using 6 diopters prism. One patient was excluded from the analysis because the saccadic movements were highly affected by blink artifacts. The FCA varied from 2.2°±0.2 to 3.0°±0.2 when increasing prism diopters from 4 to 6 (Figure 2). Conclusions: The fusional convergence can be accurately studied and evaluated using an eye tracking system. Preliminary results on subjects with normal vision showed that when increasing the prism diopters the fusional convergence ability decreases. Commercial Relationships: Michela Fresina, None; Laura Cercenelli, None; Cecilia Benedetti, None; Emilio C. Campos, None; Barbara Bortolani, None; Brunella Merante, None; Piera Versura, None; Emanuela Marcelli, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2918 Poster Board Number: D0017 Presentation Time: 8:30 AM–10:15 AM Influence of textured backgrounds on fusional vergence: preliminary results using an eye tracker Cecilia Benedetti1, Emanuela Marcelli2, Michela Fresina1, Emilio C. Campos1, Barbara Bortolani2, Guido Tiberi2, Piera Versura1, Laura Cercenelli2. 1DIMES, Ophthalmology Service, Bologna, Italy; 2 DIMES, Laboratory of Bioengineering, Bologna, Italy. Purpose: The vergences ensure and maintain binocular fixation and binocular vision. The amplitude of vergences depends on many factors, one of which is the amount of fusible material on the binocular field of vision. In casual seeing the whole surface of the two retinas is exposed to similar stimuli and the conditions for motor fusion should be optimal. The retinal periphery is a powerful factor in production of fusional movements and makes an important contribution to stabilization of relative position of the eyes. The purpose of the study was to evaluate whether the presence of a textured background in the visual stimulus may influence the convergence fusional response. Methods: Eleven subjects with normal binocular vision underwent fusional disparity stimuli: a base-out prism of 6 diopters was placed in front of the right eye to elicit disparity. Eye movements were continuously recorded using the Viewpoint infrared video eye tracker (Arrington Research, Scottsdale, AZ, USA) and a custom software was developed to automatically analyze off-line the saccadic response (gaze angle). Each subject was examined twice, once by presenting the visual stimulus (black dot) on a white background, then by presenting the same stimulus on a textured background (Figure 1). The order of presentation of the two tests was randomly chosen. Results: Eye tracking recordings showed a typical pattern for the fusional behavior: a preliminary saccadic movement of both eyes (version phase) and a following convergence movement with the eyes moving towards each other to achieve single vision (vergence phase) (Figure 2.a). When presenting the stimulus on the white background only 6 subjects (54%) achieved fusional convergence. This number increased up to 9 subjects (82%) when presenting the same stimulus on the textured background (Figure 2.b). Conclusions: The fusional vergence response can be accurately studied and evaluated using an eye tracker. In subjects with normal binocular vision the presence of a textured background seems to facilitate the fusional convergence ability. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology was still visible, prompting a button press. Eye-tracking data were obtained from the left eye while 205-channel, 512-Hz scalp EEG data were recorded. We studied event-related potentials (ERPs) timelocked to saccade events for the time courses of 650 localizable ICs assigned to 16 clusters. Results: Mean response accuracy was 92% (SD: 5%) with mean false positive rate 6% (SD: 4%). Mean reaction time was 1579 ms (SD: 235 ms). After excluding 3 frontal EOG clusters comprising 240 ICs, the major (90 ms) lambda response peak in the fixationonset locked ERPs was dominated by 3 occipital IC clusters (100 ICs, 92% of the peak scalp map accounted for) (Figure 1). ERPs time locked to saccade onsets contained a pre-saccadic spike peaking at -12 ms. Three far frontal clusters dominated this spike (260 ICs, 95% variance accounted) (Figure 2 left). However, after removing all 5 EOG and far frontal clusters (314 ICs) and 1 temporal scalp muscle (EMG) cluster (26 ICs), 4 posterior clusters (114 ICs) contributed 82% of the remaining (positive-going) pre-saccadic spike (Figure 2 right). Conclusions: ICA clustering analysis revealed multiple sources of the lambda response and pre-saccadic spikes. Posterior cortical contributions to the pre-saccadic spike might index corollary suppression of visual cortex during saccades. We plan to use this task to investigate functional vision in glaucoma patients. Commercial Relationships: Cecilia Benedetti, None; Emanuela Marcelli, None; Michela Fresina, None; Emilio C. Campos, None; Barbara Bortolani, None; Guido Tiberi, None; Piera Versura, None; Laura Cercenelli, None Program Number: 2919 Poster Board Number: D0018 Presentation Time: 8:30 AM–10:15 AM Source-resolved EEG analysis of human saccade-event related potentials Makoto Miyakoshi1, Scott Makeig1, Carolina Gracitelli3, 4, Ricardo Y. Abe3, 2, Alberto Diniz-Filho3, 5, Saif Baig3, Felipe A. Medeiros3. 1 SCCN, Inc, University of California San Diego, La Jolla, CA; 2 Ophthalmology, University of Campinas, Campinas, Brazil; 3 Visual Performance Laboratory, Department of Ophthalmology,, University of California San Diego, La Jolla, CA; 4Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; 5Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil. Purpose: We developed an active visual search task in which participants saccade freely across an evolving display of Gabor patches. Here we report the results from the EEG analyses of saccade-related brain/muscle potentials using independent component analysis (ICA) and independent component (IC) clustering. Methods: Participants were 16 healthy young adults (8 female, mean 20.8 years, SD 2.8, range 18-26). Five Gabor patches were always present on a gray background (20-inch LCD monitor at 60 cm ). A sequence of 1200 patches were pseudo-randomly selected from four patch sizes and five orientations (SOA 2 sec, duration 5 sec). The task was to detect infrequent (15%) instances in which the size and orientation of the newest patch matched those of another patch that Figure 1. Lambda response. Occipital IC source clusters of the lambda response following fixation onsets. Figure 2. Pre-saccadic spike. Left, EOG/far frontal source contributions are dominant. Right, posterior brain source contributions remaining after removing EOG and EMG ICs. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Makoto Miyakoshi, None; Scott Makeig, None; Carolina Gracitelli, None; Ricardo Y. Abe, None; Alberto Diniz-Filho, None; Saif Baig, None; Felipe A. Medeiros, Alcon Laboratories Inc (F), Alcon Laboratories Inc (R), Allergan Inc (C), Allergan Inc (F), Allergan Inc (R), Bausch & Lomb (F), Carl Zeiss Meditec Inc (C), Carl Zeiss Meditec Inc (F), Carl Zeiss Meditec Inc (R), Heidelberg Engineering Inc (F), Merck Inc (F), National Eye Institute (F), Novartis (C), Reichert Inc (F), Reichert Inc (R), Sensimed (F), Topcon Inc (F) Program Number: 2920 Poster Board Number: D0019 Presentation Time: 8:30 AM–10:15 AM Tactile acuity determined with vibration motors for use in a sensory substitution device for the blind H. Christiaan Stronks1, 2, Daniel J. Parker1, Nick M. Barnes1, 3. 1 Computer Vision, NICTA Canberra Research Laboratory, Canberra, ACT, Australia; 2Neuroscience, Australian National University, Canberra, ACT, Australia; 3College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia. Purpose: We aim to construct a back-worn tactile substitution device for the blind that redirects camera images to a vibrotactile display. To establish a feasible between-motor distance we have determined the vibrotactile acuity on the lower back. In addition, we have established what the impact of experience is on tactile acuity using an active learning procedure. Methods: This study included 15 healthy subjects. Vibrational stimuli (100-ms stimulations) were delivered by coin motors (Precision Microdrives, LLC) with a diameter of 12 mm (Stronks et al., Artif Organs. in press). The motors were mounted on a carrier of urethane at various between-motor spacings (Fig. 1). Tactile acuities were determined with an adaptive, 2-alternative forced choice task using various offsets (0 – 200 ms) between two successive motor activations (n= 12). Training effects (n= 3) were tested at a stimulation offset of 0 ms. Subjects received 30 minutes of practice with feedback after each trial. Acuity tests were done before, during and after training. Results: Average tactile acuities varied from 36 to 63 mm center-tocenter, dependent on stimulus offset. The least favorable acuities were found when the vibrational stimuli were presented simultaneously (offset 0 msec). Acuities at the longest offset tested (200 ms) significantly differed from those at 0 ms and were 41 mm on average (RM ANOVA and Tukey’s post hoc test; P< 0.05). Acuities at intermediate offsets (50 - 175 ms) did not differ significantly from those obtained at 0 and 200 ms. The correlation between acuity and offset time approached significance (linear regression and F-test, P= 0.07). After practice, two subjects improved by 30% and 90%, respectively, while one subject performed 10% worse. The average improvement was 35%. Conclusions: Based on the regression analysis, the interpolated tactile acuity at 200 ms stimulus offset was 42 mm center-to-center. Preliminary results showed that subjects improved after practice. This suggests that after training motor spacings of 32 mm may be effective for use in a vibrotactile display, provided that adjacent motors are stimulated with an offset of 200 ms. Fig. 1. Experimental setup. (A) Subject with mounted motors. (B) Urethane carrier with motors. (C) Schematic showing between-motor distances. (D) Circuit board driving the motors. (E) Available motor spacings. Commercial Relationships: H. Christiaan Stronks, None; Daniel J. Parker, None; Nick M. Barnes, None Program Number: 2921 Poster Board Number: D0020 Presentation Time: 8:30 AM–10:15 AM The Dobson Card: An electronic display for forced-choice preferential looking (FPL) assessment of infant and toddler visual acuity Joseph M. Miller1, 2, Howard P. Apple1, 3, Tina K. Green1, Deborah Apple3, Erin M. Harvey1. 1Ophthal & Vision Science, University of Arizona, Tucson, AZ; 2College of Optical Sciences and College of Public Health, University of Arizona, Tucson, AZ; 3Apple Medical Incubator, Winter Park, FL. Purpose: To determine if the looking behavior of infants and toddlers during Acuity Card Procedure (ACP) testing using electronic stimuli is similar to the behavior observed when printed stimuli are used. Methods: A trained and experienced Teller Acuity Card tester measured binocular grating acuity in 8 subjects aged 9 to 45 months. Stimuli were presented using The Dobson Card (DC), a hand-held matt-black plexiglass frame (10”x22”) that flush-mounts 2 Google Nexus-7 (N7) tablet computers to the right and left of a center peephole. One tablet displays a square wave grating (1/2 octave steps), the other a luminance-matched gray patch. Stimuli were generated using Java language. An experimenter luminance matched the 2 tablet gray patches, then matched gratings to the paired gray patch. The gray patch and paired grating had a luminance of 92 lux, ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology and widest white stripe 170 lux (Dr Meter LX1330B photometer). An assistant controlled the tablet displays via Bluetooth to preserve tester masking of grating location and permit standard ACP testing. The DC was presented in a ACP stage (Vistech Consultants). Results: All subjects looked at the gratings in a manner similar to TAC. However, observed acuities were low normal/below normal when compared to published norms obtained with the printed Teller Acuity Cards (Vistech Consultants, Inc., TAC II now manufactured by StereoOptical). Acuity ranged from 2.4 to 18.2 Cy/Deg (cpd), median 5.65 cpd, mode 4.8 cpd. Conclusions: Children exhibit interest in viewing patterns of black and white stripes over gray control stimuli presented using tablet computers set against a black background in a manner similar to printed gratings against a gray background. The tasks differ, as the tablet requires comparison and cards detection. Acuities were below those expected for children of the same age using printed stimuli. Further work is required to determine the optimum stimulus luminance and background illumination, and normative data for DC acuity will need to be generated. Previous work has shown that even different versions of printed acuity cards yield different norms (Vistech vs Stereo Optical cards, Haynes et al., ARVO 2004). While static square wave gratings are used in this initial evaluation, the Dobson Card can be used for the display of a variety of stimuli such as alternating checkerboards or displays of coherent motion vs random motion. Commercial Relationships: Joseph M. Miller, None; Howard P. Apple, None; Tina K. Green, None; Deborah Apple, None; Erin M. Harvey, None Support: NEI/NIH EY13153 (EMH), Research to Prevent Blindness (RPB) Career Development Award (EMH), RPB Center Award (JMM) Program Number: 2922 Poster Board Number: D0021 Presentation Time: 8:30 AM–10:15 AM Enhancing tolerance of image motion through perceptual learning: Static and dynamic bisection acuity Kenneth D. Tran1, Charlie Ngo1, John Bui1, Esther Yang1, Dennis M. Levi1, 2, Roger W. Li1, 2. 1School of Optometry, University of California-Berkeley, Berkeley, CA; 2Helen Wills Neuroscience Institute, University of California-Berkeley, Berkeley, CA. Purpose: Our previous findings show that practice can substantially improve dynamic bisection acuity. However, since the stimulus exposure time (300 ms) was longer than the latency for saccadic eye movements, the improved acuity could have been merely the result of improved tracking eye movements. In the present experiment, we used a shorter stimulus duration (150 ms) in order to isolate the effects of perceptual learning on motion processing. Methods: The bisection stimulus comprised of three briefly presented black square dots (duration 150ms) separated by 5 arcmin. The observer’s task was to localize the position of the central dot relative to the adjacent dots. On day 1, the pre-training session consisted of 5 stimulus conditions: [1] static horizontal orientation, [2] static oblique (45 deg) orientation [3] oblique stimulus moving in an orthogonal direction (135 deg) at 1.33 deg/s, and [4-5] oblique stimulus moving along a 45 degree trajectory at two different speeds (1.33 & 2 deg/s). Observers practiced the task with the static oblique stimulus from day 2 to 8, subsequently with the moving oblique stimulus (2 deg/ sec) from day 10 to 16. Performance for all five conditions was reevaluated in two post-training sessions on days 9 and 17. Results: Bisection acuity improved dramatically (35%) after practicing with the static oblique stimulus. Learning transferred substantially to the untrained static horizontal stimulus (26% improvement) and the three untrained moving oblique stimuli (1.33 deg/s along 135 deg, 34% improvement; 1.33 deg/s along 45 deg, 31% improvement; 2 deg/s along 45 deg, 17% improvement). Subsequent practice with the oblique stimulus in motion (2 deg/s) resulted in a further 37% improvement in dynamic bisection acuity (a total of 47% from day 1), and the performance for lower speed stimuli improved as well. Conclusions: Our findings suggest that perceptual learning enhances tolerance of image motion. We characterized the specificity of learning a bisection acuity task and showed that the learning generalizes substantially, but not completely, from static to moving stimuli, and across different stimulus speeds and orientations. Commercial Relationships: Kenneth D. Tran, None; Charlie Ngo, None; John Bui, None; Esther Yang, None; Dennis M. Levi, None; Roger W. Li, None Support: NH Grant R01EY01728 Program Number: 2923 Poster Board Number: D0022 Presentation Time: 8:30 AM–10:15 AM Effect of crowding on postural control Guillaume L. Giraudet2, 1, Marion Grun1, Jocelyn Faubert1. 1 Psychophysics & Visual Perception Lab, Universite de Montreal, Montreal, QC, Canada; 2R&D, Essilor Canada, Montreal, QC, Canada. Purpose: The aim of the current study was to determine the effect of foveal crowding on postural stability in young adults and elderly. Crowding describes the deleterious influence of neighboring objects (flankers) on the recognition of a central target. Methods: Thirty-three subjects participated in the experiment: 20 young adults and 13 elderly. They stood, barefoot and arms crossed, in front of a projection screen. Optical motion sensors, located on a helmet, and 6 IR cameras (Optotrak system) were used to track and register head movements during trials. Each trial lasted 64s. The stimulus displayed on the screen was a black and white checkerboard with an empty grey area (5° of visual angle) in front of the subject’s eyes. This peripheral checkerboard could be either static or in motion. Four different tasks, proposed in different orders, were considered: i) subjects were instructed to look at a fixation point, located in the middle of the central empty area; ii) subjects had to find target letters within RSVP sequences of letters; iii) and iv) both last tasks were the same as the second one but with flankers in the periphery, far from (task 3 – low crowding) or close to (task 4 – high crowding) the central letters. Each trial was repeated 3 times. We calculated the Velocity Root Mean Square (VRMS) of head movements based on the signal provided by the optical sensors. VRMS represented a measure of postural instability induced by the various visual conditions and tasks. Results: Results showed that subjects were more stable when they had to fixate the central point (task1) than when they were instructed to find target letters within RSVP sequences (tasks 2, 3 and 4). However, the change of postural behavior as a function of the task was significantly different between both young adults and elderly groups. While the former maintained the same level of stability for the 4 tasks, the latter was significantly affected by the RSVP tasks and crowding. Conclusions: Some previous studies showed that visual crowding increased with age, older people being more disrupted than young adults when the target to be recognized is surrounded by flankers (Scialfia et al, 2012 for review). Our experiment also showed that the effect of letter recognition and crowding on postural stability was higher for the elderly. The attentionnal load needed to perform letter recognition tasks, leaving fewer resources for the good control of postural stability, might explain this result. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Guillaume L. Giraudet, Essilor Canada (E); Marion Grun, None; Jocelyn Faubert, None Support: NSERC-ESSILOR Industrial Chair Program Number: 2924 Poster Board Number: D0023 Presentation Time: 8:30 AM–10:15 AM The Effect of Room Length on Perceived Egocentric Distance in Darkness Susan A. Kelly. Basic Science, Illinois College of Optometry, Chicago, IL. Purpose: In the dark the perceived egocentric distance of a selfilluminated target has been reported to be underestimated by a number of laboratories. This underestimation is of about the same magnitude whether perceived distance is measured using a verbal magnitude estimation task or a blind-walking motor task. We have investigated the effect of the room dimensions on the perceived egocentric distance and found this variable to be significantly affected by room length. Methods: Two groups of visually normal subjects were tested, all of whom had an eye exam within the past year. One group was tested in a room 3.8m wide and 8m long (n=20). The other group was tested in a room 11m wide and 9m long (n=15). Subjects clearly viewed the testing space prior to the testing session. After obtaining informed consent, subjects were instructed to monocularly observe the perceived distance and height of a small, self-illuminated, red target placed on the floor of an otherwise dark room. The target was randomly located at 4 distances between 1.5 and 7.5m. When ready subjects occluded their eye and blind-walked to the remembered target location. They indicated with the tip of their index finger the perceived target height. Results: A two-way analysis of variance (mixed design) was used to compare the perceived distances for the two testing spaces (IBM SPSS). The interaction effect of Distance*Room was significant (F=7.48, p<0.000). Independent t tests with Bonferroni correction indicated that perceived target distances varied significantly between testing spaces except at 1.5m. The best-fit power function exponents for the two spaces are listed below, along with those obtained from previously published data (width x length in m):1) Philbeck and Loomis (1997) 4.3x7.3; 0.54 2) Kelly (2014) 3.8x8; 0.67 3) Kelly (2014) 11x9; 0.89 4) Philbeck and Loomis (1997) 1.8x18; 0.89. Conclusions: 1. The perceived distance is significantly foreshortened when measured in a shorter room than in a longer testing space. 2. The perceived height of self-illuminated target is significantly higher in a shorter room than in a longer testing space. 3. The exponent for perceived distance is smaller the shorter the testing space, indicating spatial compression occurs more in short rooms. 4. There are a number of potential explanations for this effect which will be discussed. Commercial Relationships: Susan A. Kelly, None Program Number: 2925 Poster Board Number: D0024 Presentation Time: 8:30 AM–10:15 AM A Novel Testing Paradigm for Assessing Eye Movements during a Visual Task Timo Melman1, 2, Alberto Diniz-Filho1, 3, Erwin R. Boer1, 2, Ricardo Y. Abe1, 4, Carolina Gracitelli1, 5, Saif Baig1, Felipe A. Medeiros1. 1Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA; 2Department of Mechanical Engineering, Delft University of Technology, Delft, Netherlands; 3 Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil; 4Department of Ophthalmology, University of Campinas, Campinas, Brazil; 5 Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. Purpose: To evaluate a new test paradigm for saccadic and smooth pursuit eye movement performance during an attentional and visual performance-based task. Methods: Subjects underwent three tests to assess saccadic and smooth pursuit eye performance. In each test the subject performed 20 saccades. In each trial a square with 3 possible different levels of contrast was presented in the middle of a LCD screen. Saccadic eye movements were induced by new squares appearing randomly every 3-6 seconds around the initial square. Subjects were instructed to fixate the new target as quickly as possible. If a successful fixation was observed the square disappeared. In the first test one new target appeared each time. In the second test two targets of different sizes appeared and the subject was instructed to move the eyes towards the smaller target as quickly as possible. In the third test, two equal sized squares appeared, but one of the two squares was displayed with a 0.1 second delay. The eye movements were synchronized with the test dynamics during each performance test using the SMI Eye Tracking Glasses (SensoMotoric Instruments GmbH, Teltow, Germany). Free head movements were allowed in order to establish natural movements of the eye-head complex. The influence of different contrast levels on the latency of saccadic eye movement was assessed. Reaction time, maximum saccade velocity, number of initial direction errors, and settling time were used as metrics. Results: Five healthy subjects with mean age of 39.8 ± 18.4 years (range: 18 – 60 years) were included. There was a strong and positive correlation between mean reaction time and age (P = 0.002). The results also showed a significant negative correlation for age and number of initial direction errors (P = 0.050). Conclusions: These preliminary results showed an age-relateddegradation in saccadic reaction in response to a visual task and in number of initial direction errors in normal participants. An explanation could be that older subjects use a more top down method to perform the experiment, where younger people use the faster bottom up method instead. The proposed paradigm with free head movements may help integrate the study of eye movements and visual performance for evaluation of diseases such as glaucoma. Commercial Relationships: Timo Melman, None; Alberto Diniz-Filho, None; Erwin R. Boer, None; Ricardo Y. Abe, None; Carolina Gracitelli, None; Saif Baig, None; Felipe A. Medeiros, Alcon Inc (F), Alcon Inc (R), Allergan (F), Allergan (R), Bausch & Lomb (F), Carl Zeiss Meditec Inc (C), Carl Zeiss Meditec Inc (F), Carl Zeiss Meditec Inc (R), Heidelberg Engineering Inc (F), Merck Inc (F), National Eye Institute (F), Novartis (C), Reichert Inc (F), Reichert Inc (R), Sensimed (F), Topcon Inc (F) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 2926 Poster Board Number: D0025 Presentation Time: 8:30 AM–10:15 AM Action game training only modifies game-related visual search strategies Elham Azizi, Matthew Stainer, Larry A. Abel. Optometry and Vision Scineces, University of Melbourne, Melbourne, VIC, Australia. Purpose: Action video game playing has been shown to modify several parameters of cognitive processing. One key question is how changes that are often measured with abstracted paradigms relate to visual behavior outside the laboratory. We investigated the effect of action game training on visual search in abstract, naturalistic (counting the number of people in city street photos) and gamerelated search tasks, to examine how changes extend beyond gamerelevant tasks. Methods: 40 non-gamers (20 female, 17-35 years old) were trained for 10 hours on an action game (first person shooter) or a computerbased card game (control group). Eye movements were recorded pre- and post-training in 5 different visual search tasks: conjunctive search for a singleton, counting people in city photos, counting soldiers in action game photos and finding a gabor patch embedded in the city and action game photos. Repeated measures ANOVAs were conducted for each task with the game type (action or card) as between and session (pre or post) as within-group independent variables, and saccade amplitude, fixation duration, distribution of fixations and search time as dependent variables. Results: There was no main effect of session, game type and no interaction for saccade amplitude or fixation duration in any of the tasks; however, there was a main effect of game type (F1, 73 = 4.86, p=0.046) in the vertical distribution of fixations, but only in the soldier counting task. Action gamers showed a significant reduction in their vertical distribution of fixations after training, but there was no main effect of session (p=0.16) and no interaction (p=0.1). Repeated measures ANOVA on search time showed a significant main effect of session (F1, 74 =4.43, p=0.03) and game type (F1, = 6.152, p=0.01) of finding the gabor in game and city photos 74 respectively. Conclusions: After 10 hours of action gaming, participants learned to search game images differently, with the vertical distribution of fixations approaching that in the natural scenes. However, there was no effect of training on searching the naturalistic scenes. Faster detection of gabor patches in game and city scenes can be attributed to a test-retest effect rather than training effect, as it happened in both groups. A crucial direction for future research is to better understand how skills enhanced in gaming can also be improved in natural settings. Commercial Relationships: Elham Azizi, None; Matthew Stainer, None; Larry A. Abel, None Program Number: 2927 Poster Board Number: D0026 Presentation Time: 8:30 AM–10:15 AM Validation of the King-Devick Test Using 500-Hz Binocular Infrared Oculography M Ali Shariati1, Ming-Hui Sun2, 1, Yaping J. Liao1. 1Ophthalmology, Stanford School of Medicine, Palo Alto, CA; 2Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan. Purpose: Eye movement abnormalities are common in different neuro-ophthalmic conditions. Many eye movement measures use saccades and smooth pursuit tasks are used as markers of head trauma, and the King-Devick Test has been well used in studying head trauma in football, hockey, and other sports. In this study, we used 500-Hz infrared eye tracker to validate the hand-held KingDevick Test. Methods: We performed the hand-held or computer King-Devick test using 500-Hz binocular 2D infrared oculography and used time to perform each tests (1-3) as outcome measure. For eye movement study, we analysed the fixations, saccades, and blinks. Results: In normal individuals, mean duration of the King-Devick Test was shorter using the hand-held test (test-1: 13.5±6.5 s; test-2: 12.9±4.1 s; test-3: 13.3±6.7 s; N=9) than the computer test (test1: 15.9±0.8, P=0.04; test-2: 15.7±0.6 P=0.001; test-3: 16.5±0.7, P=0.008; N=10). In normals, there was no significant difference in the time from test-1 to test-3 (P=0.5-0.9), although test-1 was the easiest test (guiding lines, generous spacing) and the test-3 was the hardest test (no guiding lines, smallest spacing). Although each test only had 40 fixation targets (5 numbers per line, 8 lines total), eye tracking revealed that each subject made 104±5.9 (range 62-132) fixations, which is more than twice the number needed. The number of saccades was 161±38 (range 97-466), which is on average more than twice more fixations. The average saccade amplitudes were test-1: 4.8±0.1, test-2: 4.9±0.3, test-3 5.0±0.4 deg), with saccade latencies of test-1: 194.0±24.8 ms, test-2: 197.5±28.1 ms, test-3: 213.6±21.0 and average saccade velocities test-1: 98.7± deg/s, test-2: 99.6±6.6, test-3: 104.8±5.0. The subjects that took the longest time to perform the task had the most number of saccades, likely because of backtracking. Conclusions: We used 500-Hz binocular 2D infrared oculography to analyze eye movement behaviour during the King-Devick Test. Although there were 40 fixation targets per test, all subjects made at least twice as many fixation attempts. Shorter test time correlated with fewer saccades, blinks, and higher saccade amplitudes. The King-Devick saccade-based task is a useful test to assess eye movement abnormality in head trauma and various neuro-ophthalmic conditions, in order to assess why different subject populations perform differently. Commercial Relationships: M Ali Shariati, None; Ming-Hui Sun, None; Yaping J. Liao, None Support: Burroughs Wellcome Foundation Program Number: 2928 Poster Board Number: D0027 Presentation Time: 8:30 AM–10:15 AM Motion Sharpening of Looming Vertical Bars Shannon Moore, Glen L. McCormack. Vision Science, New England College of Optometry, Boston, MA. Purpose: Our lab previously showed, at ARVO ‘14, that nonfixated blurred vertical bars moving in stereoscopic depth appear sharper than when stationary. This sharpening exceeded that of conjugate lateral motion having the same retinal image velocities. The purpose of this study was to determine whether nonfixated blurred vertical bars appearing to loom within a monocular optical flow field would also be sharpened more than bars appearing to move laterally. Methods: 15 normally binocular young adults monocularly viewed four 30 minarc-wide vertical bars drawn on a monitor 40cm from the eyes. All bars appeared simultaneously for 0.5 sec about a 5 minarc white fixation spot. Two of the bars (above or below fixation) loomed toward (or away) from the subject with horizontal velocities of 1.75, 3.5, or 7∆/sec, while the other two bars were static. The edges of the bars were blurred by cosine luminance profiles, which were fixed at 25 minarc for the moving bars and adjusted by an adaptive staircase procedure for the static bars to match the blur of the moving bars. Looming bars underwent horizontal separation, vertical size change, and vertical position change commensurate with looming. In the horizontal motion control condition the two moving bars laterally separated from each other, without vertical size or position change. In the vertical motion control condition the moving bars grew and ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology moved vertically in a manner commensurate with looming, but without a horizontal position change. Results: A mixed ANOVA evaluated the effects of motion type (looming, horizontal, or vertical), subject, and velocity (1.75, 3.5, or 7) on sharpening. Motion sharpening increased significantly with velocity (f=156, p≈0.0), and differed significantly between subjects (f=4.56, p≈0), like we found previously. At the highest velocity, the looming bar edges were subjectively sharpened by 13% of their base blur of 25 minarc. Motion sharpening differed between motion types (f=20.7, p≈0), but this difference was mostly between the vertical condition and the other two conditions. Sharpening during looming was only 3% greater than during lateral motion (insignificant). Conclusions: While motion sharpening was clearly evident in the looming and lateral motion conditions, the trivial difference between them argues that the appearance of motion in depth by way of looming does not add to motion sharpening. Commercial Relationships: Shannon Moore, None; Glen L. McCormack, None Program Number: 2929 Poster Board Number: D0028 Presentation Time: 8:30 AM–10:15 AM Induced Audio/Visual Cortical Remapping via Looming Stimulus Mark H. Myers1, Daniel Albarran1, Ally Dobbins1, Charlotte Joure1, Aaron Canales2, Gavin Bidelman3. 1Ophthalmology, University of Tennessee Health Science Center, Memphis, TN; 2Psychology, University of Memphis, Memphis, TN; 3School of Communication Sciences & Disorders, University of Memphis, Memphis, TN. Purpose: Induced audio/visual integration in non-synesthetes will demonstrate similar intraparietal (IPL) behavior which has been found to elicit signature neural activity found in as individuals who have the condition known as synesthesia. The parietal activations might reflect involvement of a “multisensory nexus” that, via disinhibition, lead to synesthetic experiences. Measurement of audio/ visual integration will be accomplished via electroencephalography (EEG) signal neuro-markers. Methods: Our studies demonstrate Audio/Visual (AV) integration through the application of looming audio and visual stimuli on nonsynesthetes. Participants were subjected to a combination of looming, receding or static audio and visual stimuli during EEG recordings. AV stimuli were presented as audio-looming (AL), visual looming (VL), or audio-looming/visual looming (ALVL). Audio looms start at a low intensity and quickly increase by ~10 dB over 1000 ms (AL), while images would start small and quickly enlarge into the visual area (VL), or stimuli may occur simultaneously as ALVL. Individuals were required to rapidly judge whether stimuli was looming or receding. Behavioral responses to AV stimuli were programmatically coupled to EEG recordings so that stimuli could be later associated to cortical responses. Results: Distributed current source density analysis using low resolution electromagnetic tomography (LORETA) is applied to the EEGs of n=4 subjects. Auditory looming (AL) stimuli containing only auditory cues primarily recruit cortical areas associated with auditory sensory encoding including Heschl’s Gyrus (HG) in the superior temporal plane. Similarly, visual-only looms activate primary visual centers situated in lateral occipital (LO) cortex. In contrast, looming stimuli combining both auditory and visual cues (ALVL) engage multimodal area in intraparietal (IPL) cortex. These preliminary findings indicate that our novel stimulus paradigm induces cross-modal “hyperbinding” and the integration of AV neural activity patterns as observed in actual synesthetes. Conclusions: These preliminary findings demonstrate feasibility of the proposed stimulus paradigm and perceptual and neurophysiological correlates of cross-modal “hyperbinding”. Commercial Relationships: Mark H. Myers, None; Daniel Albarran, None; Ally Dobbins, None; Charlotte Joure, None; Aaron Canales, None; Gavin Bidelman, None 334 Amblyopia Tuesday, May 05, 2015 11:00 AM–12:45 PM 4CD Mile High Blrm Paper Session Program #/Board # Range: 3190–3196 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 3190 Presentation Time: 11:00 AM–11:15 AM Increased ‘noise’ in V2 neurons of amblyopic monkeys Bin Zhang1, 2, Xiaofeng Tao2, Janice M. Wensveen2, Earl L. Smith2, Yuzo M. Chino2. 1College of Optometry, Nova Southeastern University, Plantation, FL; 2University of Houston, College of Optometry, Houston, TX. Purpose: Experiencing early strabismus or chronic monocular defocus due to anisometropia often causes amblyopia unless treated early. Besides reduced acuity and contrast sensitivity, a broad range of more complex spatial and temporal vision deficits have been reported in amblyopes. Increased neural noise in their visual brain has been proposed as one of the sources for reduced visual functions (Levi, 2013). Here we investigated the possible origin of increased internal noise in non-human primates with anisometropic amblyopia. Methods: We recorded from multiple nearby neurons in Visual Area V2 of adult monkeys reared with monocular defocus between 3 weeks and 3 months of age and developed moderate ansiometropic amblyopia. Stimuli were drifting gratings (3.1 Hz) that were optimized for orientation, spatial frequency, and size for each neuron and were presented at low (25%) and high (80%) contrast for 100 times. For individual neurons, the variance of inter-spike intervals and variance to mean ratio (VMR) of spike counts were calculated. For multiple neurons recorded at the same site, noise correlation was computed. Results: 1) There was no difference in variance of inter-spike interval among neurons driven by the amblyopic eye, those driven by the fellow eye, and normal V2 neurons. 2) With low contrast stimuli, the VMR (trial-to-trial fluctuation) was significantly elevated in V2 neurons driven by both the amblyopic and fellow eyes compared to that in normal monkeys. With high contrast gratings, there was no difference. 3) Noise correlation in amblyopic monkeys was significantly higher than that in normal monkeys at both low and high contrasts. Conclusions: Our results suggest that the more variable (noisy) responses of individual neurons and the elevated noise correlation in V2 of amblyopic monkeys, combined with abnormal response dynamics and disorganized subfield structures of V2 neurons, may affect signal processing down stream, which in turn may limit their visual performance. Commercial Relationships: Bin Zhang, None; Xiaofeng Tao, None; Janice M. Wensveen, None; Earl L. Smith, None; Yuzo M. Chino, None Support: EY-008128, EY-003611, P30 EY-007551 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 3191 Presentation Time: 11:15 AM–11:30 AM Binocular combination in children with deprivation amblyopia Lisa M. Hamm1, Zidong Chen2, Joanna Black1, Jinrong Li2, Shuan Dai3, 4, Minbin Yu2, Benjamin Thompson1, 5. 1Optometry and Vision Science, University of Auckland, Auckland, New Zealand; 2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; 3Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand; 4 Ophthalmology, University of Auckland, Auckland, New Zealand; 5 Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada. Purpose: Binocular combination is possible in many patients with strabismic, anisometropic or mixed amblyopia when contrast is appropriately balanced between the eyes. We tested the hypothesis that children with deprivation amblyopia, due to a history of early childhood cataract, are also capable of binocular combination. Methods: Thirty-six children (mean age 9±2years) with a history of early bilateral cataract (n=9), early unilateral cataract (n=8), anisometropic amblyopia (n=9) or normal vision (n=10) were recruited. Binocular combination was assessed using an established dichoptic global motion paradigm, whereby high contrast signal elements are presented to the amblyopic or non-dominant eye and noise elements are shown to the fellow or dominant eye with varied contrast. A measurable motion coherence threshold indicates binocular combination of the signal and noise elements. Results: Binocular combination could be measured for 7 of 9 bilateral deprivation cases, 5 of 8 unilateral deprivation cases, and all participants with anisometropic amblyopia or normal vision. Children with bilateral or unilateral deprivation amblyopia required significantly larger interocular contrast differences for binocular combination than children with anisometropic amblyopia or normal vision (p < 0.05). Conclusions: It was possible for the majority of children with deprivation amblyopia to combine information from both eyes when contrast was appropriately balanced, although large interocular contrast differences were required. This suggests that treatments targeting binocular function may be effective in some cases of deprivation amblyopia. Commercial Relationships: Lisa M. Hamm, None; Zidong Chen, None; Joanna Black, None; Jinrong Li, None; Shuan Dai, None; Minbin Yu, None; Benjamin Thompson, US12528934 (P), US8006372 B2 (P) Support: Neurological Foundation Small Project Grant Program Number: 3192 Presentation Time: 11:30 AM–11:45 AM Disparity vergence in infantile esotropia reveals a congenital deficit for disparity sensitivity Krista R. Kelly1, Joost Felius2, 3, Santoshi Ramachandran2, Blesson John2, Reed M. Jost1, Eileen E. Birch1, 3. 1Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, TX; 2Laboratory for Visual Disorders and Eye Movements, Retina Foundation of the Southwest, Dallas, TX; 3 Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX. Purpose: Impaired disparity sensitivity (e.g., decreased stereoacuity) in children with infantile esotropia (ET) is thought to be a result of prolonged abnormal visual experience during an early critical period of visuomotor maturation. Even with early treatment, a stereodeficit persists in children with infantile ET. Thus, it is unclear whether the stereodeficit is entirely a consequence of abnormal visual experience or whether, at least in part, the deficit is congenital. Here, we sought to answer this question by examining disparity vergence in nonamblyopic, orthotropic children with infantile ET who experienced a short or long duration of constant misalignment. Methods: We tested three age-matched groups of children (7.8±2.8 y); 15 controls with a history of normal visual development, 10 infantile ET with a short duration (≤3 months) of constant misalignment, and 8 infantile ET with a long duration (>3 months) of constant misalignment. Disparity vergence was recorded using a 500 Hz remote-video binocular eye tracker (EyeLink 1000; SR Research) following binocular calibration. The child initially fixated on an LED located on midline at 80 cm, which was extinguished and replaced by an LED on midline at 30 cm, requiring a vergence response. A total of 10 vergence responses were recorded and at least 3 artifact-free responses were required for analyses. Mean response gain (vergence angle/vergence demand) was calculated. Results: Compared with controls, short and long duration of infantile ET resulted in a 22% and 54% decrease in disparity vergence gain, respectively (p ≤ 0.009). Even those with 0 months duration of constant misalignment (i.e., infantile accommodative intermittent ET) exhibited a 20% decrease in vergence (p = 0.012) compared with controls. Further, long duration of infantile ET resulted in a decrease of 41% compared with short duration (p = 0.037). While 14/15 controls showed smooth disparity vergence, 5/10 short duration ET and 7/8 long duration ET children exhibited pure saccades, a combination of saccades and vergence, or vergence combined with saccadic oscillations or nystagmus. Conclusions: Impaired disparity vergence following zero and short duration of constant misalignment indicates that a congenital deficit in disparity sensitivity is present in children with infantile ET, which can be exacerbated by prolonged abnormal binocular visual experience. Commercial Relationships: Krista R. Kelly, None; Joost Felius, None; Santoshi Ramachandran, None; Blesson John, None; Reed M. Jost, None; Eileen E. Birch, None Support: National Eye Institute EY022313 Program Number: 3193 Presentation Time: 11:45 AM–12:00 PM Disconjugacy of eye alignment is greater with near fixation during binocular viewing in amblyopia Howard S. Ying, Vivian Xu, Robert B. Geary, Boris I. Gramatikov, David L. Guyton, Kristina Irsch. Ophthalmology, Johns Hopkins University, Baltimore, MD. Purpose: To determine whether ocular disconjugacy in amblyopic subjects is dependent on viewing condition. Methods: Binocular eye movements were recorded at 500 Hz using the EyeLink 1000 eye tracker (SR Research Ltd., Ontario, Canada). Twenty subjects (nine normal and eleven amblyopic; age: 8-45 years) were asked to fixate on a blue cross subtending 0.5° at a near distance of 57 cm or at a far distance of 4 m for 20-second epochs of binocular or monocular viewing. Disconjugacy of eye alignment was estimated by 1) the area of the 68% bivariate contour ellipse (BCEA) for the difference between right and left eye positions, 2) the percentage of fixation time within a 0.1°x 0.1° range, and 3) microsaccade characteristics. Mean ± standard error of the mean were calculate, log(BCEA) was used to normalize the distributions, and significance testing was performed with the Student’s t-test. Results: Normal subjects during binocular viewing showed a 68% BCEA of 0.75 deg2 ± 0.09 deg2 with near fixation and 0.81 deg2 ± 0.14 deg2 with far fixation (P=0.69) while subjects with amblyopia during binocular viewing showed a 68% BCEA of 5.60 deg2 ± 0.78 deg2 with near fixation and 3.08 deg2 ± 0.31 deg2 with far fixation (P=0.01). Mean percentage of conjugate fixation time for normal subjects ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology was 99.5% ± 0.3% for near fixation and 99.6% ± 0.1 for far fixation (P=0.66), and for amblyopic subjects was 98.4% ± 0.2% for near fixation and 99.2% ± 0.1% for far fixation (P=0.02). Disconjugacy was associated with more microsaccades and more square wave jerks. Monocular viewing trials showed more disconjugacy than binocular trials for normal subjects but not for amblyopic subjects. Conclusions: Disconjugacy increases with near fixation for amblyopic subjects during binocular viewing due to increased slow drift and microsaccades. Further research is required to determine which metrics have greater diagnostic utility in amblyopia. Commercial Relationships: Howard S. Ying, Johns Hopkins University (P); Vivian Xu, None; Robert B. Geary, Johns Hopkins University (P); Boris I. Gramatikov, Johns Hopkins University (P); David L. Guyton, Johns Hopkins University (P); Kristina Irsch, Johns Hopkins University (P) Support: NIH Grant EY 19347, Research to Prevent Blindness Disney Award, William Cross Foundation Program Number: 3194 Presentation Time: 12:00 PM–12:15 PM Fixational Eye Movements in Amblyopia: The Effect of Reduced Visual Feedback Joost Felius1, 2, Santoshi Ramachandran1, Reed M. Jost1, Krista R. Kelly1, Eileen E. Birch1, 2, Angie De La Cruz1, Blesson John1. 1 Retina Foundation of the Southwest, Dallas, TX; 2Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX. Purpose: In attempts to better understand the effects of visual feedback on fixation stability in amblyopes, previous studies have included an ‘open loop’ test condition, in which the eye movements of the non-viewing (covered) eye were assessed. But interpretation of the results has been hampered by the incomplete knowledge of the link between eye movements of the two eyes. Here we study fixation stability in a ‘pseudo-open loop’ condition with reduced visual feedback to the viewing eye(s). Methods: Seventeen children with amblyopia (age 5-15 years; visual acuity 0.2-1.2 logMAR) and 10 age-similar normal controls participated. Fixational eye movements were recorded at 500 Hz under monocular (amblyopic eye) and binocular viewing conditions using two fixation targets: a small 0.3°-diameter dot and a 2-dimensional Gaussian profile (σ=1.25°), the latter appearing as a blurred disk providing only minimal visual feedback. Fixation stability was studied in terms of the bivariate contour ellipse area (BCEA) and the mean amplitude and rate of microsaccades. Results: In controls, fixation stability was best when binocularly viewing the dot (BCEA, -0.52±0.71 log deg2) and poorest when monocularly viewing the Gaussian profile (+0.60±1.09 log deg2). Similarly, in the amblyopic children, fixation stability was best when binocularly viewing the dot (BCEA, -0.17±0.53 log deg2) and poorest when viewing the Gaussian profile with only the amblyopic eye (+0.44±0.47 log deg2). However, the deterioration of fixation stability under reduced visual feedback was smallest in the amblyopes when viewing with the amblyopic eye. Group differences in BCEA were larger when viewing the dot than when viewing the Gaussian profile (2-way ANOVA, P<0.03). For both controls and amblyopes, the deterioration of fixation stability under reduced visual feedback was associated with increases in amplitude but not rate of microsaccades (P<0.016). Conclusions: Amblyopes showed a smaller-than-normal decrease in fixation stability when visual feedback was reduced in the ‘pseudoopen loop’ condition, consistent with a weakened input of visual feedback into the fixation control mechanism. This effect may hold promise as an objective ocular motor measure for the detection of amblyopia. Commercial Relationships: Joost Felius, None; Santoshi Ramachandran, None; Reed M. Jost, None; Krista R. Kelly, None; Eileen E. Birch, None; Angie De La Cruz, None; Blesson John, None Support: Orix Foundation; NIH EY022313 Program Number: 3195 Presentation Time: 12:15 PM–12:30 PM Dichoptic Movie Treatment of Childhood Amblyopia Simone L. Li1, Alexandre Reynaud2, Robert F. Hess2, Yi-Zhong Wang1, 3, Reed M. Jost1, Sarah E. Morale1, Angie De La Cruz1, Lori Dao4, David Stager4, Eileen E. Birch1, 3. 1Retina Foundation of the Southwest, Dallas, TX; 2Ophthalmology, McGill University, Montréal, QC, Canada; 3Ophthalmology, UT Southwestern Medical Center, Dallas, TX; 4Pediatric Ophthalmology & Adult Strabismus, Plano, TX. Purpose: Contrast-balanced dichoptic experience with perceptuallearning tasks, games, or both has been shown to improve visual acuity in amblyopia. We previously demonstrated that repeated binocular experience via at-home binocular iPad game play with reduced fellow-eye contrast was effective in treating childhood amblyopia1,2 and that visual acuity was maintained for ≥12 months3. However, these tasks are intensive and repetitive and up to 40% of patients are noncompliant.1,2,4 Here we investigated the efficacy of a potentially more engaging movie method to provide contrastbalanced binocular experience via complementary dichoptic stimulation. Methods: Seven amblyopic children (4-10y; 0.5-1.2 logMAR or 20/63-20/320) were enrolled in a prospective cohort study to watch 3 dichoptic movies per week for 2 weeks on a passive 3D display. Dichoptic versions of 18 popular animated feature films were created. A patterned image mask of irregularly shaped blobs was multiplied with the movie images seen by the amblyopic eye and an inverse pattern mask was multiplied with the images seen by the fellow eye. Fellow-eye contrast was initially set for each amblyopic child at a reduced level that allowed binocular vision and was incremented by 10% at each visit. At the baseline and 2-week outcome visits, BCVA, random dot stereoacuity, interocular suppression, and fixation stability were measured. None of the children had any concurrent amblyopia treatment during this study. Results: After watching 6 dichoptic movies during a two-week period (9.3±0.8 hours), mean (±SE) amblyopic eye BCVA improved from 0.71±0.10 logMAR at baseline to 0.54±0.10 logMAR (p= 0.006); i.e. 1.7 lines. Three children with 0.5 logMAR baseline BCVA improved 0.1 logMAR (1 line); three children with 0.7-0.8 logMAR baseline BCVA improved 0.2-0.4 logMAR (2-4 lines), and one child with 1.2 logMAR baseline BCVA improved 0.1 logMAR (1 line). Fellow-eye BCVA did not change significantly during the study (p=0.19). No significant change in random dot stereoacuity, interocular suppression, or fixation stability was found. Conclusions: Repeated contrast-balanced binocular visual experience significantly improved amblyopic-eye visual acuity. Contrastbalanced dichoptic feature films may result in better compliance than repetitive perceptual-learning tasks or games. 1. Li et al Eye 2014; 28:1246-53. 2. Birch et al J AAPOS in press. 3. Li et al JAMA Ophthal in press. 4. Levi et al JOV 2014; 14:959 Commercial Relationships: Simone L. Li, None; Alexandre Reynaud, McGill University (P); Robert F. Hess, McGill University (P); Yi-Zhong Wang, None; Reed M. Jost, None; Sarah E. Morale, ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology None; Angie De La Cruz, None; Lori Dao, None; David Stager, None; Eileen E. Birch, None Support: NEI Grant EY022313 Program Number: 3196 Presentation Time: 12:30 PM–12:45 PM Evaluation of a Novel Digital Infant Acuity Test Laura A. Butler1, Esther Misanjo2, Duncan Middleton3, Iain Livingstone4, Petros Kayange2. 1Care of the Elderly, NHS Lothian, Edinburgh, United Kingdom; 2Ophthalmology, Queen Elizabeth Central Hospital, Blantyre, Malawi; 3Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; 4Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom. Purpose: The testing of infant acuity is vital in treatment and prevention of amblyopia. Current card-based clinical standards encounter a number of problems including expense, wear and tear issues, portability and child engagement; digital devices provide the potential to resolve many of these limitations but have not yet been validated. The purpose of this study was to assess the validity of a novel digital tablet-based touchscreen high-frequency grating acuity test in Blantyre, Malawi. Methods: Children aged 6 to 60 months who presented to the Eye Unit were eligible. Acuity was measured using “gold standard” Keeler cards and the Peekaboo digital test (see Figure 1) for right, left, and both eyes. Following a minimum interval of 20 minutes, patients were re-tested by the same assessor. In addition to age and LogMAR acuity, child engagement was recorded using a compliance score (CS) of 0-2 (0 = no engagement, 2 = perfect compliance). Statistical methods described by Bland and Altman were used to compare the two modalities. Results: A total of 58 patients were recruited with mean age of 33 months. The average difference in acuity between modalities was -0.1 (95% lower and upper LoA -0.69, +0.49 respectively). Subset analysis of children with CS of 2 for all tests (see Figure 2) revealed a difference of +0.02 (95 % LoA of -0.33 and +0.36 respectively). CS averaged 1.5 for the digital test, compared to 1.3 with Keeler (p<0.001). On test-retest analysis, the digital test showed an average difference of +0.007 (95% LoA -0.385 to 0.370) between first and second tests compared to Keeler which demonstrated a difference of -0.04 (95% LoA -0.683 to 0.674). The digital test demonstrated 95% repeatability coefficient of 0.29, compared with 0.38 for Keeler. Conclusions: The present study demonstrates good levels of agreement between digital and card-based methods, with 95% LoA within appropriate limits for the young test population. The digital test outperformed Keeler in terms of child engagement and reliability. Digital high-frequency grating acuity testing represents a promising advance for assessing vision in the very young. Additionally, due to it’s lower cost compared to current modalities, it has the potential for use in low to middle income countires, such as Malawi. Figure 1A. Keeler Acuity Test (Keeler ltd). 1B. Peekaboo Digital Acuity test on iPad 3 (Apple inc). Bland Altman plot for Keeler vs Digital - subset of children with CS of 2 for all tests Commercial Relationships: Laura A. Butler, None; Esther Misanjo, None; Duncan Middleton, None; Iain Livingstone, None; Petros Kayange, None Support: Funding from Fiona’s Eye Fund - registered UK charity ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 381 Leber’s Hereditary Optic Neuropathy / Clinical testing Tuesday, May 05, 2015 3:45 PM–5:30 PM Exhibit Hall Poster Session Program #/Board # Range: 3856–3886/C0261–C0291 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Biochemistry/Molecular Biology, Multidisciplinary Ophthalmic Imaging, Retina, Visual Psychophysics/ Physiological Optics Program Number: 3856 Poster Board Number: C0261 Presentation Time: 3:45 PM–5:30 PM Clinically-Significant Cardiac Pathology in Leber’s Hereditary Optic Neuropathy Starleen E. Frousiakis6, Rustum Karanjia2, Jeffrey S. Tran1, Andrew E. Pouw1, Chiara La Morgia4, Milton Moraes3, Solange R. Salomao5, Peter Quiros2, Valerio Carelli4, Alfredo A. Sadun2. 1 Ophthalmology, University of Southern California, Woodland Hills, CA; 2Ophthalmology, UCLA, Los Angeles, CA; 3Instituto de Olhos de Colatina, Colatina, Brazil; 4Department of Ophthalmology, University of Bologna, Bologna, Italy; 5Federal University of Sao Paulo, Sao Paulo, Brazil; 6Ophthalmology, Univeristy of Southern California, Los Angeles, CA. Purpose: To determine the association of clinically-significant cardiac pathology with status as a carrier or affected subject, and to compare previous findings on cardiac conduction in affected patients with Leber’s hereditary optic neuropathy (LHON), 11778 mutation, to a distinct pedigree. Methods: Cardiac pathology was defined by past history of stroke, myocardial infarction, angina, and/or palpitations. Subjects were compared based on LHON status: control, carrier, or affected. A logistic regression model was constructed, controlling for age and body mass index (BMI). Data from a previously published cohort of affected Brazilian patients (n1=23) and newly-acquired values from a distinct Italian cohort (n2=21) were compared to a database of healthy controls (n2=87). Each population underwent ECG testing, performed by a cardiologist, with measurement of PR interval and QTc duration. An unpaired student’s t-test was performed to determine if there was a difference between affected populations and controls. Results: The final regression model indicates that LHON status is not correlated with an increased prevalence of cardiac pathology in the sample population. Age is a significant predictor, but interaction between age and status did not yield a significant difference between groups. BMI was not found to be a significant predictor of cardiac pathology. Mean PR intervals and standard deviations in the Italian pedigree, Brazilian pedigree and control population were 140.6±20.6, 127.2±26.1 and 136.9±9.1, respectively. There was no significant difference detected in mean PR interval between the Italian pedigree and healthy controls, thereby validating the previously-published findings in the Brazilian population. However, this study similarly demonstrated a subgroup of patients within the Italian pedigree who had a shortened PR interval (n=2). There was no significant difference in QTc duration between affected and control populations in either pedigree. Conclusions: Carrier and affected populations of LHON do not demonstrate increased prevalence of clinically-significant cardiac pathology. This study validated the previously published findings of a non-significant difference in PR interval and QTc duration in affected patients with LHON and controls. A subgroup of subjects with shortened cardiac conduction may be indicative of patients at increased risk for conduction defects. Commercial Relationships: Starleen E. Frousiakis, None; Rustum Karanjia, None; Jeffrey S. Tran, None; Andrew E. Pouw, None; Chiara La Morgia, None; Milton Moraes, None; Solange R. Salomao, None; Peter Quiros, None; Valerio Carelli, None; Alfredo A. Sadun, None Program Number: 3857 Poster Board Number: C0262 Presentation Time: 3:45 PM–5:30 PM Phenotypic Variability in a Pedigree with Leber Hereditary Optic Neuropathy (LHON) Sherry J. Bass1, Daniel Epshtein1, Sanjeev Nath2, Jerome Sherman1, 2 1 . Clinical Sciences, SUNY College of Optometry, New York, NY; 2 The Eye Institute, New York, NY. Purpose: To report typical and atypical serial findings in three members of a LHON pedigree with an mt3460 mutation Methods: Three siblings born of a mother with acute onset LHON at age 20, an mt3460 genotype and 20/1000 VA were examined and followed over a 5 year period. The 300-year pedigree was noted for a history of profound vision loss, surprisingly preferential to females. The youngest sibling studied was a 7 year-old male with an initial best-corrected visual acuity (BCVA) of 20/20 OD and 20/25 OS. The second sibling studied was a 14 year-old female with BCVA 20/20 OD/OS. The third sibling was a 16 year-old male with BCVA 20/20 OD/OS. In addition to visual acuity, testing included fundus examination with fundus photography, OCT of the retinal nerve fiber layer (RNFL) and ganglion cell analysis (GCA). Results: The 7 year-old male had an atypical finding of pale discs OU. RNFL Analysis (Zeiss Cirrus) revealed RNFL loss superiorly, temporally, and inferiorly in both eyes. GCA revealed a profound loss of ganglion cells in the macula. Examination of the 14 year-old female revealed a hyperemic disc with peripapillary telangiectatic microangiopathy. The RNFL was thickened nasally in both eyes. GCA was statistically normal. Examination of the 16 year-old brother revealed mild peripapillary telangiectatic microangiopathy in both eyes. The right eye’s RNFL was normal but superior temporal thinning was seen in the left eye. Diffuse GCA thinning was seen in both eyes with denser loss inferiorly OD and temporally OS. Examination at 5 year follow-up revealed no change in any of the above findings in any of the two siblings with peripapillary telangiectatic microangiopathy. However, in the youngest sibling with pale discs, there was a one line reduction in visual acuity in both eyes but no additional changes in the examination findings. Conclusions: The rare presentation of early onset progressive LHON has only been reported in mt17778 pedigrees. This pedigree, with a mutation in the mt3460 locus, presents with characteristic findings of both typical LHON and rare atypical early-onset progressive LHON. Fundus photography, GCA, and RNFL analysis reveal varying stages of optic nerve appearance and optic neuropathy. This pedigree also reveals the existence of atypical early onset progressive LHON with good vision and an mt3460 mutation previously (to the authors’ best knowledge) unreported in the world’s literature. Commercial Relationships: Sherry J. Bass, None; Daniel Epshtein, None; Sanjeev Nath, None; Jerome Sherman, None Program Number: 3858 Poster Board Number: C0263 Presentation Time: 3:45 PM–5:30 PM Leber’s hereditary Optic Neuropathy: cellular pathophysiology, potential animal model, and cell-based drug screens for potential therapeutics Gino Cortopassi, Alfred K. Yu, Lanying Song, Karl Murray. Molecular Biosciences, University of California, Davis, Davis, CA. Purpose: Leber’s hereditary Optic Neuropathy (LHON) is an inherited mitochondrial disease, resulting from mutations in mitochondrial complex 1, which cause degeneration of retinal ganglion cells, for which there is no cure. We analyzed ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology pathomechanism in LHON cells, implicating the mitochondrial complex I defect, and ATF4 and CHOP and inflammatory markers. We show the ndufs4 complex 1 knockout mouse has significant depletion of RGC function, and RGC loss, coincident with a strong rise in multiple inflammatory markers. We have designed and improved cell-based screening assays of 6 mitochondrial functions in cybrids bearing the LHON mutation, and screened through 1600 FDA-approved drugs to identify those which rescue LHON-specific defects. The studies of pathomechanism support a model of LHON in which primary mutations drive complex I structural changes that cause an inflammatory response and RGC functional loss and death, and the drug screening studies identify potential therapeutics. Methods: Microarrays were carried out as published previously. RNASeq and MicroElectrode Array (MEA) analysis of retinas of Ndufs4 KO and wild type controls were carried out using standard procedures. Results: Cell-based pathomechanism. Results include the mitochondrial complex-1 dependent induction of ATF4 and CHOP and potential inflammatory markers. LHON animal model. The ndufs4 KO mouse has loss of RGC function and RGC cell death as in human LHON, and a substantial induction of inflammatory markers in the retina, coincident with RGC functional loss by MEA. Drug based screening. Partial poisoning of complex I uncovers a LHON mutation-specific defect in complex I-driven ATP synthesis that can be screened for drugs that protect from this defect. Such drugs fall in particular structural and functional categories. Drug secondaries and mechanistic understanding. Secondary screening is in progress for hit confirmation, and mechanism of protective effect is being generated for particular hits. Testing in animal model of LHON. Top hits are entering animal testing, and preliminary results are likely to be available by the meeting time. Conclusions: We have identified a mechanism of LHON, an animal model of LHON, and are screening therapeutics of potential benefit in LHON cells. Commercial Relationships: Gino Cortopassi, None; Alfred K. Yu, None; Lanying Song, None; Karl Murray, None Support: R01 EY012245 Program Number: 3859 Poster Board Number: C0264 Presentation Time: 3:45 PM–5:30 PM Evaluation of visual field metrics in patients with central scotomas from LHON Alexander F. Chen1, Amitha Ganti1, Youning Zhang1, Tiffany Hwang1, Adriana Berezovsky2, Milton Moraes2, 3, Jeffrey S. Tran1, Tana Wagschal5, Rustum Karanjia4, Alfredo A. Sadun4. 1 Ophthalmology, University of Southern California, Los Angeles, CA; 2Ophthalmology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; 3Centro Universitario do Espirito Santo, Colatina, Brazil; 4 Doheny Eye Institute, Pasadena, CA; 5Visual Field Reading Center, University of Iowa, Coralville, IA. Purpose: Patients with large and dense central scotomas may be unable to reliably complete Stimulus size III (Stim III) Humphrey Visual Fields (HVF). These patients, however, do considerably better with Stimulus size V (Stim V) HVF. In Leber’s Hereditary Optic Neuropathy (LHON) the reliability of the HVF varies over the course of the disease. The purpose of this study was to determine if Stim III and Stim V mean deviation (MD) calculations are equivalent in patients with central scotomas from LHON. Methods: 10 patients with LHON were administered Stim III and Stim V HVF tests on the same day during multiple patient visits. Stim III MD values were obtained from the HVF algorithm. In addition, separate Stim III and Stim V MD values were obtained from an investigative algorithm (IA). This IA, developed by the University of Iowa Visual Field Reading Center, was used to derive patients’ MD from Stim III and Stim V HVF raw numerical data. The MD values from the HVF and IA were compared using a Pearson’s productmoment correlation coefficient. Results: A total of 72 observations, 10 patients and 18 eyes were analyzed. Stim III HVF and IA: r^2=0.99, HVF mean MD=-26.1 with standard deviation (STD)=+/-6.72. IA mean MD=24.1 with STD=+/6.30. Mean absolute difference between HVF and IA =1.98 with STD=+/-0.769. IA Stim III MD and Stim V MD: r^2=0.415, Stim V mean MD=-21.2 with STD=+/-5.52. Mean absolute difference between IA Stim III and Stim V MD=1.98 with STD=+/-2.97. Conclusions: There was near perfect correlation of Stim III MD between HVF and IA, validating the algorithm. MD values for Stim III and Stim V, however, were not interchangeable. This may reflect the variability that comes from visualizing the smaller stimulus in subjects with a dense central scotoma. Commercial Relationships: Alexander F. Chen, None; Amitha Ganti, None; Youning Zhang, None; Tiffany Hwang, None; Adriana Berezovsky, None; Milton Moraes, None; Jeffrey S. Tran, None; Tana Wagschal, None; Rustum Karanjia, None; Alfredo A. Sadun, Edison Pharmaceuticals (F) Program Number: 3860 Poster Board Number: C0265 Presentation Time: 3:45 PM–5:30 PM Functional Visual Outcome of 1st vs 2nd Affected Eye in Treated LHON Patients at 1 Year Michael Ammar1, Jasdeep S. Chahal1, Amitha Ganti1, Jeffrey S. Tran1, Edward R. Chu3, Alexander F. Chen1, Tiffany Hwang1, Rustum Karanjia2, 3, Alfredo A. Sadun2, 3. 1USC Eye Institute, University of Southern California, Los Angeles, CA; 2Ophthalmology, University of California at Los Angeles, Los Angeles, CA; 3Doheny Eye Institute, Los Angeles, CA. Purpose: Leber’s Hereditary Optic Neuropathy (LHON) is a mitochondrial optic neuropathy with no definitive therapy. Involvement of the first eye is usually followed by the second eye within a few months. Thus, the second eye is exposed to systemic treatment, such as quinone therapy, earlier relative to its onset. We carried out a retrospective chart review to test our hypothesis that functional visual outcome is better in the 2nd affected eye at 1 year in treated LHON patients. Methods: Charts from 2009 to 2014 were analyzed at a university affiliated eye institute. Patients were diagnosed with LHON, and were seen at 1 year ± 2 months after conversion for the 2nd eye. 20 patients were identified and all were given quinone therapy for the duration of the year. 14 began treatment after both eyes were affected (hence earlier for 2nd eye) and 6 began after one eye was affected (hence before visual loss in the 2nd eye). Average time to treatment after involvement of the 1st eye was 172 days. LogMAR visual acuity (VA), retinal nerve fiber layer (RNFL) thickness, and mean deviation (MD) were recorded for 1st and 2nd eyes affected. A two-tailed Student’s t-test was used for statistical analysis. Results: At 1 year in the 1st affected eye, patients treated after both eyes were affected had an average VA of 1.73 ± 1.67, an average MD of -21.44 ± 7.39, and an average RNFL thickness of 64.75 ± 13.25. In the 2nd affected eye, they had an average VA of 1.78 ± 1.77, an average MD of -15.82 ± 11.93, and an average RNFL thickness of 66.13 ± 10.97. At 1 year in patients treated after both eyes were affected, P values for the 1st vs 2nd affected eye were 0.4546 for VA, 0.1768 for MD, and 0.5342 for RNFL thickness. At 1 year in the 1st affected eye, patients treated between affected eyes had an average VA of 2.00 ± 2.08, an average MD of -29.08 ± 3.17, and an average RNFL thickness of 65.60 ± 11.01. In the 2nd affected eye, they had an ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology average VA of 1.93 ± 2.10, an average MD of -24.22 ± 4.99, and an average RNFL thickness of 60.20 ± 9.73. At 1 year in patients treated between affected eyes, P values for the 1st vs 2nd affected eye were 0.1620 for VA, 0.1556 for MD, and 0.1540 for RNFL thickness. Conclusions: In this LHON cohort, there was a trend but no statistically significant difference in visual outcome between the 1st and 2nd affected eye at 1 year. Hence, the timing of quinone therapy does not appear to be critical. Commercial Relationships: Michael Ammar, None; Jasdeep S. Chahal, None; Amitha Ganti, None; Jeffrey S. Tran, None; Edward R. Chu, None; Alexander F. Chen, None; Tiffany Hwang, None; Rustum Karanjia, None; Alfredo A. Sadun, None Program Number: 3861 Poster Board Number: C0266 Presentation Time: 3:45 PM–5:30 PM Mitochondria haplogroups in patients with dominant optic atrophy Isao Nakata, Eric D. Gaier, Daniel Navarro-Gomez, John S. Borchert, Xiaowu Gai, Louis R. Pasquale, Simmons Lessell, Dean M. Cestari, Joseph F. Rizzo, Janey L. Wiggs. Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: The most common inherited optic neuropathies are dominant optic atrophy (DOA) caused by mutations in OPA1 and Leber hereditary optic neuropathy (LHON) caused by mutations in mitochondrial DNA (mtDNA). Previous studies have suggested that background mtDNA haplogroups may affect LHON pathogenicity and expressivity, however, the role of mtDNA halogroups in DOA remains unexplored. This study aims to identify mtDNA haplogroups in OPA1-related optic atrophy patients and to investigate the impact of the haplogroups on the clinical phenotype. Methods: Fifty-nine patients with the clinical diagnosis of primary optic atrophy were studied. Genomic DNA was evaluated by next generation sequencing using the Genetic Eye Disease (GEDi) diagnostic panel that covers 234 genes (including OPA1) as well as the entire mitochondrial genome. Patients with apparent homozygosity based on consecutive single nucleotide polymorphisms were also evaluated for copy number variation (CNV) using Multiplex Ligation-dependent Probe Amplification (MLPA) analysis. The mitochondrial haplogroup was determined using our custom halplogroup-defining tool Phy-Mer (Navarro-Gomez et al., submitted). The difference in clinical phenotype (both ocular and nonocular) among mtDNA haplogroups was tested with the ANOVA test for continuous data and with the chi-square test for categorical data. Results: In the 59 optic atrophy cases, mtDNA haplogroup analysis identified 19 cases (32.2%) with haplogroup H, 10 cases (16.9%) with haplogroup U, and 8 cases (13.6%) with haplogroup J. Next generation sequencing and CNV analysis identified 21 patients (35.6%) with OPA1 disease-causing mutations and one patient (1.7%) with a primary LHON mutation (m.11778G>A). In the overall group (both with and without OPA1 mutations), significant differences in age of onset, visual acuity, and visual field among haplogroups was not observed (P > 0.05) although extra-ophthalmological abnormalities such as hearing loss and peripheral neuropathy tended to be more frequent in haplogroup J (42.9%) compared with haplogroups U/H (16.0%, P = 0.157). In the cases with OPA1 mutations (n = 21), we found significantly more extra-ocular abnormalities in haplogroup J cases (75.0%) compared to haplogroup U/H cases (0.0%, P = 0.0140). Conclusions: This study showed a potential association between mtDNA haplogroup and extra-ocular findings in DOA with OPA1 mutation. Commercial Relationships: Isao Nakata, None; Eric D. Gaier, None; Daniel Navarro-Gomez, None; John S. Borchert, None; Xiaowu Gai, None; Louis R. Pasquale, None; Simmons Lessell, None; Dean M. Cestari, None; Joseph F. Rizzo, None; Janey L. Wiggs, None Support: JSPS Postdoctoral Fellowships for Research Abroad (IN), Alcon Research Institute Award (JLW) Program Number: 3862 Poster Board Number: C0267 Presentation Time: 3:45 PM–5:30 PM Improvements on a Method for Recognizing Colorblind Malingering Andrew E. Pouw1, Rustum Karanjia2, Alfredo A. Sadun2. 1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA. Purpose: Standard tests of colorblindness screen for organic disease. We have developed a method that attempts to recognize malingerers of colorblindness. The purpose of this study is to validate this test in a sample population. Methods: An online survey was distributed to 84 self-reported and verified colorblind participants and 131 participants instructed to simulate colorblind malingering. The survey contained three sets of twelve color-adjusted versions of the standard Ishihara color plates, as well as one set of twelve unmodified plates. Participants were asked to identify numbers on these 48 plates. Two tests were then created, each using six unique plates. A “balanced test” emphasizing both sensitivity and specificity was assembled by prioritizing test plates that colorblind participants most often correctly identified, as well as those test plates which malingering simulators most often incorrectly identified. A second set of six test plates comprised the “specific test,” which maximized test specificity. This was assembled by prioritizing only those plates that colorblind participants most often correctly identified. Statistical measures of both the “balanced test” and “specific test” (sensitivity, specificity, and Youden indexes) were assessed at each possible cut-off threshold, and a receiver operating characteristic (ROC) function with its area under the curve (AUC) charted. Results: For the “balanced test,” colorblind and colorblind simulating participants had a difference of means of 60.1% (CI: 53.6% to 66.5%). Statistical measures showed an optimal cut-off of at least 1 missed “balanced test” plate to recognize a colorblind malingerer (Youden index: 0.81, sensitivity: 88.6%, specificity: 92.9%), with an AUC of the ROC of 0.93. For the “specific test,” colorblind and colorblind simulating participants had a difference of means of 41.6% (CI: 34.8% to 48.4%). Statistical measures showed a cut-off of at least 2 missed “specific test” plates to identify a colorblind malingerer with 100% specificity (sensitivity 51.9%, Youden index 0.52, AUC of 0.85). Conclusions: Our method for recognizing colorblind malingering demonstrates a high degree of reliability in a large population, and can be used to both screen for colorblind malingerers and to identify them with 100% specificity. Commercial Relationships: Andrew E. Pouw, None; Rustum Karanjia, None; Alfredo A. Sadun, None Program Number: 3863 Poster Board Number: C0268 Presentation Time: 3:45 PM–5:30 PM Clinical Value of Electrophysiology in Determining the Diagnosis of Visual Dysfunction in Neuro-Ophthalmology Patients GH Yap1, LY Chen2, R Png2, Loo JL2, Tow S2, Mathur Ranjana2, Chia A2. 1Singapore General Hospital, Singapore, Singapore; 2Singapore National Eye Center, Singapore, Singapore. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Purpose: Neuro-ophthalmologists often refer patients for electrophysiology to distinguish between retinal and post-retinal pathology, and to aid in diagnosis. We performed a retrospective review to assess clinical value of visual electrophysiology in identifying causes of visual dysfunction in patients referred from neuro-ophthalmology clinics. Methods: A retrospective review of 410 subjects (0.3 – 88 years, mean 43.6 +/- SD 20.0) referred for visual electrophysiology from various neuro-ophthalmologists between 2009-2013 was performed. Most underwent pattern, full-field and multifocal electroretinography and pattern visual evoked potential (VEP) tests. Flash and multifocal VEP were included where indicated. Main outcome measures were the site of pathology and sensitivities for each test. Results: 158 were referred for poor vision for investigation, 102 for unexplained visual field defects, 97 for miscellaneous visual symptoms and 53 for other reasons. Most subjects referred for poor vision for investigation had electrophysiology findings of retinopathy (37%) or post-retinal pathology (34%), and those with vision poorer than 6/24 more likely having abnormal findings (86% vs 62%, p=0.0020). Among those with unexplained visual field defects, findings of retinopathy, post-retinal pathology and normality were noted in 31%, 24% and 28%, respectively. Most subjects with miscellaneous visual symptoms had normal findings (69%). Among the tests, multifocal ERG was most sensitive for retinopathy (96%) and maculopathy (95%) and pattern VEP was most sensitive for postretinal pathology (94%). An indeterminate result was noted in 9%. Conclusions: Electrophysiology was effective in allowing differentiation between retinopathy, optic neuropathy and electrophysiologic normality in 91% of subjects. Pre-testing provisional diagnoses of retinopathy and post-retinal pathology were revised in 30% and 42% respectively as a result of electrophysiologic testing. A clear understanding of the characteristics of each test used in correlation with the clinical picture and interpretation of all results in totality are important in localising the site of pathology. Commercial Relationships: GH Yap, None; LY Chen, None; R Png, None; Loo JL, None; Tow S, None; Mathur Ranjana, None; Chia A, None Program Number: 3864 Poster Board Number: C0269 Presentation Time: 3:45 PM–5:30 PM Factors Predicting King-Devick Test Performance in Adults and Adolescents Yi Pang1, Robert J. Steinmetz2, Danielle F. Leong3, 2, Leonard V. Messner1, Sherry Audycki4, James Fanelli5, Dan McGehee6, Wendy Stone1, Katherine Lynch1, Heather Moss7. 1Illinois Coll of Optom, Chicago, IL; 2SoLo Eye Care, Chicago, IL; 3King-Devick Test, LLC, Oakbrook Terrace, IL; 4Advanced Eye Center, Bedford, MA; 5 Cape Fear Eye Institute, Wilmington, NC; 6Swagel Wootton Hiatt Eye Center, Mesa, AZ; 7Department of Ophthalmology and Visual Sciences and Department of Neurology & Rehabilitation, University of Illinois at Chicago School of Medicine, Chicago, IL. Purpose: The King-Devick (K-D) test is a rapid number naming test that has been studied extensively as a marker of neurological disease and concussion. Potentially confounding variables have not been studied in a large sample. The purpose of this study was to determine important confounding variables that are associated with K-D test performance. Methods: In this cross-sectional, multi-center study, subjects ≥15yrs old with binocular near visual acuity < 20/30 completed two trials of the K-D test protocol. Exclusion criteria included concussion within 3-months, post-concussion syndrome, dyslexia or neuro-degenerative disorders. History of concussion, amblyopia, strabismus as well as demographic variables of education, race/ethnicity, gender and age were assessed by subject interview. Multiple linear regression analysis was performed. Independent variables were modeled as categorical (age (< or > 40 years), race/ethnicity, gender, education, concussion, amblyopia, strabismus) and continuous (age in years greater than 40 years) terms. Results: Subjects (n=691, age 39.8±17.7 years) were enrolled across 5 sites. The average best K-D time was 41.2±8.2s. Table 1 shows the results of multiple regression analysis. The final multiple regression model included age beyond 40 years, education, black race and Hispanic race. With other variables held constant, the K-D test time worsened by 0.27s for each year in age above 40, improved by 1.94s for each category of higher education level achieved, worsened by 3.67s for black race and improved by 2.38s for Hispanic ethnicity. Gender, White race, Asian race, amblyopia, strabismus, or history of concussion was not associated with K-D test performance. Conclusions: Age greater than 40 years, education, black race and Hispanic ethnicity were significantly associated with K-D test performance. Knowledge of these confounding variables is important for applications of K-D test in neurologically diseased populations and its development as a clinical measurement tool. Commercial Relationships: Yi Pang, None; Robert J. Steinmetz, None; Danielle F. Leong, King-Devick Test, LLC (E); Leonard V. Messner, None; Sherry Audycki, None; James Fanelli, None; Dan McGehee, None; Wendy Stone, None; Katherine Lynch, None; Heather Moss, None Program Number: 3865 Poster Board Number: C0270 Presentation Time: 3:45 PM–5:30 PM THE MULTIPLE RAREBIT TEST (DIGITSTEP): FEASIBITILY STUDY IN A PEDIATRIC POPULATION Danielle Coury1, Julie Racine2, David Rogers1, 2. 1Ophthalmology, The Ohio State University, Columbus, OH; 2Ophthalmology, Nationwide Childrens Hospital, Columbus, OH. Purpose: PURPOSE: In adult patients, assessment of vision is often measured by visual acuity alone. Although suitable to detect optical defect, visual acuity may fail to detect anomalies of the retina and/or the optic nerve. Alternative tests such as the Humphrey visual field (HVF) and the contrast sensitivity test (CST) have been used to address the above. More recently, a new technique was developed, the multiple rarebit test, to quickly address neuronal damage in patients with optic nerve anomalies. The multiple rarebit test has been used in adults with success, but has not been used in pediatric populations. Therefore, the purpose of this study was to 1- assess the feasibility of this new method in a pediatric population and 2- to compare the results with other methods such as the VF and the CST. Methods: METHODS: ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Ten subjects aged between 5 and 10 years of age with no known ophthalmic pathology were recruited from the Nationwide Children’s Hospital eye clinic to participate. Four tests were obtained for all participants: Snellen visual acuity (VA), Humphrey visual field (HVF), contrast sensitivity (CST) and multiple rarebit test (Digitstep). All tests were performed monocularly and both eyes were tested in the same session. Time to complete the test, ‘likeliness’ of the test and the efforts needed to perform the test were compiled. Results: RESULTS: All subjects were able to perform all four tests. The VA, CST and the Digitstep were well performed by subjects. Each test took less than 5 minutes to complete and subjects enjoyed the tests. On the other hand HVF was very difficult to perform in younger patients (≤ 6y.o) and it was time-consuming. Conclusions: CONCLUSION: The multiple rarebit test in a pediatric population is feasible. It is easier for a child to perform the multiple rarebit test than to perform the HVF. It is a quick test that children enjoyed. We noticed two downsides of the test, first being the speed at which the numbers are presented is fixed and can be sometimes too fast for the younger subjects (≤6 years old) and second the digital numbers 2 and 5 are similar in morphology and are often mistaken one another in children younger than 6 years of age. In the future, the multiple rarebit test could be use to asses the utility of the multiple rarebit test in children affected with retinal or optic nerve damage. Commercial Relationships: Danielle Coury, None; Julie Racine, None; David Rogers, None Support: The Ohio Lions Eye Research Foundation 319712 Program Number: 3866 Poster Board Number: C0271 Presentation Time: 3:45 PM–5:30 PM Proper ordering and interpretation of studies to avoid diagnostic delay in optic nerve sheath meningioma Thomas Ableman, Steven A. Newman. Ophthalmology, University of Virginia, Charlottesville, VA. Purpose: Optic nerve sheath meningiomas are often discovered after substantial delay. The fact that fractionated radiation therapy may substantially improve the prognosis underlies the importance of timely diagnosis and treatment. We performed a retrospective analysis of 7 cases of optic nerve sheath meningiomas with substantial diagnostic delay to identify the circumstances and pitfalls which led to the delay. Methods: Retrospective analysis of 7 cases of optic nerve sheath meningiomas with substantial diagnostic delay including records, imaging, and diagnostic studies Results: In several cases significant progressive visual loss occurred during the 1-10 year delay in diagnosis. Some of these reversed with radiation therapy after definitive diagnosis and referral to the interventional radiology service. : Four potentially preventable problems resulting in diagnostic delay were identified: 1. Lack of ordering imaging studies often due to an alternative diagnosis such as AION or papillitis. 2. Lack of appropriately directed imaging (head scans instead of orbital scans, the lack of employment of fat sat and gadolinium). 3. Miss-reading requiring reinterpretation. 4. Misinterpretation of OCT data because blocked axonal transport masks development of optic atrophy. Conclusions: Advances in technology have improved our ability to identify potentially treatable optic nerve sheath meningiomas. However, it remains incumbent on the evaluating ophthalmologist to be familiar with appropriate ordering and interpretation of such studies to avoid diagnostic delay. Commercial Relationships: Thomas Ableman, None; Steven A. Newman, None Program Number: 3867 Poster Board Number: C0272 Presentation Time: 3:45 PM–5:30 PM Eye movement enhancement in Parkinson’s disease as a result of CN-NINM intervention: a case study Yakov Verbny, Kimberly Skinner, Mitchell Tyler, Kurt Kaczmarek, Yuri Danilov. Biomedical Engineering, University of Wisconsin-Madison, Madison, WI. Purpose: The neurorehabilitation of sensory and motor functions in Parkinson’s disease (PD) patients is undeveloped, and recovery of eye-movement control is largely unexplored. There are very few methods that show the possibility of rehabilitation of eye movements affected by PD. The goal of this research was to investigate how well cranial-nerve non-invasive neuromodulation (CN-NINM) can reduce the effects of PD-induced impairments of oculomotor function and help to recover eye movement control. Methods: We completed a 4-month intervention with a 66-yearold male 6 years after he was diagnosed with PD symptoms. This individual demonstrated abnormal gait, poor posture and balance, occasional tremor and noticeable impairment of oculomotor function. The CN-NINM intervention used a combination of both physical and cognitive exercises with electrotactile stimulation to the tongue using a Portable Neuromodulation Stimulator (PoNStm). Assessment of oculomotor function was performed before and after the CN-NINM intervention using special 4-channel binocular eye tracking goggles (VisualEyes, Micromedical Inc). To evaluate the state of subject’s eye movements we used three static nystagmus tests (vertical and horizontal gaze, and spontaneous nystagmus) and three dynamic tests (random saccade, smooth pursuit and optokinetic). All of the tests were performed without tongue stimulation. Results: The CN-NINM intervention resulted in the gradual enhancement of patient eye movement control in all 6 tests. We observed improvement of eye fixation, accuracy and stability in nystagmus and gaze tests, increased eye movement accuracy and precision, improved gain and velocity of target tracking, and changes in both smoothness and synchronization of binocular movement control in oculomotor tests. The most significant improvements in eye movement control were found during performance of smooth pursuit and random saccade testing. We also observed improvement in his gait, posture and balance. Conclusions: Our study establishes a proof of concept and effectiveness of a new non-invasive neuromodulation therapy. The improvements of eye movement control demonstrated by this individual suggest that rehabilitation using a combination of exercise and tongue-based neurostimulation may benefit people affected by PD and would offer a novel treatment option for this disease. Commercial Relationships: Yakov Verbny, None; Kimberly Skinner, None; Mitchell Tyler, Advanced Neurorehabilitation LLC,Madison,WI (I), Advanced Neurorehabilitation LLC,Madison,WI (P), Advanced Neurorehabilitation LLC,Madison,WI (S), Helius Medical Technologies, Newtown, PA (I), Helius Medical Technologies, Newtown, PA (P), Helius Medical Technologies, Newtown, PA (S), NeuroHabilitation Corp., Newtown, PA (P), NeuroHabilitation Corp., Newtown, PA (R); Kurt Kaczmarek, Advanced Neurorehabilitation LLC,Madison,WI (I), Advanced Neurorehabilitation LLC,Madison,WI (P), Advanced Neurorehabilitation LLC,Madison,WI (S), Helius Medical Technologies, Newtown, PA (I), Helius Medical Technologies, Newtown, PA (P), NeuroHabilitation Corp., Newtown, PA (C), NeuroHabilitation Corp., Newtown, PA (P), NeuroHabilitation Corp., Newtown, PA (R); Yuri Danilov, Advanced Neurorehabilitation ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology LLC,Madison,WI (I), Advanced Neurorehabilitation LLC,Madison,WI (P), Advanced Neurorehabilitation LLC,Madison,WI (S), Helius Medical Technologies, Newtown, PA (I), Helius Medical Technologies, Newtown, PA (P), Helius Medical Technologies, Newtown, PA (S), NeuroHabilitation Corp., Newtown, PA (C), NeuroHabilitation Corp., Newtown, PA (P), NeuroHabilitation Corp., Newtown, PA (R) Support: University of Wisconsin Foundation and the Jane Bradley Pettit Foundation Program Number: 3868 Poster Board Number: C0273 Presentation Time: 3:45 PM–5:30 PM Higher prevalence of visual symptomatology in individuals with Parkinson’s disease Helene Kergoat1, 4, Estefania Chriqui1, 4, Caroline Law1, 4, Elizabeth L. Irving3, Marie-Jeanne Kergoat4, 2, Bernard-Simon Leclerc5, 4 , Michel Panisset2, 6, Sylvain Chouinard2, 6, Ronald Postuma7, 8 1 . Optometrie, Universite de Montreal, Montreal, QC, Canada; 2 Medecine, Universite de Montreal, Montreal, QC, Canada; 3School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada; 4Institut universitaire de geriatrie de Montreal, Montreal, QC, Canada; 5CSSS de Bordeaux-Cartierville–SaintLaurent-CAU, Montreal, QC, Canada; 6Centre hospitalier de l’Universite de Montreal, Montreal, QC, Canada; 7Montreal General Hospital, Montreal, QC, Canada; 8McGill University, Montreal, QC, Canada. Purpose: We have recently reported that the prevalence of visual symptoms linked with convergence insufficiency (CI) was higher in a group of individuals with Parkinson’s disease - PD (27%) compared to those in an age-matched group without PD (9%). Here, we investigated the prevalence of visual symptomatology in individuals with vs without PD who, based on a co-existing oculovisual condition, were excluded from participation in our original study. We hypothesize that the prevalence would be higher in those with PD than those without. Methods: Two study groups (n= 82 each) were included: 1) participants having PD (Avg. ± SD: 71.2 ± 10.4 yrs) recruited from two specialized neurology departments, and 2) age-matched participants not having PD (70.5 ± 9.2 yrs). These participants had various oculovisual conditions (eg. strabismus, glaucoma) excluding them from the CI study. The Convergence Insufficiency Symptom Survey (CISS-15) was also used here to verify visual symptomatology in the 2 study groups. A score of ≥ 21 is considered positive for symptomatology. The CISS-15 and a detailed oculovisual questionnaire were administered to each participant by a telephone interview. Confidence intervals and t-tests were performed using SPSS. Results: The participants did not differ for age (p = 0.60). The results indicated that 45.1% of participants with vs 17.1% of those without PD presented a score of ≥21 on the CISS-15 questionnaire (p < 0.05). Conclusions: We have previously shown that the prevalence of visual symptoms is higher in individuals with vs without PD but without a co-existing oculovisual condition. We demonstrate here that this prevalence remains higher in individuals with vs without PD who also have a co-existing oculovisual condition. These results indicate that PD per se places individuals with the disease at greater risk of visual symptomatology. Commercial Relationships: Helene Kergoat, None; Estefania Chriqui, None; Caroline Law, None; Elizabeth L. Irving, None; Marie-Jeanne Kergoat, None; Bernard-Simon Leclerc, None; Michel Panisset, None; Sylvain Chouinard, None; Ronald Postuma, None Support: Canadian Institutes of Health Research; Canadian Optometric Education Trust Fund; Comité aviseur pour la recherche clinique-Institut universitaire de gériatrie de Montréal Program Number: 3869 Poster Board Number: C0274 Presentation Time: 3:45 PM–5:30 PM Spectral-domain Optical Coherence Tomography in Huntington Disease: Potential Biomarker? Joao N. Beato1, Carlos Andrade2, Ana Monteiro2, Andreia Costa2, Joana Guimarães2, Carolina Garrett2, Elisete Brandão1, Fernando Falcão-Reis1, 3, Susana Penas1, 3. 1Ophthalmology, São João Hospital Center, Porto, Portugal; 2Neurology, São João Hospital Center, Porto, Portugal; 3Department of Sense Organs, Faculty of Medicine Of University of Porto, Porto, Portugal. Purpose: Clinical evaluation, neuroimaging, and biochemical biomarkers have been extensively investigated in Huntington’s disease, but none has been established. We performed a prospective cross-sectional observational study to investigate retinal and choroidal changes in HD and evaluate any potential correlation with stage of the disease. Methods: A thorough neurological evaluation was performed on HD patients, including Motor Score of the Unified Huntington’s disease rating scale (TMS-UHDRS), total functional capacity (TFC) and independency status (IS). Age and sex matched healthy controls enrolled were collected from the Ophthalmology Department database. Both groups underwent examination through dilated pupil using the Spectralis HRA+OCT®, Heidelberg® with the enhanced depth imaging (EDI). Peripapillary RNFL and choroidal thickness (PCT), macular and choroidal thickness (MT, CT) and respective volumes (MV, CV) were evaluated. Results: A total of 15 eyes of 8 HD patients were included. Sixteen eyes of 8 healthy sex, age and mean refractive error-matched controls were selected. Nasal RNFL, temporal PCT, superior peripheral MT and MV and all macular choroidal thickness and volume measurements were significantly (p<0.05) reduced in patients when compared to controls. Several MT and MV measurements, were positively correlated with TFC and IS and negatively correlated with TMS-UHDRS, along with PCT measurements. Conclusions: This findings suggest that both retina and choroid may be affected in HD. Moreover, macular thickness and volume tend to decrease with increasing severity of the disease. This could open a way for the potential role of SD-OCT as a biomarker in HD. Commercial Relationships: Joao N. Beato, None; Carlos Andrade, None; Ana Monteiro, None; Andreia Costa, None; Joana Guimarães, None; Carolina Garrett, None; Elisete Brandão, None; Fernando Falcão-Reis, None; Susana Penas, None Program Number: 3870 Poster Board Number: C0275 Presentation Time: 3:45 PM–5:30 PM Alzheimer disease and Mild Cognitive Impairment assessment using Optical Coherence Tomography Miguel Castilla Marti1, Octavio Rodriguez Gomez1, Sergi Mojal García2, Mercé Boada i Rovira1. 1fACE - Barcelona Alzheimer treatment & research center, BArcelona, Spain; 2IMIM - Hospital del Mar, BArcelona, Spain. Purpose: Early markers are needed for experimental and clinical diagnosis and follow-up of Alzheimer disease (AD) and earlier stages as Mild Cognitive Impairment (MCI). Retinal Nerve Fiber Layer (RNFL) thinning have been observed in AD and MCI patients. We performed a prospective, observational clinical study to ascertain how RNFL thickness, as measured by Optical Coherence Tomography (OCT), can be correlated with different grades of cognitive impairment. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Methods: All patients who came to our center during an open door initiative carried out between September and October of 2014 were invited to participate in neurological and complete neuropsychological examination, and then sorted between three different diagnostic groups: Healthy controls (C), MCI and AD. All patients who agreed undergone through a complete ophthalmological examination, including measurements of RNFL and macular thickness by OCT Model 3D OCT-1 Maestro (Topcon, Japan). All statistical analyses were performed using the Statistical Package for the Social Sciences (version 20.0; SPSS, Inc., Chicago, IL, USA) Results: 200 eyes from 100 patients (38 Healthy controls, 41 MCI and 21 AD) were included . Mean age for the whole sample was 67 years (SD=10.46) and 59.5 years for Control group, 67.71 for MCI and 80.52 for AD. Those differences showed to be statistically significant with a p value <0.001. No differences were observed on Macular thickness between groups. RNFL measurements showed to be different for overall thickness (p<0.001), superior (p<0.001), temporal (p=0.002) and inferior (p=0.003) quadrants. Statistical significance dissapeared when age adjustment was applied, resulting the superior quadrant thickness values for each group (C=113.01mm, MCI=111.67mm, AD=100.95mm) to be marginally significant (p=0.070). When compared individually, AD group showed to be statistically different from C (p=0.037) and MCI (p=0.024) on upper quadrant, with no differences between MCI and Controls. Conclusions: Data suggests a tendency to RNFL thinning on AD patients. Nevertheless, age revealed to be the main factor related with RNFL thinning in our series. If OCT is an appropriate method for AD and MCI assessment, capable to discriminate between disease and normal age related changes on retinal thickness layers, need to be further evaluated. Commercial Relationships: Miguel Castilla Marti, None; Octavio Rodriguez Gomez, None; Sergi Mojal García, None; Mercé Boada i Rovira, None Program Number: 3871 Poster Board Number: C0276 Presentation Time: 3:45 PM–5:30 PM Examination of retinal structure and visual function in civilian patients with Traumatic Brain Injury Jakaria Mostafa1, Divya Narayanan2, Suzanne Wickum1, Kassaundra Johnston1, Nimesh B. Patel1, Laura J. Frishman1, Jason Porter1. 1 College of Optometry, University of Houston, Houston, TX; 2 Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX. Purpose: Recent reports suggest that veterans with traumatic brain injury (TBI) may have optic nerve head (ONH) and inner retinal damage in addition to reduced visual performance. We seek to (1) quantify the extent to which abnormalities exist in retinal/ONH structure and visual function in civilian TBI patients and (2) correlate structural and functional measurements in the same eyes. Methods: Spectral domain optical coherence tomography volume scans of the ONH and macula were acquired in 14 eyes of 7 TBI patients (36 ± 12 years). Peripapillary retinal nerve fiber layer [RNFL] and macular retinal ganglion cell-inner plexiform layer [GCIPL] thicknesses were quantified globally and in sectors, and compared with instrument-based normative data. Functional measurements were acquired with the full-field flash electroretinogram (to quantify photopic negative response [PhNR] amplitude) and 30-2 standard automated perimetry (to quantify mean deviation [MD] and mean sensitivity). The percentage of agreement between global structural and functional measures (i.e., whether compared measures were both normal or abnormal) was calculated, as was the probability of agreement when corrected for chance (AC1 statistics). Structural and functional measures were correlated on global and local scales via regression analyses. Results: GCIPL and RNFL thickness abnormalities were detected in 8/14 and 5/14 eyes, respectively. Abnormalities in PhNR amplitude compared to normative values were found in 12/14 eyes and in MD in 10/14 eyes. The strongest agreements occurred between PhNR and MD (64% of eyes, AC1=0.42), GCIPL and RNFL thickness (64%, AC1=0.31), and RNFL thickness and MD (64%, AC1=0.29). Significant linear relationships (P<.05) were found across eyes between GCIPL and RNFL thicknesses (R2 =0.62), MD and GCIPL thickness (R2 =0.49), and MD and RNFL thickness (R2 =0.63). Only 9/56 comparisons were statistically significant when using published structure-function correspondence maps to correlate sector measures of GCIPL/RNFL thickness with corresponding local measures of visual field sensitivity. Conclusions: While structural abnormalities exist in some eyes, our data indicate a high prevalence of functional abnormalities in TBI patients. A better understanding of retinal/ONH structure, visual function and their correlation in TBI patients may enable more effective diagnosis, classification and treatment of injury. Commercial Relationships: Jakaria Mostafa, None; Divya Narayanan, None; Suzanne Wickum, None; Kassaundra Johnston, None; Nimesh B. Patel, None; Laura J. Frishman, None; Jason Porter, None Support: NIH Grant P30 EY007551, Fight for Sight Summer Student Fellowship, University of Houston College of Optometry Program Number: 3872 Poster Board Number: C0277 Presentation Time: 3:45 PM–5:30 PM Imaging of optic disc drusen: Swept-Source (SS)-OCT versus B-scan ultrasound Michelle Ahn1, Andrew W. Eller2, Bo Wang2, Ellen Mitchell2, Joel S. Schuman2, Chen D. Lu3, Ireneusz Grulkowski3, James G. Fujimoto3, Gadi Wollstein2, Gabrielle R. Bonhomme2. 1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; 3Department of Electrical Engineering and Computer Science, and Research Laboratory for Electronics, Massachusetts Institute of Technology, Cambridge, MA. Purpose: Optic disc drusen are currently diagnosed by B-scan ultrasonography, but this modality is difficult to maneuver, uncomfortable to patients, and operator-dependent. The aim of this prospective study was to determine whether an alternative imaging technology, the Swept-Source (SS)-OCT, improves the ability to identify optic disc drusen compared to the gold standard of B-scan ultrasonography. Methods: We recruited patients who were of 5 years of age or more and diagnosed with anomalous optic nerve heads. Subjects received a complete ophthalmologic exam of the anterior and posterior segments as well as a B-scan ultrasound and SS-OCT. The prototype SS-OCT system was operated at 1060nm wavelength with 100kHz axial scan rate. Images from each of the two imaging technologies were then independently and qualitatively assessed for the presence and visibility of drusen. Results: A total of 13 patients (4 males and 9 females) were recruited. The average age was 47.6 years. Among these subjects, there were 21 eyes with optic disc drusen. Drusen were confirmed in B-scans by hyper-reflectance of the calcium deposits at low gain. In the SS-OCT, they were hypo-reflective bodies that could be visualized in a 3D cube, making it possible to also pinpoint their locations. Optic disc drusen were identifiable through SS-OCT in ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology all 21 eyes (100%), had well-demarcated borders in 19 (90.5%), and were seen along their entire depths in 16 (76.2%). Conclusions: While the B-scan tests for the hyper-reflective properties of the calcified bodies, the SS-OCT allows anatomic visualization of the actual deposits. Here, we were able to identify optic disc drusen in all of the eyes that were diagnosed with this condition through B-scan. The SS-OCT therefore has equal ability to detect drusen compared to B-scan ultrasonography, and the additional benefits of ease of conducting the exam, patient comfort, data standardization, and potential quantification of drusen size make it more clinically useful. Commercial Relationships: Michelle Ahn, None; Andrew W. Eller, None; Bo Wang, None; Ellen Mitchell, None; Joel S. Schuman, Zeiss (P); Chen D. Lu, None; Ireneusz Grulkowski, None; James G. Fujimoto, Optovue (I), Zeiss (P); Gadi Wollstein, None; Gabrielle R. Bonhomme, None Support: NIH R01-EY013178, R01-EY011289, P30 EY008098; Eye and Ear Foundation (Pittsburgh, PA); Research to Prevent Blindness (New York, NY) Program Number: 3873 Poster Board Number: C0278 Presentation Time: 3:45 PM–5:30 PM Macular Edema Associated with Anterior Ischemic Optic Neuropathy: An OCT Study Christopher Weaver, Steven A. Newman. Ophthalmology, University of Virginia, Charlottesville, VA. Purpose: Thickening of nerve fiber layer is characteristic of anterior ischemic optic neuropathy. Disc edema, if severe enough, can track into the macula. This may be responsible for some of the decreased vision seen in acute anterior ischemic optic neuropathy. To study the incidence of effect of macular swelling, a retrospective study was undertaken of patients with anterior ischemic optic neuropathy that had OCT of both nerve fiber layer and macula. Methods: A retrospective chart review was performed of longitudinal data from the University of Virginia from December 2005- January 2014 with inclusion criteria consisting of the diagnosis of AION and exclusion criteria of pre-existing macular edema from other comorbidities (n=127). Results: Of the 127 patients reviewed in this study, 14 had macular edema as demonstrated on macular OCT (11%), which invariably resolved over the course of approximately three months. These patients had improved mean outcomes in visual acuity relative to those without macular edema, in comparison to baseline visual acuity in both groups (p<0.05). Conclusions: Macular edema associated with AION was found in 11% of patients, with these patients demonstrating improvement in visual acuity at three months compared to those patients who presented without macular edema. Further studies investigating the possible correlation between retinal nerve fiber layer thickness and presence of macular edema are warranted given the uncertainty of the inciting factors in the development of macular edema in AION. Commercial Relationships: Christopher Weaver, None; Steven A. Newman, None Program Number: 3874 Poster Board Number: C0279 Presentation Time: 3:45 PM–5:30 PM Multicolour Imaging in Acute Macular Neuro-retinopathy Rashi Arora4, 2, Sara Vaz-Pereira1, 3, Gabriella De Salvo2. 1Hospital de Santa Maria, Lisbon, Portugal, Lisbon, Portugal; 2University Hospital of Southampton, Southampton, United Kingdom; 3Faculty of Medicine, University of Lisbon, Portugal, Lisbon, Portugal; 4 Moorfields Eye Hospital, London, United Kingdom. Purpose: To evaluate the role of multicolor imaging (MC) in the diagnosis and follow up of acute macular neuroretinopathy (AMN) and to compare its features to fundus color photograph, near-infrared reflectance (NIR) and spectral domain optical coherence tomography (SD-OCT). Methods: Color fundus photographs, MC, NIR and SD-OCT were performed in 5 patients who presented with central scotoma and without any specific visible fundus features. Results: AMN was identified as an area of hypo-reflectance in NIR in 8 eyes of 5 patients. SD-OCT confirmed its location in the outer retina below the outer plexiform layer in 7 eyes (type 2) and above the outer plexiform layer in 1 eye (type 1). Additional MC was performed at baseline in 5 eyes (3 patients) and at follow-up in all eyes. Subsequent follow up demonstrated improvement of symptoms and this was objectively confirmed on both NIR and MC by gradual decrease of hypo-reflectance, with the latest showing higher contrast between the affected and the physiologic areas. SD-OCT showed a partial recovery of the ellipsoid zone in type 2 and inner nuclear layer thinning in type 1. Conclusions: MC is a new non invasive imaging modality which allows the detection of fine anatomic retinal details. In our patients, MC imaging emerged as a very useful tool in the detection and follow-up of AMN. We believe that, when available, MC should be routinely used to complement SD-OCT in the diagnosis and follow up of this rare inflammatory condition. Commercial Relationships: Rashi Arora, None; Sara Vaz-Pereira, None; Gabriella De Salvo, None Program Number: 3875 Poster Board Number: C0280 Presentation Time: 3:45 PM–5:30 PM OPA1 sequencing analysis and detailed ophthalmic examinations including the investigation of microcystic macular edema in 18 patients with bilateral optic atrophy Shuhei Kameya1, Kiyoko Gocho1, Sachiko Kikuchi1, Kenichi Yoshino2, Masahiro Miura3, Hiroko Yamazaki4, Kei shinoda5, Atsushi Mizota5, Kunihiko Yamaki1, Hiroshi Takahashi6. 1Ophthalmology, Chiba Hokusoh Hosp Nippon Med Sch, Inba, Japan; 2Yoshino Eye Clinic, Taito-ku, Japan; 3Ophthalmology, Tokyo Medical University Ibaraki Medical Center, Ami, Japan; 4Ophthalmology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan; 5 Ophthalmology, Teikyo University School of Medicine, Itabashi-ku, Japan; 6Ophthalmology, Nippon Medical School, Bunkyo-ku, Japan. Purpose: Autosomal dominant optic atrophy (ADOA), also known as Kjer’s disease, is the most common hereditary ocular neuropathy. ADOA is characterized by a decrease in the visual acuity that develops in childhood, temporal palor of the optic discs, centrocecal scotoma, and color vision defects. The purpose of this study was to distinguish patients with ADOA and optic atrophy with unknown origin by comparing the results of OPA1 sequencing analysis and clinical characteristics of the patients. Methods: 18 patients with bilateral optic atrophy underwent detailed ophthalmic examinations. The ophthalmological examinations included measurements of the best-corrected visual acuity, fundus photography, perimetry, SD-OCT analysis of nerve fiber layer thickness, color vision test, differences of severity between right and left eyes, and investigation of microcystic macular edema (MME) in SD-OCT. 12 patients underwent an adaptive optics analysis for detailed examination of MME. Mutational screening of all coding and flanking intron sequences of the OPA1 gene in 18 patients was performed by sanger DNA sequencing. Results: We have identified pathological mutations of OPA1 gene in 7 patients from 5 families. All patients with OPA1 mutation revealed temporal palor of optic discs, centrocecal scotoma or blind spot ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology enlargement binoculary. 6 patients with OPA1 mutation showed color vision deficiency. All patients with OPA1 mutation revealed very thin retinal nerve fiber layer between optic nerve and macular by a vertical SD-OCT scan at about 1 mm from the edge of optic disc. Majority of patients without OPA1 mutation lack some of these observations commonly found in patients with OPA1 mutation. MME in SD-OCT was found in 2 patients with OPA1 mutation and 2 patients without OPA1 mutation. Adaptive optics analysis revealed MME in 2 patients with OPA1 mutation and 2 patients without OPA1 mutation. Conclusions: A vertical SD-OCT scan at about 1 mm from the edge of optic disc is useful way to visualize and evaluate the temporal palor of optic disc that is a remarkable feature of ADOA. MME were identified in both groups with and without OPA1 mutation. Since sanger sequencing could not detect a large deletion of the gene, further studies such as multiplex ligation-dependent probe amplification will be needed. Commercial Relationships: Shuhei Kameya, None; Kiyoko Gocho, None; Sachiko Kikuchi, None; Kenichi Yoshino, None; Masahiro Miura, None; Hiroko Yamazaki, None; Kei shinoda, None; Atsushi Mizota, None; Kunihiko Yamaki, None; Hiroshi Takahashi, None Program Number: 3876 Poster Board Number: C0281 Presentation Time: 3:45 PM–5:30 PM Characteristics of microcystic macular edema determined by adaptive optics scanning laser ophthalmoscopy (AO-SLO) in eyes with optic neuropathy Takao Endo1, Takashi Fujikado2, Masakazu Hirota2, Hiroyuki Kanda2, Takeshi Morimoto2, Shinichi Usui1, Kohji Nishida1. 1Department of Ophthalmology, Osaka Univ Grad School of Med, Suita, Japan; 2 Applied Visual Science, Osaka Univ Grad School of Med, Osaka, Japan. Purpose: Microcystic macular edema (MME) is detected as an arcuate-shaped low reflectance area in the macula in the infrared fundus photographs and in the adaptive optics scanning laser ophthalmoscopic (AO-SLO) images. The low reflectance area corresponds to the area of microcystic changes in the inner nuclear layer (INL) detected by optical coherence tomography (OCT), and they have been reported in a variety of optic nerve diseases. The purpose of this study was to determine whether MME was present in eyes with optic neuropathy and to determine their characteristics. Methods: This was a retrospective study of 41 eyes of 25 patients with optic neuropathy or glaucoma. There were 7 eyes with traumatic optic neuropathy, 3 eyes with ischemic optic neuropathy, 4 eyes with ethambutol optic neuropathy, 4 eyes with Leber’s optic neuropathy, 5 eyes with optic neuritis, 6 eyes with optic nerve atrophy and 12 eyes with glaucoma. All of the patients were examined by AO-SLO and OCT at the Osaka University Hospital between August 2013 and October 2014. The visual acuity and incidence of MME were determined in these patients. Results: Low-reflectance areas in the AO-SLO image with microcysts in the OCT images were observed in 11 eyes (26.8%). The visual acuity was significantly poorer in eyes with MME (1.9±1.2 logMAR units) than in eyes without MME (0.42±0.73 log units; P<0.0). Eight of the 11 eyes with MME had arcuate low reflectance area but 3 eyes with glaucoma had a nerve fiber layer defect (NFLD)-like low reflectance area by AO-SLO. This NFLD-like low reflectance area did not correspond to the scotoma in the Humphery visual fields, which were different from the ordinal NFLD. Conclusions: The presence of MME may be related to an advanced stage of optic neuropathy. The shape of the MME in the AO-SLO images is not only arcuate but can also be NFLD-like. Commercial Relationships: Takao Endo, None; Takashi Fujikado, None; Masakazu Hirota, None; Hiroyuki Kanda, None; Takeshi Morimoto, None; Shinichi Usui, None; Kohji Nishida, None Program Number: 3877 Poster Board Number: C0282 Presentation Time: 3:45 PM–5:30 PM A Decade Of Diagnosing Inherited Retinal Dystrophies and Optic Atrophies: The Evolution Towards An Advanced Standardized Retinal Imaging and Molecular Genetic Approach Ulrich Kellner1, 2, Heidi Stöhr3, Susanne Kohl4, Bernhard H. Weber3, Bernd Wissinger4, Teresa Neuhann5, Silke Weinitz1, 2, Ghazaleh Farmand1, Simone Kellner1, 2. 1Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH, Bonn, Germany; 2RetinaScience, Bonn, Germany; 3Institute for Genetics, Regensburg, Germany; 4Molecular Genetics, Institute for Ophthalmic Research, Tübingen, Germany; 5Molekulargenetisches Zentrum (MGZ), München, Germany. Purpose: An early diagnosis of inherited retinal or optic nerve disorders (IROD) is frequently delayed due to unspecific clinical signs, variability of clinical manifestations and the underlying genetic defects. The present study evaluates the impact of non-invasive retinal imaging techniques (fundus autofluorescence (FAF), nearinfrared autofluorescence (NIA), spectral domain OCT (SD-OCT), three wavelength MultiColor spectral reflectance imaging (MC)) and molecular genetic analysis on the diagnostic process of IROD. Methods: In a single specialized center 1045 patients with IROD were examined and confirmed based on electrophysiological, retinal imaging or molecular genetic data between 2004 and 2014. Followup was available in 378 patients (median 3.9 y.). In addition to the basic ophthalmological examination electrophysiological testing (ERG n=358; EOG n=53; VEP n=102; mfERG n=283) and noninvasive retinal imaging (FAF n=947; NIA n=698; SD-OCT n=621; MC n=242) were performed at least once. Molecular genetic analysis was performed in 545 patients. Results: The combination of non-invasive retinal imaging with molecular genetic analysis has continuously replaced electrophysiological testing as a primary tool for the diagnosis of IROD. Multiple novel imaging phenomena have been observed specific for IROD, although frequently not specific for certain associated genes. Early phenomena in retinal imaging modalities frequently precede ophthalmoscopic visible alterations and therefore facilitate early diagnosis. Mostly in cone dysfunction and congenital stationary night blindness ERG is superior to retinal imaging. Molecular genetic testing confirmed disease-causing mutations (1 in dominant or x-linked disorders, 2 in recessive disorders) in 229 patients (44.4%). Conclusions: Non-invasive retinal imaging techniques advanced towards the primary tool for the diagnostic approach in suspected IROD and serve as the basis for planning of molecular genetic analysis. Multiple novel characteristic retinal imaging phenomena have been observed and increased our understanding of IROD. Patients have the advantage that imaging techniques are more widespread available than electrophysiological testing. A targeted diagnostic strategy reduces the diagnostic delay, enables an earlier counselling and therapy and avoids unnecessary diagnostic tests. Commercial Relationships: Ulrich Kellner, None; Heidi Stöhr, None; Susanne Kohl, None; Bernhard H. Weber, None; Bernd Wissinger, None; Teresa Neuhann, None; Silke Weinitz, None; Ghazaleh Farmand, None; Simone Kellner, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 3878 Poster Board Number: C0283 Presentation Time: 3:45 PM–5:30 PM LSFG-measured reduction of temporal optic disc circulation in ADOA patients Maki Inoue, Noriko Himori, Takayuki Takeshita, Naoko Aizawa, Kazuko Omodaka, Yukihiro Shiga, Kazuichi Maruyama, Koji Nishiguchi, Toru Nakazawa. Tohoku university, Sendai, Japan. Purpose: To evaluate optic nerve head microcirculation in autosomal dominant optic atrophy (ADOA) patients with laser speckle flowgraphy (LSFG), a recently introduced method to assess blood flow. Methods: This study comprised 14 eyes of 8 ADOA patients (mean age: 37.7 ± 14.0 years; spherical equivalent: -3.66 ± 2.15 D; LogMAR visual acuity: 0.51 ± 0.39). Clinically, the ADOA patients were diagnosed by low visual acuity, pallid temporal optic nerve discs, visual field defects, a family history consistent with autosomal dominant inheritance and the presence of mutations in the OPA1 gene. Eighteen normal eyes of 9 age-matched subjects served as controls (mean age: 41.6 ± 12.7 years; spherical equivalent: -3.11 ± 1.75 D; LogMAR visual acuity: -0.14 ± 0.05). Blood flow in the optic nerve head was assessed with LSFG, and the mean blur rate (MBR) ratio was calculated for each optic nerve head quadrant (superior, temporal, inferior and nasal) by dividing tissue MBR in that quadrant by the entire tissue MBR in the optic nerve head. We then compared the MBR ratio in each quadrant in the two groups. Results: In all quadrants, MBR was significantly lower in the ADOA patients than in the controls (superior: 8.23 ± 1.50 vs. 13.84 ± 3.28; temporal: 5.12 ± 1.02 vs. 10.33 ± 2.48, inferior: 7.04 ± 1.31 vs. 13.65 ± 2.46, nasal: 8.70 ± 1.13 vs. 13.94 ± 2.32, respectively, p < 0.01). Only in the temporal quadrant, the MBR ratio was significantly lower in the ADOA patients (0.74 ± 0.09 vs. 0.82 ± 0.07, respectively, p < 0.05). Conclusions: In ADOA, the temporal optic disc generally appears pale in fundus imaging. This suggests that blood flow on the temporal side of the optic disc should be reduced compared to other disc areas, but precise measurements of blood flow in the optic nerve head of ADOA patients have not yet been reported. Here, we found that blood flow in the optic disc, particularly on the temporal side, was indeed significantly lower in ADOA patients than in normal controls. Due to the anatomical characteristics of the optic nerve, the papillomacular bundle is susceptible to damage caused by mitochondrial dysfunction, which occurs in ADOA. Thus, our results suggest that reduced blood flow in the temporal optic disc in ADOA patients is caused by damage to the papillomacular bundle. Commercial Relationships: Maki Inoue, None; Noriko Himori, None; Takayuki Takeshita, None; Naoko Aizawa, None; Kazuko Omodaka, None; Yukihiro Shiga, None; Kazuichi Maruyama, None; Koji Nishiguchi, None; Toru Nakazawa, None Program Number: 3879 Poster Board Number: C0284 Presentation Time: 3:45 PM–5:30 PM Peripapillary and subfoveal choroidal thickness in non-arteritic anterior ischemic optic neuropathy (NA-AION) Libin Jiang. Eye Center, Beijing Tongren Hospital, Beijing, China. Purpose: To study whether peripapillary and subfoveal choroidal thicknesses of NA-AION patients is normal or not. Methods: The study involved 44 unilateral NA-AION patients (23 men and 21 women), whose mean age was 50.84±9.95 years (mean±SD), and 60 normal subjects (60 eyes) with similar age (50.30±1.18 years) and diopter. The patients were divided into two groups: 19 patients with optic disc edema in group 1 and 25 patients with optic disc edema resolution in group 2. Peripapillary and subfoveal choroidal thicknesses in all the eyes studied were measured by enhanced depth imaging Heiderberg Spectralis optic coherence tomography (EDI-OCT, Heidelberg engineering, Software Version:5.3.2). Peripapillary choroidal thickness was measured at the nasal superior (NS), nasal (N), nasal inferior (NI), temporal inferior (TI), temporal (T) and temporal superior (TS) segments. Choroidal thicknesses in the suffering eyes and the unaffected fellow eyes of the patients were compared with that of normal subjects. Choroidal thicknesses of the patients in Group 1 and Group 2 were also compared. The correlation between choroidal thickness and retinal nerve fiber layer (RNFL) thickness, logMAR visual acuity (logMAR VA), and the mean defection (MD) of Humphrey static perimetry (242) in the NA-AION suffering eyes were analyzed. Results: It was only found that peripapillary choroidal thickness at the nasal, nasal inferior and temporal inferior segments in the suffering eyes in group 1 were significantly thicker than that of normal subjects (P<0.05). We found no difference in choroidal thickness (1) between the suffering eyes and the unaffected fellow eyes of the NA-AION patients, (2) between the unaffected fellow eye of the NA-AION patients and normal eyes of healthy subjects, (3) between group 1 and group 2 (all P>0.05). There were no correlations between choroidal thickness and RNFL thickness in both two groups (all P>0.05). Neither logMAR VA nor MD correlated with choroidal thickness in the eyes affected by NA-AION (all P>0.05). Conclusions: Although peripapillary choroidal thickness in some segments become thicker in the eyes with optic disc edema caused by NA-AION, there are no evidences to prove that choroidal thickness is abnormal in NA-AION compared with normal subjects with similar age and diopter. Commercial Relationships: Libin Jiang, None Program Number: 3880 Poster Board Number: C0285 Presentation Time: 3:45 PM–5:30 PM Serum Level of Vascular Endothelial Growth Factor and Opening Lumbar Pressure Significantly Correlated with Optic Disc Edema in Patients with POEMS Syndrome Takehito Iwase, Hirotaka Yokouchi, Takayuki Baba, Toshiyuki Oshitari, Shuichi Yamamoto. Japanese Ophthalmological Society, Chiba, Japan. Purpose: It has been shown that the intracranial pressure (ICP) can induce optic disc edema (ODE), and high serum levels of vascular endothelial growth factor (VEGF) can also induce ODE in patients with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. We performed a cross sectional observational study to determine whether there is a significant correlation between the peripapillary retinal nerve fiber layer (RNFL) thickness and the serum level of VEGF and the spinal lumbar pressure (LP). Methods: We studied 32 eyes of 16 treatment-naïve patients (11 men, 5 women) with the POEMS syndrome at the Chiba University Hospital from September 2012 through October 2014. The diagnosis of POEMS was made by the criteria established by Dispenzieri in 2007. The peripapillary RNFL (pRNFL) thickness was determined by optical coherence tomography (OCT: RTVue-100 Optovue, Inc.). The serum level of VEGF was measured by enzyme-linked immune sorbent assay (ELISA). The opening (LP) pressure was measured instead of the ICP. The correlation between the pRNFL thickness and the serum level of VEGF and opening LP pressure was determined by the Spearman’s rank-correlation coefficient. Results: The mean serum level of VEGF was 5130 ± 3590 pg/ ml with a range of 1330 to 11900 pg/ml. The mean opening LP pressure was 179.1 ± 56.4 mmH2O. There was a significant positive correlation between the pRNFL thickness and the opening LP pressure (r=0.67, P=0.0002), and also between the pRNFL thickness ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology and the serum level of VEGF (r=0.37, P=0.03). In addition, there was a strong positive correlation between the pRNFL thickness of the right and left eyes (r = 0.81, P=0.0001). On the other hand, the correlation between the serum level of VEGF and opening LP pressure was not significant (r=0.32,P=0.32). Conclusions: The significant positive correlation between the pRNFL thickness and the opening LP and also with the serum levels of VEGF are in accord with previous studies reporting that the ICP and the serum levels of VEGF can affect the ODE in POEMS patients. These results suggest that both the higher LP and the serum levels of VEGF can account for the development of ODE in patients with POEMS syndrome. Commercial Relationships: Takehito Iwase, None; Hirotaka Yokouchi, None; Takayuki Baba, None; Toshiyuki Oshitari, None; Shuichi Yamamoto, None Program Number: 3881 Poster Board Number: C0286 Presentation Time: 3:45 PM–5:30 PM Characterizing optic disc edema in the setting of neurosyphilis John J. Chen1, Matthew Thurtell2. 1Ophthalmology, Mayo Clinic, Rochester, MN; 2Ophthalmology, University of Iowa, Iowa City, IA. Purpose: Syphilis can affect any part of the eye, including the optic nerve. Patients can have disc edema without visual compromise, which has been attributed to papilledema from raised intracranial pressure or optic perineuritis from optic nerve sheath inflammation. However, these attributions were proposed before MRI was largely available. We performed a retrospective, clinical observational study to better understand the mechanism of optic disc edema in neurosyphilis. Methods: We reviewed all patients seen at the University of Iowa from 2010 to 2014 with a diagnosis of neurosyphilis affecting the optic nerve, which revealed three patients with optic disc edema. The visual acuity, fields, OCT, fundus photos, lumbar puncture, and MRI results were examined to determine the mechanism of the optic disc edema. Neurosyphilis was confirmed with reactive VDRL in the CSF. Results: One patient had unilateral optic disc edema and two patients had bilateral optic disc edema. The visual fields showed enlargement of the blind spots only, except for one eye of a patient who had concomitant chorioretinitis and trace optic disc edema resulting in a cecocentral scotoma. All three patients denied symptoms of raised intracranial pressure. The opening pressure was normal in the two patients who had it measured; the opening pressure in the patient with unilateral disc edema was not measured. MRI of the orbits demonstrated no optic nerve sheath enhancement in any of the patients. Conclusions: With modern diagnostic imaging, we were able to demonstrate a lack of optic nerve sheath enhancement in three patients with optic disc edema and preserved visual function, suggesting papillitis may be a better term than optic perineuritis in many cases of isolated disc edema from neurosyphilis. 62 year-old male with bilateral optic disc edema in the setting of neurosyphilis. The right eye has severe optic disc edema with normal visual fields other than enlargement of the blind spot. The left eye has a cecocentral scotoma due to chorioretinitis in conjunction with trace optic disc edema. OCT shows an elevated retinal nerve fiber layer thickness in both eyes, right greater than left, and photoreceptor disruption in the macula of the left eye confirming chorioretinitis. Magnetic resonance imaging of the orbit demonstrates no optic nerve or sheath enhancement. Commercial Relationships: John J. Chen, None; Matthew Thurtell, None Program Number: 3882 Poster Board Number: C0287 Presentation Time: 3:45 PM–5:30 PM Current intensity-dependent neuroprotection in eyes with traumatic optic neuropathy by transcorneal electrical stimulation Takeshi Morimoto1, Takao Endo2, Kohji Nishida2, Takashi Fujikado1. 1 Applied Visual Science, Osaka Univ Graduate Sch of Med, Suita, Japan; 2Ophthatmology, Osaka University Graduate School of Medicine, Suita, Japan. Purpose: To determine whether the improvement of the visual acuity in eyes with traumatic optic neuropathy (TON) is associated with the current intensity of transcorneal electrical stimulation (TES). Methods: This was a prospective, randomized, partially blinded, clinical trial of 27 patients at the Osaka University Hospital. All patients had TES (10 ms, biphasic pulses, 20 Hz) for 30 min once a month in their TON eyes for 6 months. The patients were randomly divided into two groups; 1.0 mA (n = 17) or 0.3 mA (n = 9). The primary outcome measurement was the change in the best-corrected visual acuity (BCVA) at 3 and 6 months after the start of the TES ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology treatment. An improvement in visual acuity was defined as a change of ≥0.2 logarithm of the minimum angle of resolution (logMAR) units. The changes in the BCVA in the two groups were compared. Results: The improvement in the BCVA in the 0.3 mA group was 0.10 ± 0.085 logMAR units and that in the 1.0 mA group was 0.11 ± 0.049 logMAR units at 3 month (P=0.73). The improvement in the BCVA at 6 month in the 0.3 mA treatment group was 0.04 ± 0.085 logMAR units which was significantly less than that in the 1.0 mA group of 0.26 ± 0.049 (P=0.039) logMAR units. The improvement of the BCVA was found in 22.2% of the patients in the 0.3 mA group and 23.5% of the patients in the 1.0 mA group at 3 months, and 22.2% in the 0.3 MA group and 47.1% in the 1.0 mA group at 6 months. The differences were not statistically significant (P=0.94 and P=0.21, respectively). Conclusions: TES at 1.0 mA can improve the VA in patients with TON more effectively than at 0.3 mA. These results indicate that there is probably an optimal neuroprotective current intensity of TES for eyes with TON. These value will provide a guideline for the use of TES in patients with TON. Further studies with larger sample sizes and longer duration are needed to confirm the findings and to define the optimal stimulation parameters. Commercial Relationships: Takeshi Morimoto, None; Takao Endo, None; Kohji Nishida, None; Takashi Fujikado, None Support: Japanese government grant 22791658 Clinical Trial: UMIN000005049 Program Number: 3883 Poster Board Number: C0288 Presentation Time: 3:45 PM–5:30 PM Diagnostic performance of ganglion cell and retinal nerve fiber layer thickness in alcoholic optic neuropathy Stéphanie Michau1, Pascal Perney2, Hélène Donnadieu-Rigolle2, Max Villain1, Vincent Daien1. 1Ophtalmology, University Hospital of Montpellier, Montpellier, France; 2Addictology, University Hospital of Montpellier, Montpellier, France. Purpose: To explore the diagnostic performance of optic nerve parameters in early alcoholic optic neuropathy. Methods: 395 eyes of 200 patients were included prospectively during hospitalisation for alcohol withdrawal from January 2010 to October 2013 in the University Hospital of Montpellier. The definition of alcoholic optic neuropathy was the assocation of alterated visual field with impaired color vision. Optic nerve variables were assessed by visual-evoked potential, Heidelberg Retina Tomograph III (HRT-III), spectral-domain optic coherence tomography (SD-OCT) (ganglion cell layer [GCL] and retinal nerve fiber layer [RNFL]) and scanning laser polarimetry (GDx). Optic nerve variables were compared between patients with and without optic neuropathy by age- and sex-adjusted analysis of covariance. Diagnostic performance was determined by area under the receiver operating characteristic curve (AUC), sensitivity and specificity. Results: In total, 47 (24%) patients presented alcoholic ON (mean (SD) age of 47 (11) years; 33 men). Peripheral neuropathy was more frequent in patients with than without alcoholic ON (p<.001) and GCL and RNFL were thinner (mean (SD) of 12.91 (0.7) vs 14.78 (0.3) mm, p=0.015; and 90.27 (2.1) vs 99.57 (1.08) mm, p<.001, respectively). The AUC was highest for superior GCL (AUC=0.78; (95% CI, 0.67-0.89)) and global RNFL thickness from SD-OCT (AUC=0.72; (95% CI 0.62-0.82)) and had the best sensitivityspecificity pair 82.1–62.0% and 79.4–63.4%, respectively. The AUC for GDx and HRTIII ranged from 0.52 to 0.68. Conclusions: Objective examination including GCL and RNFL thickness on SD-OCT could be useful to improve the diagnostic of alcoholic ON. Commercial Relationships: Stéphanie Michau, None; Pascal Perney, None; Hélène Donnadieu-Rigolle, None; Max Villain, None; Vincent Daien, None Program Number: 3884 Poster Board Number: C0289 Presentation Time: 3:45 PM–5:30 PM Comparison of retinal nerve fiber layer thickness measurement by Stratus and Cirrus OCTs in retrobulbar optic neuritis and non arteritic anterior ischemic optic neuropathy Barbara Giambene, Gianni Virgili, Ugo Menchini, Stanislao Rizzo. University of Firenze, Eye Clinic, Firenze, Italy. Purpose: To compare retinal nerve fiber layer thickness (RNFLT) measurement by Stratus and Cirrus OCTs and to evaluate the agreement between the two instruments in retrobulbar optic neuritis (RON), non arteritic anterior ischemic optic neuropathy (NAION) and normals. Methods: Eighty-nine eyes with RON, ninety-two with NAION (both in the chronic phase, six to twelve months after diagnosis of acute disease), and one hundred fifty-five normal eyes were studied. Average RNFLT was measured by Stratus and Cirrus OCTs. Comparisons among groups were performed by ANOVA test. The agreement between the two instruments was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval (CI), and Bland-Altman analysis. Statistical significance was set at p ≤0.5. Results: Average RNFLT was lower in NAION eyes than in RON and normal ones using both OCTs (60.0 ±1.2, 69.9 ±1.2 and 97.4 ±0.9 m, p<0.001 by Cirrus; 49.7 ±1.5, 65.9 ±1.9 and 99.2 ±1.3 m, p<0.001 by Stratus). RNFLT values were higher with Cirrus than with Stratus in NAION (+10.30 μ, CI 7.82 – 12.79 μ) and RON (+4.01 μ, CI 1.32 – 6.70 μ) eyes, and slightly lower in normal ones (-1.75 μ, CI -3.51 – 0.01 μ). A stronger agreement between the two instruments was found in normal and RON eyes than in NAION ones (ICC 0.682, CI 0.566-0.771; 0.635, CI 0.467-0.758; 0.321, CI 0.1320.472, respectively). Conclusions: Both Stratus and Cirrus OCTs can identify RNFLT reduction in eyes with RON and NAION in the chronic phase. Absolute RFNLT values differ between the two instruments, hence they have not to be considered interchangeable. Commercial Relationships: Barbara Giambene, None; Gianni Virgili, None; Ugo Menchini, None; Stanislao Rizzo, None Program Number: 3885 Poster Board Number: C0290 Presentation Time: 3:45 PM–5:30 PM Predictive Value of Perioperative Circumpapillary Retinal Nerve Fiber Layer Thickness in Primary Rhegmatogenous Retinal Detachment Macular Anatomic Outcomes Julia Kuhn1, Joseph Martel2. 1School of Medicine, University of Pittsburgh, Pittsburgh, PA; 2Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA. Purpose: Despite successful rhegmatogenous retinal detachment (RRD) surgery, postoperative macular edema, epiretinal membrane (ERM) formation, and macular atrophy are difficult to predict, yet important factors influencing final visual outcome. We performed a retrospective observational clinical study to examine the perioperative spectral domain optical coherence tomography (sdOCT) circumpapillary retinal nerve fiber layer (cpRNFL) thickness as a predictor for the development of postoperative macular disease in patients undergoing successful RRD repair surgery. Methods: A review of longitudinal data from 2009 – 2014 at the University of Pittsburgh Medical Center identified 36 patients having undergone successful primary RRD surgery without previous posterior segment surgery, optic nerve disease, or macular disease, and availability of preoperative and postoperative cpRNFL and ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology macular sdOCT imaging data. The nonoperative contralateral eye was used for all group comparisons as a control. Statistical analyses were performed using a two-tailed Student’s t test and Wilcoxon rank-sum test. Results: Of 36 patients who met inclusion criteria, 28 underwent RRD repair with vitrectomy and 8 with scleral buckling. Median follow-up time was 12 months (range 0.5-55 months), and mean follow-up visits was 2.0 (range 1-10). Mean cpRNFL was 91.97mm ±14.73 in RRD eyes and 85.48mm ±12.09 in control eyes (p<0.0001). Mean macular central subfield thickness (CST) was 325.51mm ±76.19 and 293.30mm ±59.21 in RRD and control eyes, respectively (p=0.0076). For RRD patients who developed late postoperative central macular edema (CST >300mm), median cpRNFL thickness in the early postoperative period was significantly greater than for RRD patients who did not develop late postoperative central macular edema (p=0.0027). In RRD patients who developed late central subfield macular thinning (CST<250mm), median cpRNFL thickness was not found to be significantly less than in those patients who did not develop macular thinning (p=0.9552). Conclusions: Early perioperative cpRNFL thickening may be a predictor for late postoperative macular edema in patients undergoing successful RRD repair surgery. Relative cpRNFL thinning or thickening was not predictive of central macular thinning. Commercial Relationships: Julia Kuhn, None; Joseph Martel, None Program Number: 3886 Poster Board Number: C0291 Presentation Time: 3:45 PM–5:30 PM Assessment of retinal nerve fiber layer thickness in healthy, full term neonates Mays El-Dairi1, Monica B. Sevilla1, Adam Rothman1, Sharon Freedman1, 2, Amy Tong1, Vincent Tai1, Du Tran-Viet1. 1 Ophthalmology, Duke University Medical Center, Durham, NC; 2 Pediatrics, Duke University School of Medicine, Durham, NC. Purpose: To measure average retinal nerve fiber layer (RNFL) thicknesses in healthy, full term neonates. Methods: Healthy infants born between 37-42 weeks post-menstrual age were imaged with handheld spectral domain optical coherence tomography (Bioptigen, Inc., Research Triangle Park, NC). A custom MATLAB script (Mathworks, Inc., Natick, MA) segmented the RNFL; the fovea and optic nerve center were manually selected. A second script measured the average RNFL thickness along the papillomacular bundle, defined as the arc from -15° to +15° on the axis from the optic nerve to fovea, with radii of 1.1, 1.3, 1.5, and 1.7 mm from the center of the optic disc. Shapiro-Wilk W tests assessed these measurements for normality to determine the age-appropriate radial distance for subsequent analyses. Average RNFL thicknesses for four temporal 45° sectors (superior temporal, temporal superior, temporal inferior, and inferior temporal) as well as the temporal quadrant were calculated and compared to demographic parameters for all infants. Results: Fifty full-term infants were adequately imaged for RNFL analysis. RNFL thicknesses at 1.5 mm radial distance from the optic nerve were the most normally distributed. While there was a trend towards greater mean superior temporal RNFL thickness for both Black and Hispanic versus White infants (128 ±27, 124 ±30, and 100 ±19 μm, respectively, P=0.04 for both comparisons), there were no other significant differences noted in RNFL thicknesses by race, sex, gestational age, or birth weight. Conclusions: We present RNFL thickness measurements for healthy, full term infants that may serve as normative data for future analyses. Commercial Relationships: Mays El-Dairi, None; Monica B. Sevilla, None; Adam Rothman, None; Sharon Freedman, None; Amy Tong, None; Vincent Tai, None; Du Tran-Viet, None 408 Eye movements Wednesday, May 06, 2015 8:30 AM–10:15 AM 4CD Mile High Blrm Paper Session Program #/Board # Range: 3993–3999 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 3993 Presentation Time: 8:30 AM–8:45 AM Absence of Intramuscular Elastin Correlates with Independent Mechanical Behavior of Extraocular Muscle (EOM) Compartments During Active and Passive Mechanical Loading Andrew Shin, Lawrence H. Yoo, Joseph L. Demer. Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, CA. Purpose: Intramuscular innervation of horizontal rectus EOMs is segregated into superior & inferior (transverse), compartments while all EOMs are also divided into global (GL) & orbital (OL) layers with scleral & pulley insertions. Mechanical coupling among EOM compartments was investigated during passive tensile and active loadings, and correlated with histological distribution of elastin, a connective tissue constituent localized to high mechanical stress. Methods: Bovine rectus EOMs were rapidly removed after slaughter. For passive loading, one compartment was extended, while the other was stationary, as forces in both channels were monitored. For active contraction, the EOM was immersed in 50 mM CaCl2 labeled with fluorescein while one compartment was coated with petrolatum to prevent permeation; contraction was in the other compartment while tensions in both channels were monitored. Fresh EOMs were then sectioned transversely for yellow-green fluorescence photography under blue light, and a formalin-fixed whole orbit was transversely sectioned and stained with elastin van Geison stain for histology. Results: There was abundant elastin in pulley tissues, but intramuscular elastin only in blood vessels, not in intercompartmental boundaries. (Fig. A). Fluorescein penetration confirmed selective CaCl2 permeation inducing selective active contraction (Fig. B). For both passive elongation and active contraction, intercompartmental force coupling was always ≤10%. Active tensions in GL and OL could change in opposite directions (Fig. C). Conclusions: Absence of elastin in intercompartmental regions of EOMs correlates with minimal active and passive force coupling. Marked mechanical independence of EOM compartments under both passive and active loading endows each EOM with potential for separately controllable actions required by the active pulley & transverse compartmental hypotheses. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology A. Low magnification cross section of lateral rectus muscle. A.(a) Boundary between OL and GL. A(b) Pulley contains abundant elastin (black). A(c) Elastin present only in blood vessel walls, not among muscle fiber bundles. B. Cross section showing fluorescein permeated only GL of lateral rectus muscle. OL was coated by petrolatum. C. in B. After initial buoyancy effect, force increased only in GL, while decreasing in OL. Commercial Relationships: Andrew Shin, None; Lawrence H. Yoo, None; Joseph L. Demer, None Support: NIH EY08313 Program Number: 3994 Presentation Time: 8:45 AM–9:00 AM Whole Exome Sequencing Identifies a New Splicing Factor Gene Causative of X-linked Spinocerebellar Ataxia Mervyn G. Thomas1, Cris S. Constantinescu2, Viral Sheth1, Moira Crosier3, Jayesh Patel4, Rob A. Dineen2, Paul Maddison2, Thabit Sabbubeh2, Irene Gottlob1. 1The University of Leicester Ulverscroft Eye Unit, University of Leicester, Leicester, United Kingdom; 2 Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; 3MRC-Wellcome Trust Human Developmental Biology Resource, Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom; 4Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, United Kingdom. Purpose: The genetic basis of X-linked Spinocerebellar Ataxia (SCA-X5: OMIM 300703) remains unclear, although previous linkage analysis identified a candidate locus on Xq25-q27.1. We identified a large family with a phenotype consistent with SCA-X5. We aimed to use whole exome sequencing (WES) to identify the causative gene, characterize the phenotype and the spatiotemporal expression of the protein. Methods: Detailed ophthalmic and neurological examinations were performed. Eye movement recordings were used to assess eye movement abnormalities using a series of fixation and smooth pursuit tasks. MRI, nerve conduction studies, electromyography and muscle biopsies were obtained from affected subjects. WES was performed on a large three-generation family (6 affected). We identified rare variants by focusing on protein-altering and splice-site changes with an allele frequency <1% in SNP databases and absent from 56 local exomes of unaffected subjects. Mutation was verified using sanger sequencing. Spatiotemporal expression was characterized using immunohistochemistry in human embryonic brain. Results: Five subjects had variable vertical and horizontal conjugate nystagmus with an increasing slow phase velocity. All affected subjects had saccadic smooth pursuit, ataxia and mild learning difficulties. Four subjects had abnormal head posture and strabismus. Affected females had macro-square wave jerks. Visual acuity ranged from 0.1-0.4 logMAR and stereopsis ranged between 110” of arc to no detectable stereopsis. MRI studies revealed a variable degree of cerebellar vermian atrophy, which was more severe in the male subject (hemizygous mutation) compared to the females (heterozygous mutation). Neuromuscular tests and investigations were normal. Variant filtering from WES dataset identified a splicing factor gene, SRPK3 at Xq28, mutation of which was causative of SCA-X5. The mutation co-segregated with the phenotype and was absent in the control exomes and SNP databases. Expression was noted in the developing cerebellum, with intense staining in the adjacent choroid plexus epithelium. Conclusions: For the first time we have identified the gene, SRPK3, mutation of which is causative of SCA-X5. We have shown the detailed phenotypical characteristics associated with SCA-X5, with females less severely affected. We have also characterized the spatiotemporal expression of this protein in the developing brain. Commercial Relationships: Mervyn G. Thomas, None; Cris S. Constantinescu, None; Viral Sheth, None; Moira Crosier, None; Jayesh Patel, None; Rob A. Dineen, None; Paul Maddison, None; Thabit Sabbubeh, None; Irene Gottlob, None Support: Ulverscroft Foundation and Medical Research Council Program Number: 3995 Presentation Time: 9:00 AM–9:15 AM Accommodation and vergence during measurement of fusional ranges in infants and pre-school children Vidhyapriya Sreenivasan1, Erin Babinsky2, Yifei Wu1, T R. Candy1. 1 Optometry, Indiana University, Bloomington, IN; 2Universitat Pompeu Fabra, Barcelona, Spain. Purpose: Accurate binocular alignment requires motor fusion, which must compensate for heterophoria. Infants and young children experience uncorrected hyperopia and narrow IPDs that could lead to excessive convergence (and esophoria) resulting from neural coupling. How well are fusional reserves coping with this challenge? This study evaluated accommodation and vergence behaviour of infants and young children during measurement of vergence ranges to determine fusional reserves around their phoria. Methods: Purkinje image tracking and eccentric photorefraction (MCS PowerRefractor) were used to record eye alignment and accommodation in infants (Inf) (3 to 5 months; n=17), pre-school children (PreSch) (2.5 to 5 years; n=19) and uninstructed, naïve pre-presbyopic adults (Ad) (n=14). Phoria was derived from the difference between eye alignments measured in monocular and binocular viewing, while viewing a naturalistic target at 80 cm. Motor fusion was measured objectively with the photorefractor by introducing base-in (BI) and base-out (BO) prism (2-40pd). The prism value at which motor fusion failed was computed . Results: Mean OD spherical equivalent refraction was +2.4D (SD ±1.2) in infants and +1.1D (± 0.6) in pre-schoolers. The average phoria was not significantly different (p=0.11) with age (Inf:-0.79 ±2.5 pd; PreSch:-2.43±2.0 pd; Ad:-1.0±2.7 pd). Mean vergence range was also similar between groups for BI (Inf = 11.2±2.5; PreSch: 8.8±2.8 pd; Ad: 11.8±5.2) and BO prism (Inf, 13.7±0.4pd; PreSch:15.1±8.3 pd; Ad: 20±9.2pd). Change in accommodation with ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology the highest fusable prism was positive (more accommodation than naturalistic viewing) with BO (Inf:1.69 ±1.4D; PreSch:1.35±1.6D; Ad:1.22±1.0D) and negative for BI (Inf:-0.96 ±0.3D; PreSch:0.78±0.6D; Ad:-0.62±0.3D), with similar magnitude across age (BO: p=0.6; BI: p=0.4). Conclusions: Despite typical levels of hyperopia, infants and young children exhibited small exophorias, that were comparable in mean to adults. Furthermore, participants in all age groups demonstrated substantial fusional reserves, evidence that the youngest participants are capable of responding to a large range of disparities. Accommodation increased wih BO and relaxed with BI by similar amounts across age. Collectively, these data suggest that motor performance is compensating for developmental hyperopia and IPD, in that these characteristics remain consistent with age. Commercial Relationships: Vidhyapriya Sreenivasan, None; Erin Babinsky, None; Yifei Wu, None; T R. Candy, None Support: NIH (R01 EY014460, P30 EY019008) and Fight for Sight awarded to VS Program Number: 3996 Presentation Time: 9:15 AM–9:30 AM Saccadic control in anorexia nervosa Larry A. Abel1, Andrea Phillipou1, 2, Susan L. Rossell3, 4, David Castle4, 2, Caroline Gurvich5. 1Optometry & Vision Sciences, University of Melbourne, Parkville, VIC, Australia; 2The University of Melbourne, Department of Psychiatry, Parkville, VIC, Australia; 3 Swinburne University of Technology, Brain and Psychological Sciences Research Centre, Hawthorn, VIC, Australia; 4Psychiatry, St Vincent’s Hospital, Fitzroy, VIC, Australia; 5Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia. Purpose: Anorexia Nervosa (AN) is a psychiatric illness characterised by 3 main criteria: significantly low body weight, a fear of weight gain and a disturbance in the experience of one’s own body weight or shape. Neurobiology studies in AN have been inconsistent. Since the neurobiology of saccades is relatively well understood, we examined tasks ranging from simple prosaccades to the scanning of clinically relevant images, as has been done in other psychiatric disorders. Methods: 24 AN subjects and 25 age-matched controls (all female) were studied. Eye movements were recorded at 500 Hz. Prosaccades, antisaccades and a go/no-go task were interleaved and cued by colour of the fixation spot. Memory-guided and self-paced saccades were also studied. During fMRI scanning, subjects viewed emotional faces and were asked to identify gender, not emotion; an image of their own face was interleaved. They also viewed biological motion stimuli showing walkers of both sexes and differing weights, either identifying sex or estimating weight. Results: Prosaccade latency was significantly shorter for AN: 206.87±33.72 vs. 250.42±70.97ms, p=.011. Other prosaccade parameters were normal, as were the antisaccade & go/no-go tasks. AN participants made significantly more errors on the memoryguided task: 14.81±10.98 vs.8.47±5.32, p=.021. Intersaccadic interval on the self-paced task fell just short of significance: 164.46±156.12 vs. 401.67±51.28ms, p =.068. For emotional faces AN subjects made significantly more fixations than controls: 23.67±1.02 vs. 20.42±.99, p=.027. Their fixation durations were also briefer: 279.06±18.1 vs. 351.65±17.21ms, p=.006. When viewing their own faces, AN subjects attended salient and non-salient features equally; controls attended to the salient features (the inner face “triangle”) more. For biological motion, fixations were again more frequent and briefer for AN subjects than controls. Conclusions: Prosaccade generation was intact but initiation was abnormally short in AN. This and the brief fixations for faces and biological motion could point to weaker fixation drive but the hyperscanning on the face and biological motion tasks is consistent with that seen in anxiety disorders. Their normal antisaccades and impaired memory-guided saccades differ from results in obsessivecompulsive disorder, with which AN shares some features. This 1st study of saccades in AN reveals a distinctive pattern of performance. Commercial Relationships: Larry A. Abel, None; Andrea Phillipou, None; Susan L. Rossell, None; David Castle, None; Caroline Gurvich, None Support: Jack Brockhoff Foundation; Dick and Pip Smith Foundation Program Number: 3997 Presentation Time: 9:30 AM–9:45 AM Visual processing in infantile nystagmus is not slow Matt J. Dunn, Thomas H. Margrain, Joy Margaret Woodhouse, Jonathan T. Erichsen. Cardiff University, Cardiff, United Kingdom. Purpose: Therapeutic interventions aimed at slowing the incessant eye movements of infantile nystagmus (IN) have elicited subjective reports of improved visual function, even in cases where visual acuity was not significantly changed. The purpose of this study was to investigate the extent to which temporal aspects of vision affect the visual experience of IN; in particular whether the presumed ‘slow to see’ phenomenon is primarily due to delays in redirecting the gaze or an increase in visual processing time. Methods: The time taken to fixate and respond to the orientation of peripherally presented Gabor patches was measured in 11 subjects with IN and 11 controls. Subjects viewed a fixation cross on a screen at a distance of 2m. After a random delay of 1-3s, a Gabor patch was presented 3° away from the primary position in one of four locations (up/down/left/right). Each Gabor patch was tilted to one of two orientations. As soon as subjects could locate and identify the targets, a response box was used to report the direction of tilt. This was repeated until at least 10 presentations in each direction had occurred. Spatial frequency of the Gabor patch was adjusted relative to each subject’s visual acuity in order to make the task equally difficult for all subjects. For targets presented either above or below the primary position, the time from presentation until the target acquiring saccade, and the time from the end of the saccade until the response was calculated. Due to the presence of horizontal nystagmus, it was not possible to detect the time to fixation for targets presented left or right of the primary position. Results: For vertically displaced targets, subjects with IN took significantly longer than controls to redirect their gaze towards the targets (IN: 0.25s [IQR 0.23 – 0.39s], controls: 0.19s [IQR 0.18 – 0.21s], P < 0.01). However, there was no significant difference between subject groups in the time between saccade termination and subject response (IN: 0.59 s [IQR 0.48 – 0.84s], controls: 0.63s [IQR 0.59 – 0.65s], P = 0.78). Conclusions: The results of this study suggest that IN does not affect the time taken to process visual information; once a target has been foveated, it is processed at a ‘normal’ speed. This study furthers our understanding of the visual difficulties associated with the condition, showing that the ‘slow to see’ phenomenon arises as a result of delayed targeting saccades, rather than slowed visual processing. Commercial Relationships: Matt J. Dunn, None; Thomas H. Margrain, None; Joy Margaret Woodhouse, None; Jonathan T. Erichsen, None Support: Nystagmus Network, College of Optometrists ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 3998 Presentation Time: 9:45 AM–10:00 AM Examination of Extraocular Muscles and Their Innervation from Subjects with Infantile Nystagmus Syndrome and Optic Nerve Hypoplasia Linda K. McLoon1, Matthew D. Kunz1, Joost Felius2, David Stager2, Jill S. Anderson1, Erick D. Bothun1. 1University of Minnesota, Minneapolis, MN; 2Retina Foundation of the Southwest, Dallas, TX. Purpose: Infantile nystagmus syndrome (INS) is an eye motility disorder characterized by involuntary conjugate oscillatory eye movements. INS is often associated with structural abnormalities in the afferent visual pathways. Our previous work suggested that the idiopathic form of INS and INS associated with albinism may be related to dysregulation of innervation. INS may also occur in conjunction with optic nerve hypoplasia (ONH). Our working hypothesis is that the extraocular muscles (EOM) from INS patients with ONH will have innervational adaptations that may provide insight into possible mechanisms that cause INS. Methods: We have examined EOM specimens removed as part of the normal surgical treatment of 2 patients with INS and ONH (age 6 and 10 years) compared to 3 age matched normal controls and 3 age matched subjects with idiopathic INS. They were examined for neuromuscular junction density and neuromuscular junction morphology. All studies were approved by the IRB at the University of Minnesota. Results: The EOM from the subjects with INS and ONH showed a number of features suggestive of innervational dysregulation. Neuromuscular junctions were almost 50% smaller than in control EOM, but resembled the smaller neuromuscular junctions of the idiopathic INS and INS/albinism EOM. Additionally, there was an increase in the density of slow myofibers, at 28% of total myofibers, compared to idiopathic INS and normal controls, at 22% and 16% respectively. Most striking was the presence of the immature gamma subunit of the acetylcholine receptor on fast myofibers in the neuromuscular junctions from the muscles obtained from INS patients with ONH, at almost 100%, compared to EOM from patients with idiopathic INS and to controls, where this occurred only rarely. Conclusions: Similar to our previous results for muscles from subjects with INS and albinism, it appears that the EOM in patients with INS and ONH have changes suggestive of a dysinnervation syndrome. This includes increased density of neuromuscular junctions which are reduced in size, as well as retention of the gamma subunit on fast myosin-expressing myofibers. These results suggest potential new approaches that focus on neuromuscular junction maturation that might be used to alleviate the abnormal oscillatory movements associated with INS. Commercial Relationships: Linda K. McLoon, None; Matthew D. Kunz, None; Joost Felius, None; David Stager, None; Jill S. Anderson, None; Erick D. Bothun, None Support: NIH RO1EY015313, NIH P30EY11375, Minnesota Lions and Lionesses, Research to Prevent Blindness, Inc. Program Number: 3999 Presentation Time: 10:00 AM–10:15 AM Clinical Contrast Sensitivity (CS) Testing in Patients with Infantile Nystagmus Syndrome (INS) Before and After Eye Muscle Surgery Richard W. Hertle, megan cochran. Ophthalmology, Children’s Hosp Medical Ctr of Akron, Akron, OH. Purpose: The purpose of this report is to characterize the change in contrast sensitivity using a commercially available technique in patients with INS before and after eye muscle surgery. Methods: This is a prospective, case series using the CSV-1000ER (VectorVision) contrast sensitivity (CS) test performed binocularly, with best corrected acuity, under office lighting (~85.0 candelas [cd] m2), before and 6 weeks after eye muscle surgery for nystagmus. The CS values are documented in log units. Sensitivity levels at each frequency ranged from 0.70 to 2.08 (3 cpd), 0.91 to 2.29 (6 cpd), 0.61 to 1.99 (12 cpd), 0.17 to 1.55 (18 cpd) log units. The Friedman test was used to evaluate the differences in the CS before and after surgery. The correlation between the absolute change in CS against the change in visual acuity was also evaluated using the Spearman correlation coefficient (r). Results: 25 patients with INS patients aged 12-55 years are included in this report. The INS patients’ best binocular acuity ranged from 20/125 to 20/30. Associated sensory system deficits included albinism, strabismus, amblyopia, and optic nerve dysplasia and retinal dystrophy. There was a statistically significant increase in CS at 6 weeks after surgery (P< .0012). There was no correlation between in visual acuity changes after surgery and the improvement in CS (r=.49, P=.10). Conclusions: INS patients with or without sensory system deficits display deficiencies in CS function which improves after eye muscle surgery independent of changes in high spatial frequency acuity. Enhanced CS may explain the subjective improvement in vision patients report after eye muscle surgery for nystagmus. CS may have potential as a primary clinical outcome measure in interventional trials in patients with INS. Commercial Relationships: Richard W. Hertle, None; megan cochran, None Support: The Rebecca Considine Research Institute, Akron Children’s Hospital, Akron Ohio 445 Oculoplastics Wednesday, May 06, 2015 11:00 AM–12:45 PM Exhibit Hall Poster Session Program #/Board # Range: 4733–4763/D0178–D0208 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 4733 Poster Board Number: D0178 Presentation Time: 11:00 AM–12:45 PM Current Anesthetic Practices Among Oculoplastic Surgeons Anna Berry1, Jason Sokol1, Peter Timoney2. 1Ophthalmology, University of Kansas Medical Center, Prairie Village, KS; 2 Ophthalmology, University of Kentucky, Lexington, KY. Purpose: To evaluate the practice of and influencing factors on the choice of anesthesia for various orbital surgeries by Oculoplastic surgeons. Methods: An IRB exempt anonymous survey using REDCap electronic capture tools hosted at University of Kansas Medical Center was sent via email to the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASPORS) members. The survey contained two parts for each surgical procedure: anesthetic preference and primary influencing factor. Demographics including number of years in practice and practice type were also collected. Responses were analyzed using standard statistical methods. Results: One hundred and eighteen ASOPRS members responded to the survey during a two-week period for a response rate of 23.6%. General anesthesia was the anesthetic method of choice for eight of the nine surgical procedures: enucleation (88.1%), evisceration (74.6%), external dacryocystorhinostomy (DCR) (54.2%), endoscopic DCR (55.1%), endoscopic brow lift (37.3%), external ethmoidectomy (49.2%), orbital floor decompression (95.8%), and ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology lateral wall orbital decompression (94.1%). Monitored anesthesia care (MAC) was the anesthetic of choice for open brow lift (68.6%). “Current facility practices” was the primary factor for anesthetic choice with endoscopic DCR (30.0%), open brow lift (32.2%), and endoscopic brow lift (32.2%). “Fellowship training” was the primary choice with orbital floor decompression (45.8%) and lateral wall orbital decompression (44.9%). The category “other” was the primary factor for enucleation (50.9%), evisceration (50.9%), external DCR (42.4%) and external ethmoidectomy (20.3%). Patient comfort was the most frequent response for “other” for each surgical procedure. Conclusions: General anesthesia is the most common anesthetic method used but the underlying reasoning for the choice varied by surgical procedure. The most agreement by ASOPRS members on anesthetic choice was found, in descending order, for orbital floor decompression, lateral wall orbital decompression, enucleation, and evisceration. Methods: We performed a prospective, non-randomized assessment of 55 patients. 30 were undergoing eyelid surgery under local anesthesia (LA) and 25 were undergoing squint surgery under general anesthesia (GA). All the patients were treated in similar conditions. Anxiety was evaluated pre-operatively by the French version of the APAIS. This scale is composed of 6 simple questions: 2 evaluate the anxiety regarding anesthesia, 2 concern anxiety about the surgery and 2 questions evaluate the need for information about the surgery and anesthesia. Each question is rated on a severity scale of 1 to 5. For each patient a global APAIS score, considering all parameters was calculated. Individual anesthesia, surgery and need for information APAIS scores were also calculated. The APAIS scores were collected and tabulated. The data was analyzed with nonparametric Mann Whitney U, ANOVA, Tukey’s and Bartlett’s tests. P<0.05 was considered significant Results: Of the 55 patients studied, 24 were female. the mean age was 54 years. The global anxiety scale was not significantly different between male and female patients (P=0.09). Also, there was no significant difference in global and surgery APAIS scores between the oculoplastic and strabismus surgery groups (P=0.38). Likewise, the need for information was similar in both groups of patients. However, there was significant difference in APAIS scores between GA and LA groups, the GA group, having higher APAIS scores (P=0.002) Conclusions: The APAIS assessment scale revealed similar anxiety levels and need for information in both oculoplastic and strabismus procedures. Higher anxiety levels were found for GA than LA. This study has clinical implications as results of pre-operative anxiety assessment can assist with operative and post-operative patient management. This is the first study using the APAIS scale for pre-operative evaluation of anxiety in oculoplastic and strabismus surgeries Percentage of anesthetic choice per procedure. *Margin of Error Commercial Relationships: Anna Berry, None; Jason Sokol, None; Peter Timoney, None Program Number: 4734 Poster Board Number: D0179 Presentation Time: 11:00 AM–12:45 PM EVALUATION OF PREOPERATIVE ANXIETY IN PATIENTS UNDERGOING OCULOPLASTIC AND STRABISMUS SURGERY; A PROSPECTIVE STUDY Camille Bosc5, JOYCE MBEKEANI2, 3, franck jaspart1, HELENE DALENS5, Frederic Chiambaretta5, Hachemi Nezzar5, 4. 1CHU Clermont Ferrand, Clermont Frrand, France; 2Dept of Surgery,. North Bronx Health Network, Bronx, NY, New York, NY; 3Dept of Ophthalmology and Visual Science, Albert Einstein College of Medicine,, new York, NY; 4OPHTHALMOLOGY, KING FAISAL SPECIALIST HOSPITAL & RESEARCH CENTER, Riyadh, Saudi Arabia; 5ophtalmologie, CHU Clermont Ferrand, Clermont Ferrand, France. Purpose: Preoperative anxiety is well known to influence response to anesthesia and analgesic consumption The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has been utilized in various surgical scenarios and found to have validity in evaluating preoperative anxiety. The purpose of this study is to evaluate the preoperative anxiety in adult patients undergoing oculoplastic and squint surgeries using the APAIS scale. To date no such study has been conducted Commercial Relationships: Camille Bosc, None; JOYCE MBEKEANI, None; franck jaspart, None; HELENE DALENS, None; Frederic Chiambaretta, None; Hachemi Nezzar, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 4735 Poster Board Number: D0180 Presentation Time: 11:00 AM–12:45 PM Aesthetic benefits of CO2 laser photorejuvenation treatment for malar mounds (festoons) Juan C. Jimenez1, Jose R. Montes1, Joseph Maldonado2. 1 Ophthalmology, UPR Medical Sciences Campus, San Juan; 2School of Medicine, UPR Medical Sciences Campus, San Juan. Purpose: To review the effectiveness of CO2 laser for malar mounds in patients undergoing lower eyelid blepharoplasty. Methods: Retrospective medical chart review of patients that had lower eyelid blepharoplasty and received CO2 laser in an oculoplastic practice during the past 3 years. Outcome measures were improvement or resolution of malar mounds after CO2 laser treatment. Inclusion criteria were malar mounds in addition to periocular fat herniation. Exclusion criteria were any patient that has had lower lid blepharoplasty in the past. Age, sex, smoking status, medical history, type of skin (Fitzpatrick scale), degree of skin thickness and laser parameter were recorded. Pre and post operative pictures were compared by three independent observers to determine if CO2 laser was effective as a treatment for malar mounds. Results: Six patients (2 men and 4 women) with a mean age of 71 years old + 10 (standard deviation; range of 57 - 86 years old) that met the inclusion criteria underwent treatment with partial festoon resolution in 2 (33%) and complete festoon resolution in 4 (66%). Three (50%) patients had skin type IV, 2 (33%) had skin type III-IV and 1 (17%) had skin type IV-V. Four (66%) patients had medium skin thickness, 1 (17%) had large skin thickness and 1 (17%) had fine to medium skin thickness. Complications were scleral show in 3 (50%), hyperemia in 6 (100%) and hyperpigmentation in 1 (17%). Conclusions: CO2 laser ablation is an effective and safe procedure for treatment of malar mounds. Ideal patients are those with fine to medium skin thickness and mild to moderate edema. The darker the skin the higher the risk for post inflammatory hyperpigmentation which is a common adverse event that can be prevented or treated with topical agents such as Hydroquinone 4% and anti-inflammatory drugs. Other adverse events such as erythema and scleral show are common and usually self limiting. Commercial Relationships: Juan C. Jimenez, None; Jose R. Montes, None; Joseph Maldonado, None Program Number: 4736 Poster Board Number: D0181 Presentation Time: 11:00 AM–12:45 PM Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil: a novel non-surgical treatment for cicatricial ectropion Alexandra E. Levitt1, Bradford Lee2, Audrey C. Ko1, Wendy W. Lee1. 1 Bascom Palmer Eye Institute, Miami, FL; 2Shiley Eye Center, San Diego, CA. Purpose: Periocular scarring can cause significant functional and cosmetic distortions of the eyelid. Surgical treatments for cicatricial ectropion (CE) using full-thickness skin grafting are associated with complications such as recicatrization, donor site morbidity, and textural and pigmentary abnormalities. This case series reports on the efficacy and safety of a novel non-surgical approach to treating CE using ablative fractional laser resurfacing (AFLR) and laser-assisted delivery of 5-fluorouracil (LA 5-FU). Methods: The records of three patients with CE who were treated with AFLR and LA 5-FU were retrospectively studied. All patients received at least 3 rounds of AFLR with Erbium:YAG 2940nm, YSGG 2790nm, or CO2 10600nm lasers with the additional use of topically applied LA 5-FU immediately following treatment. Functional and cosmetic outcomes were evaluated via fluorescein and lissamine green staining of the ocular surface, Ocular Surface Disease Index questionnaire (OSDI), Patient and Observer Scar Assessment Scale (POSAS), a questionnaire on patient satisfaction with scar appearance, and clinical photographs documenting the external exam. Results: Case 1 presented with CE, lagophthalmos, severe pigmentary and textural skin abnormalities, and exposure keratopathy secondary to facial burns, and underwent 4 AFLR treatments along with LA 5-FU. Following treatment, he had complete resolution of lagophthalmos, CE, brow elevation, and keratopathy (Figure 1). Cases 2 and 3 presented with CE and eyelid retraction following Mohs reconstructions and received 3 treatments of AFLR with LA 5-FU. Both saw improvement in fluorescein staining. Case 2 had complete resolution of CE, symptomatic improvement of dry eye syndrome (reduction of OSDI) and reduced lissamine green staining. Case 3 had partial improvement of CE but ultimately opted for skin grafting. All patients had marked improvement in scar elevation and textural and pigmentary abnormalities and high self-reported satisfaction with treatment. No adverse events were reported. Conclusions: AFLR with LA 5-FU appears to be a safe and effective treatment for CE with the additional benefit of improving scar elevation, skin texture and pigmentary abnormalities, all of which cannot be addressed by surgical interventions. Commercial Relationships: Alexandra E. Levitt, None; Bradford Lee, None; Audrey C. Ko, None; Wendy W. Lee, Cutera (C), Lumenis (C) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 4737 Poster Board Number: D0182 Presentation Time: 11:00 AM–12:45 PM Anatomical Relationships of Hyaluronic Acid Gel Following Injection to the Temporal Fossa Rao Chundury1, Adam Weber1, Nathaniel Sears1, Jennifer McBride3, Thomas Plesec2, Julian D. Perry1. 1Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH; 2Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH; 3Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH. Purpose: With age, the subcutaneous fat, temporalis muscle and temporal bones are thought to thin resulting in temporal hollowing. A restorative and more youthful appearance can be accomplished using hyaluronic acid (HA) filler rejuvenation. Hyaluronic acid fillers have been commonly used to address temporal fossa hollows by injecting either deep to the temporalis muscle or subcutaneously. However, there have been case reports of vascular injury when injecting within this area. This study aims to investigate the histologic location of HA gel following subcutaneous injection for temporal fossa hollows in cadaver specimens. Methods: Bilateral temporal fossas of 3 fresh cadaver specimens (6 samples) were dissected following subcutaneous injection of HA, Belotero Balance (Merz Aesthetics, Inc., Greensboro, NC, USA). Each injection was delivered in a fan and cross-hatch pattern directly within a subcutaneous injection plane (Figure 1). Conservative post-injection molding to the smooth the contour was performed on each specimen similar to that used in a clinical setting. The soft tissue specimens were grossly dissected to the supraperiosteal plane. The specimens were fixed, stained with H&E and then histologically examined. Results: Hyaluronic acid was directly visualized in all specimens as shown in Figure 2. The majority (95%) of HA was noted to be deposited in subcutaneous fat in all but one specimen. In one specimen HA was noted to be in close proximity to a muscular artery (Figure 2). Conclusions: This study presents the first histoanatomical view of the position of HA following subcutaneous injection of the temporal fossa. Subcutaneous injection of filler in the temporal region may pose risk for inadvertent intravascular injection due to the proximity of the superficial temporal fascia and associated temporal vessels. Care should be taken to superficially inject filler when injecting subcutaneously for temporal hollows. Figure 1: External photograph of cadaver demonstrates temporal fossa dissection borders post-HA injection and molding Figure 2: Low power photomicrograph of hemotoxylin- and eosin-stained temporal fossa sample showing HA filler within the subcutaneous fat (black arrows) and surrounding a muscular artery (blue arrow). 18x magnification Commercial Relationships: Rao Chundury, None; Adam Weber, None; Nathaniel Sears, None; Jennifer McBride, None; Thomas Plesec, None; Julian D. Perry, None Support: Cleveland Clinic Foundation Travel Subsidy ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 4738 Poster Board Number: D0183 Presentation Time: 11:00 AM–12:45 PM Google Glass in Oculoplastic Surgery: measurement of the margin reflex distance Rohini Rao, Catherine Choi, Michael K. Yoon. Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, MA. Purpose: Google Glass is a commercially available wearable technology consisting of a camera, optical display, microphone, touchpad, accelerometer, gyroscope, and bone-conduction speaker. It is relatively new to the market, and its application in healthcare has been rapidly expanding.1,2 Amongst its use in oculoplastic surgery is documentation of eyelid position. The margin reflex distance-1 (MRD-1) is the distance between the corneal light reflex and the upper eyelid margin in primary gaze. We have demonstrated the use digital photography with a handheld camera in image measurements of eyelid position. In the present study, we explore whether Google Glass can also be used for digital photography analysis of eyelid position. This proof of concept study compared clinically measured MRD-1 and Google Glass photographs. 1. Emergency providers see big potential for Google Glass. ED Manag. 2014;5(26):55-8. 2. Kantor J. First look: google glass in dermatology, mohs surgery, and surgical reconstruction. JAMA dermatology 2014;150(11):1191. Methods: 11 healthy patients (22 eyes) without ophthalmic disease were examined and photographed. The MRD-1 was measured with a handheld ruler. Google Glass photographs were taken of each subject with a ruler placed on the forehead in plane with the corneal surface. Digital image analysis of the photographs was performed to obtain the MRD-1 with ImageJ (http://rsbweb.nih.gov/ij). Unpaired t-test was used to compare the clinical measurement to the image analysis (www.graphpad.com/quickcalcs/ttest1.cfm). Results: There were 10 women and 1 man. Mean clinical MRD-1 was 4.16 (range 3.0 to 6.0). The mean digital MRD-1 was 4.30 (range 3.08 to 5.78). Unpaired t-test revealed no statistically significant difference between these two groups (P = 0.56). Conclusions: Google Glass offers the ability to analyze photographs for clinically relevant measurements. Our analysis demonstrates that these measurements were not statistically different from clinical evaluation. There were limitations to using this device, including camera positioning. However, this proof of concept study opens the possibility to modifications to the hardware and/or software of Google Glass to refine the photographic ease of use and resolution. Commercial Relationships: Rohini Rao, None; Catherine Choi, None; Michael K. Yoon, None Program Number: 4739 Poster Board Number: D0184 Presentation Time: 11:00 AM–12:45 PM Effect of Upgaze on Lower Eyelid Position in Congenital Ptosis Livia Teo1, 2, Chang Yeom Kim2, Sang Yeul Lee2. 1Oculoplastics, Singapore National Eye Centre, Singapore, Singapore; 2 Oculoplastics, Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea (the Republic of). Purpose: The purpose of this study was to determine the effect of upgaze on lower eyelid position in patients with unilateral and bilateral congenital ptosis. Methods: Thirty- five patients were recruited for this study. Clinical photographs and measurements were taken in primary gaze and upgaze. An 8-millimeter circular disc was placed on the child’s forehead as a measuring guide. Measurements taken from photograph and clinical records include inferior scleral show (ISS), vertical lower lid height (LL) and canthal tilt angle (CTA). Results: There were 35 patients with congenital ptosis. 62.9% (n=22) of them were male. The mean age of the patients was 4.38 ± 1.81 years. 62.9% (n=22) of the patients had unilateral ptosis and 37.1% (n=13) had bilateral ptosis. There was more ISS in unilateral ptosis eyes compared to the normal side in both primary gaze (0.3± 0.5mm; 0.1± 0.2mm) (p<0.05), as well as in upgaze (3.3± 1.3mm; 2.1± 1.3mm) (P< 0.01); with corresponding increase in ISS on upgaze (p<0.05). There was also more ISS in unilateral ptosis eyes as compared to bilateral ptosis eyes in primary gaze (0.3 ± 0.5mm; 0.1± 0.2mm) (p<0.05) as well as in upgaze (3.3± 1.3; 1.6± 1.3)(P<0.01); with accompanying increase in ISS on upgaze (P<0.01). There was less elevation of the lower lid in ptosis eyes (0.5± 0.7mm) versus normal eyes (0.8± 0.7mm) but this was not statistically significant (p=0.07). CTA was lower in ptosis eyes compared to normal eyes in primary gaze (2.8± 3.5°; 5.2± 3.4°) (p<0.01) as well as in upgaze (0.7± 3.9°; 3.2± 4.6°)(p<0.05). Conclusions: Upgaze appears to increase inferior scleral show in children with congenital ptosis. We propose that the contraction of the superior complex to allow foveation results in compensatory inferior rectus contraction and a tightening of Lockwood ligament with superior globe displacement. There is underdevelopment of the levator muscle in congenital ptosis, which results in less compensatory contraction of the lower eyelid retractor and less elevation of the lower lid in ptosis eyes. Canthal tilt is lower in congenital ptosis than in normal eyes on primary gaze and upgaze. The weaker levator muscle is unable to counteract this, hence resulting in greater downward angulation at the lateral canthus (the fulcrum). It is important to understand the vectors of movement, as patients need to be counseled for possible cosmetic asymmetry on upgaze. Commercial Relationships: Livia Teo, None; Chang Yeom Kim, None; Sang Yeul Lee, None Program Number: 4740 Poster Board Number: D0185 Presentation Time: 11:00 AM–12:45 PM Frontalis muscle flap transposition as a novel technique for lateral eyebrow ptosis repair Preethi S. Ganapathy, Rao Chundury, Julian Perry. Cleveland Clinic Cole Eye Institute, Cleveland, OH. Purpose: Eyebrow ptosis is a significant aesthetical and functional age-related change of the upper face. We previously described anatomic variation in frontalis muscle landmarks in elderly Caucasian cadavers that may account for the pathogenesis of lateral brow ptosis; we subsequently developed a novel, minimally invasive technique to transpose a flap of lateral frontalis muscle to improve lateral brow elevation. In this study, we tested the hypothesis that the frontalis muscle flap transposition (FMFT) procedure would significantly elevate the lateral brow and substantially improve lateral eyebrow ptosis. Methods: The charts of patients who underwent FMFT from December 2013 through September 2014 were reviewed. In brief, a 1.5cm ellipse of skin and subcutaneous tissue was first excised in the region of a lateral forehead rhytid. Blunt dissection exposed the lateral frontalis muscle and a pedicle flap was created, trimmed, and transposed laterally in a graded approach to achieve optimal eyebrow height and contour. The incision was closed with 5-0 polypropylene suture. Pre- and post-operative photos were taken of each patient, and the following parameters assessed using Image J (provided by the National Institutes of Health): corneal diameter (CD), margin reflex distance (MRD1), central brow height (CBH), medial brow height (MBH), lateral brow height (LBH), and central pupillary brow height (CPBH). Measurements were normalized to CD, and an average CD of 11.5mm was used to calculate millimeters of brow height ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology elevation. Statistical analysis was performed using the Student’s t-test with p<0.05 considered significant. Results: 32 total patients were analyzed; of these 27 underwent FMFT + blepharoplasty and 5 underwent FMFT alone. In the combined procedure group, there was significant increase in LBH by 1.8mm (p<0.05), CPBH by 1.76mm (p<0.05), and MRD1 by 0.91mm (p<0.01). In brows that underwent FMFT alone, there was a greater significant increase in LBH by 4.1mm (p<0.05), CPBH by 3.32mm (p<0.05), and no significant change in MRD1. Conclusions: We have shown that FMFT alone results in substantial lateral brow elevation. In combination with blepharoplasty, this technique provides a less robust, yet still significant elevation in LBH. This study provides the first objective outcome measures for FMFT as a novel and effective technique for lateral eyebrow ptosis repair through a small concealed incision. Commercial Relationships: Preethi S. Ganapathy, None; Rao Chundury, None; Julian Perry, None Program Number: 4741 Poster Board Number: D0186 Presentation Time: 11:00 AM–12:45 PM Frontalis Suspension for Congenital Ptosis: Evaluation of Suture Material in Pediatric Patients Cajal Patel1, 2, Chrysavgi Adamopoulou2, Leemor Rotberg2. 1 Ophthalmology, Wayne State University, Detroit, MI; 2Children’s Hospital of Michigan, Detroit, MI. Purpose: Congenital ptosis is caused by myogenic dysgenesis, which can cause deprivation or refractive amblyopia in young patients. To compensate, they often adopt an anomalous head position, which can limit mobility and cause neck strain. For patients with poor levator function, the ptosis is typically managed by frontalis sling to correct the head position and manage or prevent amblyopia. Several studies have evaluated the outcomes of this procedure. However, patients with ptosis of any etiology as well as of all ages were included in those studies. We assessed the surgical outcomes of pediatric patients undergoing frontalis sling strictly for congenital ptosis without a previous history of eyelid surgery. We hypothesized that recurrence rates would vary depending on the material used. Methods: The charts of 39 patients with congenital ptosis who underwent frontalis sling were retrospectively reviewed. All surgeries were performed by the same surgeon and the same surgical technique was used in all patients. Forty-nine (n=49) eyes were included in the study. Patients with previous lid surgery or ptosis of an etiology other than congenital were excluded. The mean age of patients was 9.5 months. Data collected at the time of surgery included age, visual acuity, refractive error, margin to light reflex distance(MRD1), levator function, suture material, as well as the presence of amblyopia, strabismus or chin up position. MRD 1 was also recorded in all post-operative visits as well as the time to recurrence. The average follow-up was 18.1 months for those who did not develop recurrence. Suture material used included ptose-up, (N=17),supramid (N=28) and silicone rods (N=4) . Results: No statistical significance was found in the rate of recurrence between the two materials. Conclusions: Evaluation of a larger sample size may help determine if suture material has any bearing on surgical outcome, recurrence and complication rate, which may help guide surgical practice in the management of congenital ptosis. Commercial Relationships: Cajal Patel, None; Chrysavgi Adamopoulou, None; Leemor Rotberg, None Program Number: 4742 Poster Board Number: D0187 Presentation Time: 11:00 AM–12:45 PM Total Upper Eyelid Reconstruction with Modified Cutler-Beard Procedure Using Autogenous Auricular Cartilage Shilpa G. Reddy1, James C. Fleming1, Brian Fowler1, Salil K. Mandal2. 1Ophthalmology, University of Tennessee, Memphis, TN; 2 Medical College of Calcutta, Calcutta, India. Purpose: In this study, we aim to evaluate the efficacy of the modified Cutler-Beard procedure using autogenous ear cartilage for tarsal plate reconstruction in the repair of upper eyelid defects greater than 70%, as the procedure is traditionally used only for lid large lid defects up to 70%. In addition, we aim to discuss cost and safety of using autogenous ear cartilage rather than other alternatives, such as synthetic graft tissue and allografts, for tarsal plate reconstruction. Methods: This is a retrospective, interventional case series of eight patients over a period of three years. All patients had malignant tumors of the upper lid requiring removal of 70-100% of the upper eyelid. All patients’ lid defects were repaired using a modified Cutler-Beard procedure, utilizing autogenous auricular cartilage for stability of the lid that the tarsal plate normally imparts. Patient were followed over a period of six months to one year with postoperative ophthalmologic examinations and photos at each visit. Results: Upper eyelid recreation was successful in all cases without complications. The autogenous auricular cartilage graft maintined excellent architecture and motility in all patients at follow-up visits, resulting in good cosmetic result and functionality. Conclusions: The modified Cutler-Beard procedure using an autogenous auricular cartilage graft is an effective procedure for repair of eyelid defects greater than 70%, with good functional and cosmetic results. Moreover, it is particularly useful in resource-poor areas, due to lower cost than other available options, such as the use of synthetic graft tissue and allograft materials. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Patient with sebaceous cell carcinoma, which was excised. Modified Cutler-Beard procedure was then used to repair the lid defect. margin distances were calculated in pixels by digitally rendering vertical lines 15 degrees apart (00, 150, 30°, 45°, 60°, 75°, 90°, 105°, 120°, 135°, 150° and 1800) using NIH ImageJ64 software (Bethesda, MD). Eyelid contour was computed and evaluated as the ratios of equidistant angles from the midline similar to a previously published study (for example: 105°/75°). A ratio of 1 represents favorable contour. Student’s t-tests were used to compare the pre-operative and post-operative contour ratios to the fellow non-operative eye. Results: Eight patients met inclusion criteria. Central eyelid elevated by a mean of 285.92% post-ELR. The mean lateral/medial ratios at each angle pre and post-ELR and in the fellow non-operative eye are listed in Table 1. The four central post-ELR lateral/medial ratios were significantly more symmetric than the fellow non-operative eye as shown in Table 2. Conclusions: Eyelid contour changes significantly following external levator resection for blepharoptosis. In this study, pre and post-ELR equidistance angle ratios were analyzed and compared to a fellow non-operative eye. The ELR procedure was found to result in a significantly improved eyelid contour when compared to the fellow non-operative eye. Table 1: Radial mid-pupil distance ratios Table 2: p-value: Comparing pre-ELR and post-ELR to fellow nonoperative eye Commercial Relationships: Maria M. Choudhary, None; Rao Chundury, None; Tal Rubinstein, None; Julian Perry, None Another patient, with good lid opening after large eyelid defect repaired with modified Cutler-Beard procedure. Commercial Relationships: Shilpa G. Reddy, None; James C. Fleming, None; Brian Fowler, None; Salil K. Mandal, None Program Number: 4743 Poster Board Number: D0188 Presentation Time: 11:00 AM–12:45 PM Effect of External Levator Resection for Blepharoptosis Repair on Eyelid Contour Maria M. Choudhary, Rao Chundury, Tal Rubinstein, Julian Perry. Cole Eye Institute, Cleveland, OH. Purpose: Eyelid contour is important for eyelid symmetry and represents an important clinical outcome after blepharoptosis repair. We sought to quantitatively determine the effect of external levator resection for blepharoptosis repair on upper eyelid contour. Methods: After obtaining Institutional Review Board (IRB) approval we retrospectively reviewed charts of consecutive patients undergoing unilateral external levator resection (ELR) for blepharoptosis repair at the Cole Eye Institute between June 2012 and October 2013. Exclusion criteria included concurrent or prior eyelid or eyebrow surgery, lack of appropriate photographs, and a known history of systemic disease affecting the eyelid. Preoperative and postoperative digital images of the palpebral fissure in primary gaze of patients were analyzed. Radial mid-pupil to eyelid Program Number: 4744 Poster Board Number: D0189 Presentation Time: 11:00 AM–12:45 PM Conjunctiva Muller Muscle Resection Belpharoptosis Repair: Efficient, Reliable and Predictable sara khandan1, John Koh2, 1. 1Ophthalmology, William Beaumont Hospital, Troy, MI; 2Ophthalmology, Wayne State University, Detroit, MI. Purpose: To demonstrate predictability and outcomes with conjunctiva Muller muscle resection (CMR) for blepharoptosis repair using a new algorithm. Methods: Retrospective review of 105 patients and 182 eyelids that underwent CMR at one site with a single surgeon. 77 women and 28 men aged between 25-90 years old. Measured endpoints included pre and post-operative MRD1, symmetry, complication rates and symptomatic dry eye post-operatively. Patients were followed for a 12 month post-operative period. Results: Pre-operative MRD1 ranged between -3 to +3 mm with a mean of 0.6 mm. Post-operative MRD1 ranged between 1 to 4.5 mm with a mean of 2.6 mm. 95.1% of patients had symmetry up to 1 mm and 89% up to 0.5 mm. 17.6% patients were undercorrected. 11.5% of patients were overcorrected. 1% of patients sustained a corneal abrasion post-operatively. Patients with glaucoma filtering blebs had no post-operative complications. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: Using a new algorithm, this modified CMR technique is highly reliable and predictable. It is an effective treatment for mild to severe ptosis; it does not worsen dry eye symptoms; and it can be using safely in the presence of glaucoma filtering blebs. Other advantages of CMR include preservation of natural eyelid contour and the ability to perform this procedure under general anesthesia. Commercial Relationships: sara khandan, None; John Koh, None Program Number: 4745 Poster Board Number: D0190 Presentation Time: 11:00 AM–12:45 PM A Retrospective Study Comparing Lateral Tarsal Strip with Everting Sutures to Two Other Surgical Methods for Lower Lid Involutional Entropion Repair Ru-ik Chee1, Gary J. Lelli1, Benjamin M. Levine1, Lorraine Cassidy2. 1 Ophthalmology, Weill Cornell Medical College, New York, NY; 2 Ophthalmology, Trinity College Dublin, Dublin, Ireland. Purpose: The Lateral Tarsal Strip with Everting Sutures (LTSES) procedure has been described as a simple effective surgery for involutional entropion. We performed a retrospective, observational clinical study to evaluate the outcomes of LTS-ES and two other surgical methods in the management of lower lid involutional entropion. Methods: We reviewed all surgeries performed for lower lid involutional entropion at the Royal Victoria Eye and Ear Hospital, Ireland, from January 2004 through December 2009. Patients were excluded if they had 1) less than 12 months of follow-up; 2) prior lid surgery, enucleation or trauma; 3) facial nerve palsy; 4) isolated use of everting sutures; 5) other causes of entropion such as cicatricial or congenital. Outcomes included any suboptimal result (recurrence of entropion, overcorrected ectropion, wound dehiscence), and need for re-operations. Student’s t, Chi-square, and Fischer’s exact tests were used in statistical analysis. Results: A total of 189 eyes from 164 patients were included. The most common procedure performed was LTS+ES (118 eyes, 62.4%), followed by Wies (43 eyes, 22.8%) and Wies with lateral full thickness wedge resection (Wies-R) (28 eyes, 23.7%). Mean age (77.2 vs. 80.2 years, p=0.1039), gender (59.3% vs. 46.5% males, p=0.1173), and follow up duration (16.3 vs. 19.9 months, p=0.944) were not significantly different between LTS-ES and non-LTS-ES groups. Suboptimal results were significantly lower for LTS-ES (6 of 118 eyes, 5.1%) compared to Wies (14 of 43 eyes, 32.6%; p<0.0001), Wies-R (7 of 28 eyes, 25%; p=0.0035), and both nonLTS-ES procedures combined (21 of 71 eyes, 29.6%; p=<0.0001). The proportion of cases requiring re-operations was not significantly lower for LTS-ES (3 of 118 eyes, 2.5%) compared to Wies-R (3 of 28 eyes, 10.7%; p=0.0848), but significantly lower compared to Wies (9 of 43 eyes, 20.9%; p=0.0004), and both non-LTS-ES procedures combined (12 of 71 eyes, 16.9%; p=0.0006). Conclusions: The LTS-ES procedure was associated with higher rates of success with no suboptimal outcome (94.9%), compared to the Wies (67.4%) or Wies-R (75%) procedures. LTS-ES addresses lateral canthal tendon laxity and retractor attenuation, resulting in effective repair of involutional entropion. To our knowledge, our study is the first to directly compare surgical outcomes for LTS+ES, Wies and Wies-R procedures. Commercial Relationships: Ru-ik Chee, None; Gary J. Lelli, None; Benjamin M. Levine, None; Lorraine Cassidy, None Program Number: 4746 Poster Board Number: D0191 Presentation Time: 11:00 AM–12:45 PM Eyebrow position following upper blepharoplasty Adam Weber1, Suhail Dar2, Tal Rubinstein1, Julian D. Perry1. 1Cole Eye Institute, Cleveland Clinic, Cleveland, OH; 2Case Western Reserve School of Medicine, Cleveland, OH. Purpose: To evaluate the effect of upper blepharoplasty on eyebrow height, accounting for ocular dominance, fat excision, change in MRD1, and degree of dermatochalasis. Methods: Retrospective review of patients undergoing upper blepharoplasty between January 2013 and July 2014. Patients with a prior history of ocular trauma, disease, and surgery were excluded. Digital photographs were analyzed using NIH ImageJ software to measure pre and postoperative eyebrow height at the medial, central, and lateral positions, MRD1, and dermatochalasis. Univariable comparisons of brow height and MRD1 were performed. A multivariate analysis was used to assess for the effect of percentage change in MRD1 and dermatochalasis and of ocular dominance and fat excision in mean percentage change of eyebrow height. Results: Charts of 19 patients were reviewed. Mean age was 73.2 years (SD = 8.86). There were 9 male (47.4%) and 10 female (52.6%) patients. There were 11 right eye dominant (57.9%) and 8 left eye dominant (42.1%) patients. 13 patients (68.4%) underwent fat removal. A univariable comparison found insufficient evidence to suggest a significant change from 0 postoperatively in brow height at all positions. A multivariable comparison found insufficient evidence to suggest MRD1, ocular dominance, or dermatochalasis were significantly associated with mean percentage change in brow height at all positions with or without fat excision. Conclusions: Upper blepharoplasty does not change eyebrow height at the medial, central, or lateral positions, after accounting for any impact of ocular dominance, fat excision, change in MRD1, or degree of dermatochalasis. Commercial Relationships: Adam Weber, None; Suhail Dar, None; Tal Rubinstein, None; Julian D. Perry, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 4747 Poster Board Number: D0192 Presentation Time: 11:00 AM–12:45 PM Surgical Outcomes and Dry Eye Symptoms following Anterior or Posterior Approach Blepharoptosis Surgery in the Elderly Patient Saba Alniemi1, Ahsen Hussain2, David Hodge1, Elizabeth Bradley1. 1 Department of Ophthalmology, Mayo Clinic, Rochester, MN; 2St. Paul’s Eye Unit, Liverpool, United Kingdom. Purpose: Dry eye symptoms increase in the elderly and following blepharoptosis surgery. This study aims to compare the surgical outcomes and prevalence of dry eye symptoms following blepharoptosis surgery in patients ≥ 80-years-old when compared to younger, case matched controls. Methods: A retrospective chart review of 166 patients ≥ 80-years-old who were post-blepharoptosis surgery (+/- blepharoplasty), through an anterior or posterior approach for involutional ptosis at the Mayo Clinic in Rochester, MN, between January 1, 1990 and December 31, 2010 was performed. A younger case matched control group of 169 patients ≥40 and ≤79-years-old who had undergone the same operation(s) within 12 months of one another was also reviewed. Patients with history of corneal graft, conjunctival surgery, ocular surface disease besides dry eye, history of trauma, previous ptosis surgery within the past 10 years, neurogenic ptosis, mechanical ptosis, or the inability to follow up within 6 months of surgery were excluded. Results: A total of 335 consecutive patients were included in the study: 169 younger patients (mean age 67.4, SD 7.79) and 166 elderly patients (mean age 83.8, SD 3.37). The majority of patients were female (57%) and Caucasian (96.4%). There were more non-white patients in the younger group (p=0.02). The majority of patients (55.8%) underwent a combined levator advancement and blepharoplasty. Preoperatively, 134 patients (40%) reported dry-eye symptoms. At the first post-op visit (mean 14 days), 35 (10.5%) patients had new or worse dry-eye. This increased to 58 (17.3%) patients by the second post-op visit (performed within 6 months). No significant difference was found between the groups for new or worse dry-eye at the 1st or 2nd post-op visit (p=0.54). The presence of preoperative dry-eye had no relation to worsened symptoms by 6 months (p=0.17). Pre-operative mean reflex distance 1 (MRD1) was smaller (p=0.002) for the 80+ group. There was no significant difference in surgeon, gender, procedure type, MRD1 post-op, MRD1 asymmetry post-op, or complication rate between the two groups (p-values >0.05). Conclusions: Dry eye symptoms and adverse surgical outcomes were not found to be increased post-blepharoptosis surgery (+/blepharoplasty) in the elderly population when compared to younger case-matched controls. Commercial Relationships: Saba Alniemi, None; Ahsen Hussain, None; David Hodge, None; Elizabeth Bradley, None Support: Research to Prevent Blindness Program Number: 4748 Poster Board Number: D0193 Presentation Time: 11:00 AM–12:45 PM Congenital Blepharoptosis: Clinical Characteristics and Surgical Outcomes in Mexican Population Cesar M. Portilla-Espinosa, Pablo J. Guzman-Salas, Jose L. TovillaCanales. Instituto de Oftalmologia Fundacion Conde de Valenciana, Cuahutemoc, Mexico. Purpose: Report the number and clinical characteristics of patients with congenital ptosis who underwent surgery and their outcome in a period of time. Methods: Retrospective case series study in one academic tertiary care Oculoplastics and Orbit Department with 243 patients diagnosed with congenital blepharoptosis from January 2007 to January 2014. We reviewed clinical electronic records from patients of “Instituto de Oftalmologia Conde de Valenciana” in Mexico City, regarding the following: age, gender, eye (s) affected, palpebral fissure, ptosis severity graded as no ptosis (100 mm or more), mild (80-99 mm), moderate (40-79 mm) and severe (0-39 mm) on their first consultation, type of surgery (if practiced); palpebral fissure and ptosis severity after surgery. Results: The total population for this study was 243 patients. Average age of 7.95±10.13 years, with 139 (57.2%) males and 99 (40.7%) females. 90 patients (37%) had only their right eye affected, 124 patients (51%) had only their left eye affected and 29 patients (11.9%) had both eyes affected. Average palpebral fissure 60.2±16.2 mm. We had 159 (65.4%) patients with moderate ptosis, 44 (18.1%) with mild ptosis, 39 (16%) with severe ptosis, and 1 patient without ptosis (0.4%). 134 (55.1%) underwent surgery, of which 55 (41% of this specific surgery group) had frontal suspension, 38 (28.3%) had resection and reinsertion of aponeurosis, 14 (10.4%) had supramaximal reinsertion, 1 (0.7%) had Fassanella-Servat and 1 (0.7%) had Mullerectomy. After surgery the average palpebral fissure was 79.4±15.2 mm. After surgery, 51 patients (46.8%) had mild ptosis, 43 (39.4%) had moderate ptosis, 14 (12.8%) had no ptosis and 1 (0.4%) remained with severe ptosis. Conclusions: We had a predominant male population in the first decade of life, with the majority having only one eye affected; most had mild to moderate ptosis and half of them were treated with surgery. The most practiced surgery was frontal suspension and the outcomes were mostly satisfactory. This study provides valuable epidemiological information for and is the first of its kind in Mexico. Commercial Relationships: Cesar M. Portilla-Espinosa, None; Pablo J. Guzman-Salas, None; Jose L. Tovilla-Canales, None Program Number: 4749 Poster Board Number: D0194 Presentation Time: 11:00 AM–12:45 PM Buccal mucous membrane grafting for cicatricial entropion Hee-Bae Ahn, Seoung Hyun An, Choi Woo seok, Eun Jung Sohn. Ophthalmology, Dong-A University Hospital, Busan, Korea (the Republic of). Purpose: To evaluate the use of anterior lamellar recession or posterior lamellar resection with buccal mucous membrane grafting for treatment of cicatricial entropion. Methods: A retrospective chart review was performed of all cases of anterior lamellar recession or posterior lamellar resection with buccal mucous membrane grafting performed by one surgeon for cicatricial entropion or trichiasis of the upper or lower eyelids from June 2008 to May 2014. The height of each graft was measured during and after surgery and the amount of contraction was measured for each graft. Results: 12 eyelids underwent anterior lamellar recession, 14 eyelids underwent posterior lamellar resection and all patients had procedure of buccal mucosal graft. 26 eyelids (14 upper lids, 12 lower lids) were identified in 16 patients. The patients’ mean age was 56.3 years. The mean follow-up period was 7.9 months (range 2-24 months). One eyelid underwent repeat grafting for recurrent entropion secondary to graft dislocation. The mean graft contraction rate was 18% after 12 months. There was a reduction in the frequency of patients reporting discomfort, foreign body sensation, tearing and pain following treatment in 23 eyelids. 2 eyelids had recurrent entropion that was managed by electrolysis or cilia epilation. Conclusions: Minimal graft contraction can be anticipated with the use of mucosal graft. Anterior lamellar recession or posterior lamellar resection with buccal mucous membrane grafting in patients with cicatricial entropion is a simple and cosmetically effective procedure without complications. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Hee-Bae Ahn, None; Seoung Hyun An, None; Choi Woo seok, None; Eun Jung Sohn, None Program Number: 4750 Poster Board Number: D0195 Presentation Time: 11:00 AM–12:45 PM Prevalence of the Histopathologic Etiologies of Lacrimal Gland Lesions Judy Chen, Vinay K. Aakalu, Pete Setabutr. Ophthalmology, University of Illinois Chicago, Chicago, IL. Purpose: To describe the prevalence of the etiologies of lacrimal gland lesions treated at a tertiary, urban referral center in the United States, as proven by histopathologic diagnosis from surgical biopsy. Methods: A retrospective chart review was performed of the clinical records of patients who underwent lacrimal gland biopsy by the oculoplastics service from 2010 to 2014 at a tertiary, urban referral center in the United States. Data such as patient demographics, clinical presentation, imaging studies, and pathologic diagnosis were recorded. Results: Forty patients with lacrimal gland lesions were identified. Twenty-eight (70%) of patients were female and twelve (30%) were male. The average age at presentation was 42±14 years. Eleven (28%) of patients presented with bilateral disease while twenty-nine (72%) presented with unilateral disease. Symptomatically, nineteen (48%) presented with pain, ten (25%) with visual acuity changes, ten (25%) with diplopia, thirty-two (80%) with lid swelling, twenty-four (60%) with injection, six (15%) with globe displacement, seventeen (43%) with ptosis, and ten (25%) with restriction of extraocular motility. The average duration of symptoms was 51 weeks (range 1 day to 8 years). The most common histopathologic diagnosis was dacryoadenitis (52.5%, n=21), followed by orbital inflammatory syndrome (15%, n=6) and sarcoidosis (10%, n=4). One case each was noted of hemangiopericytoma infiltrating the lacrimal gland, pleomorphic adenoma, recurrent follicular lymphoma, Sjogren’s disease, prolapsed orbital fat, IgG4 sclerosing disease, eosinophilic angiocentric fibrosis (EAF), glass retained foreign body, and retained lacrimal stones. Conclusions: Lacrimal gland lesions constitute a small portion of patients referred to tertiary care centers. While the vast majority of histopathologic etiologies are inflammatory – specifically dacryoadenitis, orbital inflammatory syndrome, and sarcoidosis – no clinical or imaging features reliably differentiate inflammatory from neoplastic causes. Therefore, lacrimal gland biopsy with histopathologic diagnosis should remain the standard of care. Commercial Relationships: Judy Chen, None; Vinay K. Aakalu, None; Pete Setabutr, None Support: NH Grant EY001792, Unrestricted Grant from RPB Program Number: 4751 Poster Board Number: D0196 Presentation Time: 11:00 AM–12:45 PM Botulinum toxin injection in the palpebral lacrimal gland for the management of epiphora Imtiaz A. Chaudhry1, Farrukh A. Shamsi2, Yonca O. Arat3, Waleed A. Al-Rashed4, Osama Al-Sheikh4, Milton Boniuk5. 1Houston Oculoplastics Associates, Memorial Herman Med Plaza TX Med Ctr, Houston, TX; 2Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3University of Wisconsin, Madison, WI; 4King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 5 Baylor College of Medicine, Houston, TX. Purpose: To report our experience with Botulinum toxin injections into the palpebral lacrimal gland through transconjunctival approach in the management of epiphora due to different causes. Methods: We reviewed our experience with transconjunctival Botulinum toxin injection (2.5 - 5 U) in the palpebral lacrimal galnd of 56 adult patients in the management of epiphora due to different causes. Some of the causes of epiphora in our patients included crockadile tears (gustatory) secondary to aberrant regeneration of the facial nerve after facial nerve palsy, epiphora despite patent functional nasolacrimal system, ideopathic hypersecretion, persistent partial epiphora despite successful lacrimal drainage sugery and reflex tearing due to different causes. Results: Fourty-eight (86%) of our patients reported improvement from the Botulinum injections into their palpebral lacrimal gland through transconjunctival approach in the form of significantly decreased symptoms of epiphora. Patients remained symtpoms free between 2 to 6 months (average 4.4 month) after Botumlinum injection. Complications were low and inlcuded subconjunctival hemorrhage at the site of injection in 6 patients and transient diplopia in 2 patients and ptosis in 2 patients. Both the transient diplopia and ptosis resolved in 1 to 3 weeks in all patients. Conclusions: Use of a single Botulinum toxin injection into the palpebral lobe of the lacrimal galnd through transconjunctival approach may be a viable option in adult patients with epiphora due to differnet causes with relatively mninimal complications. Commercial Relationships: Imtiaz A. Chaudhry, None; Farrukh A. Shamsi, None; Yonca O. Arat, None; Waleed A. Al-Rashed, Xeoman (S); Osama Al-Sheikh, None; Milton Boniuk, None Program Number: 4752 Poster Board Number: D0197 Presentation Time: 11:00 AM–12:45 PM A 4-year retrospective chart review of sphenoid wing meningiomas Anjulie K. Quick1, Alina V. Dumitrescu1, Jason Sokol1, Thomas Whittaker1, Roukoz B. Chamoun2, Paul J. Camarata2. 1 Ophthalmology, University of Kansas Medical Center, Kansas City, KS; 2Neurosurgery, University of Kansas Medical Center, Kansas City, KS. Purpose: Sphenoid wing meningiomas (SWM) are benign invasive tumors that can cause significant ocular morbitity. The aim of this study was to determine the demographics, clinical exam and imaging findings, and post operative outcomes in our population of patients. Methods: A retrospective, descriptive, chart review was performed after IRB approval. All biopsied/surgically removed orbital lesions treated in our department between 2010 and 2014 were identified by surgical CPT codes. Those patients with SWM were then identified. In each case gender and age of the patients, pathological diagnosis, and laterality were registered. Results: Out of 141 patients identified during chart review, 8 patients met criteria for SWM over a 4-year period. There was a predominance of female patients (87%) and average age at the time of diagnosis was 55. Patients presented with proptosis (4), visual loss (2), jaw pain (1), and subdural hematoma (1). 75% of patients presented with visual acuity 20/25 or better. Major clinical findings included afferent pupillary defect (6), average of 3.5 mm increase in proptosis, ophthalmoplegia (4), and diplopia (4). 87% of patients had formal visual fields and of those, 85% had an inferior field defect. Post resection, two of the patients who had repeat visual fields showed similar defects as before surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) were the imaging of choice in all patients. 62% were correctly identified as SWM by radiologist on MRI. Imaging findings consistent with SWM included hyperostosis, homogenous enhancing mass, and osseous involvement. All tumors were removed by an oculoplastics surgeon with an orbitozygomatic approach with collaboration from neurosurgery. Diagnosis was confirmed by pathology report. Post-operatively, 62% of patients experienced ptosis and in all patients visual acuity improved or remained the same. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: SWM present a unique situation that combines the efforts of ophthalmology and neurosurgery. An ophthalmologist may be the first person to recognize the tumor as the majority of patients present with ocular complaints. Although those with compressive optic neuropathy from SWM maintain good vision they can still have residual pupillary defects and visual field loss. An orbitozygomatic surgical approach is a safe and effective method for removal of SWM. Future research involves exploring genetic and pathologic markers. Commercial Relationships: Anjulie K. Quick, None; Alina V. Dumitrescu, None; Jason Sokol, None; Thomas Whittaker, None; Roukoz B. Chamoun, None; Paul J. Camarata, None Program Number: 4753 Poster Board Number: D0198 Presentation Time: 11:00 AM–12:45 PM Modified multipare Z-plasty surgery to correct the angular deformity of the eyelid after injury Huayi Lu2, 1, Yaru Dong1. 1Ophthalmology, JiLin university, ChangChun, China; 2Ophthalmology, University of Louisville, Louisville, KY. Purpose: The longitudinal scar in the eyelids tissue can make the eyelid to angular deformity, even to be the greater risk of lagophthalmos ectropion or exposure keratitis.Those disease may impact nomal vision. Eyelid angular deformity correction surgery can restore the eyelid function and change patients’s appearance Methods: 7 eyelids of 7 patients (1 woman, 6 men) underwent this procedure. Gentian violet was used to draw a line on the eyelid scar place. Sliced incision was placed through the skin and subcutaneous tissue, The scar tissue was resected, The meibomian was cut along dislocation healing lineand completely release eyelid so that the eyelid could returned to normal range of activity .The meibomian was sutured and make it to a normal radian. 4-5 groups of Z lines were drawed along the direction of skin incision by gentian violate . Then the skin incision were placed and according the line of the tension, exchange the position of the flap. Subcuteous tissue were suture by 6/0 absorbable suture and the skin were sutured by 6/0 nylon suture line nodular skin suture. Functional and cosmetic results were evaluated and the advantages of this technique were stressed. Results: Mean age was 34.0 years (range 26 - 50) with a mean follow-up period of 12 months (range 6 - 22). All cases eyelids achieved good to excellent final lid positions and adequate cosmetic results with no postoperative complications. On the basis of our experience and the bibliography reviewed, we decided to use the multipare Z-plasty surgery can effectively prevent the recurrence of eyelid angular deformity after postoperative scar contraction. We found it was a good election for this patient since we achieved good functional, anatomical, and aesthetical results. Conclusions: Multipair transposition flap is a effectively treatment for eyelid angular deformity. Because of the multipair transposition flap changed the scar traction direction, and effectively decrease the intensity of the wounded skin in the length of the main shaft direction, so can effectively prevent postoperative scar contraction appear again eyelid angular deformity. Commercial Relationships: Huayi Lu, None; Yaru Dong, None Program Number: 4754 Poster Board Number: D0199 Presentation Time: 11:00 AM–12:45 PM Dermoid Cysts: Imaging in the prevention of complications Lucas T. Lenci, Meredith Baker, Richard C. Allen. Ophthalmology and visual sciences, university of iowa, Iowa City, IA. Purpose: Dermoid Cysts are common lesions in the periocular region. They account for approximately 5% of all orbital lesions (1). The majority arise in children in the superotemporal region from the frontozygomatic suture (2). To our knowledge, there has been no study evaluating decisions about when/if to image patients with presumed dermoid cysts. The purpose of this study is to determine clinical characteristics which may guide imaging decisions in the management of presumed dermoid cysts. Methods: A retrospective chart review was performed on our dermoid cyst patient database at the university of Iowa over the last 5 years. Clinical, pathologic and imaging data were obtained. We analyzed whether the imaging data obtained changed the patients course. We defined a change in management if an alternate diagnosis, significant intraorbital or intracranial extension, or significant bony erosion was found. Results: 57 patients charts met our criteria. The mean age was 6.4 years with 21 females and 36 males. 40/57 (70%) were located superotemporally and 10 (18%) superomedially. 27/57 (47%) patients obtained imaging mostly in the form of CT or MRI. 42/57 (74%) patients had comments about mobility. 12 (21%) lesions were immobile. 8 (14%) cases of gross rupture during surgery were found. 3 were located medially (21% chance of rupture), 5 laterally (12%). Imaging changed management in 3/27 (11%) cases that had imaging and only 3/57 (5%) total cases. Each of these cases had other significant clinical findings including new onset strabismus, proptosis, and recurrence. The average age was 28.8 for these complicated lesions, which also had no mobility on exam. Conclusions: There is little to no guidance on when dermoids should be imaged. Management was altered by imaging in only 3/57 (5%) total patients, while 47% of patients underwent imaging. Location of the dermoid doesn’t seem to have an impact on management, however medial lesions tend to have an increased risk of intraoperative rupture (21%). Orbital findings such as proptosis, strabismus, or significant mass effect are reasons to obtain imaging as well as recurrence and older age. Lack of mobility was seen in all of our complicated dermoids. Medial canthal lesions have not been associated with intracranial extension or misdiagnosis in our case series, which is similar to other studies (3,4). Thus, imaging is likely not necessary for periocular dermoid lesions without other clinical findings. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Lucas T. Lenci, None; Meredith Baker, None; Richard C. Allen, None Program Number: 4755 Poster Board Number: D0200 Presentation Time: 11:00 AM–12:45 PM Evisceration of Eyes with Intraocular Erosion of MIRAgel Scleral Buckles Tal Rubinstein, Julian D. Perry, Rao Chundury. Ophthalmology, Cleveland Clinic, Cleveland, OH. Purpose: MIRAgel (hydrogel) scleral buckles have been associated with significant complications such as orbital inflammation, intraocular erosion, and endophthalmitis. Patients with intraocular erosion in a painful, blind eye may benefit from evisceration to remove the intraocular contents and the inciting MIRAgel material. We explore preoperative and intraoperative findings of such eviscerations and their postoperative course. Further, we define a method of transocular-approach orbitotomy to remove orbital components of the scleral buckle through the eviscerated eye. Methods: This is an IRB approved, retrospective case series of consecutive patients who underwent evisceration at the Cleveland Clinic between the years 2000 and 2014. Patients were included if they had concurrent explantation of MIRAgel scleral buckle material; all other patients were excluded. Patient files were searched for age, gender, laterality, pre-operative findings, pre-operative ocular imaging, intraoperative surgical procedure and findings, postoperative findings, complications, and duration of follow up. Results: Preliminary review identified four patients who met criteria. All were female with an average age of 65.25 years (range 55-80). All patients had blind, painful eyes; one also had endophthalmitis. Two of four pre-operative B-scans identified intraocular erosion of the scleral buckle. One evisceration was performed in 2002, the rest between 2011-2013. Three of four eviscerations were left eyes. All eviscerations identified intraocular MIRAgel components. All eviscerations were concurrently performed with orbitotomies for removal of orbital MIRAgel components, of which three were performed through a trans-ocular approach into the orbit. Average follow up time was 17.5 months (range 1-36). Two patients needed subsequent external levator resection to help with prosthetic retainment. One patient had inability to maintain prosthesis due to adhesions and foreshortened inferior fornix. Conclusions: MIRAgel scleral buckles should be avoided as they may lead to devastating complications such as intraocular erosion of the material. Evisceration of blind, painful eyes with concurrent explantation of orbital MIRAgel material can be done through a transocular-approach orbitotomy, which increases efficiency and reduces additional approaches of entering the orbit. Prior scarring and extensive dissection of the MIRAgel may compromise post-surgical results. Commercial Relationships: Tal Rubinstein, None; Julian D. Perry, None; Rao Chundury, None Program Number: 4756 Poster Board Number: D0201 Presentation Time: 11:00 AM–12:45 PM Plasma surface modification of porous polyethylene implants in orbital reconstruction Seong-Won Yang1, Saemi Park2. 1Ophthalmology, Chosun University Hospital, Gwangju, Korea (the Republic of); 2Ophthalmology, Kim’s eye hospital, Seoul, Korea (the Republic of). Purpose: Various alloplastic materials are used in orbital wall reconstruction. We investigated the pre-osteoblast adhesion and osseointegration on porous polyethylene (PE) with hydrophobic surface using a plasma surface treatment. Methods: Surface modified PE was prepared by oxygen or nitrogen plasma. After plasma treatment, adhesion and differentiation of MC3T3-E1 cells was evaluated using a MTT assay and alkaline phosphatase (ALP) activity respectively. A total of 10 white rabbits orbital medial, inferior, and maxilla bone were exposed. After that, pre-treated implant was inserted. Micro-CT, Immunostaining were performed before exposure, 4 weeks, and 8 weeks, afterward to allow for serial comparisons. Results: Plasma-treated PE implants significantly increased cell adhesion and ALP activity and up-regulated expression of osteogenesis-related genes such as alkaline phosphatase, osteopontin and osteocalcin in MC3T3-E1 cells. In vivo results showed that plasma-treated samples demonstrate the good bone formation than the control. Conclusions: Plasma-treated porous polyethylene can be used as a useful material for Orbital fracture. Commercial Relationships: Seong-Won Yang, None; Saemi Park, None Program Number: 4757 Poster Board Number: D0202 Presentation Time: 11:00 AM–12:45 PM Viability, Structural Integrity and Aqueous Humor Dynamics are Established in an Orthotopic Whole Eye Transplant Model Kia M. Washington1, Yang Li1, 2, Bo Wang3, 4, Maxine R. Miller1, 3, Yolandi van der Merwe3, 4, Leon Ho3, 4, Michael Steketee3, Joel S. Schuman3, 4, Kevin C. Chan3, 4, Vijay S. Gorantla1. 1Department of Plastic and Reconstructive Surgery, UPMC, VCA Lab, Pittsburgh, PA; 2Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China; 3 Department of Ophthalmology, UPMC Eye Center, Ear and Eye Institute, Ophthalmology and Visual Science Research Center, Pittsburgh, PA; 4Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA. Purpose: Approximately 39 million people worldwide suffer from blindness. The permanent nature of vision loss is largely due to the inability of retinal ganglion cells to regenerate. Whole eye transplantation (WET) gives the opportunity to provide viable retinal ganglion cells and an entire optical system to recipients with irreversible vision loss. The purpose of our study is to evaluate viability, structural integrity and aqueous humor dynamics in our orthotopic whole eye transplant model. Methods: Syngeneic transplants were performed in Lewis (RT1l) rats. Donor flaps are composed of ocular tissue anterior to the optic chiasm, the skin of the eyelid and external ear. Recipient sites are prepared by removing a similar region of skin and ocular tissue with the optic nerve cut at the base of the globe. Grafts are transplanted to the recipient, vascular anastomoses are performed, as are nerve appositions between donor and recipient optic nerves. Slit lamp examination, Optical Coherence Tomography (OCT) and histological analysis were performed to evaluate the viability and structural integrity of the transplanted eye. Gadolinium (Gd)-enhanced MRI was employed to evaluate ocular physiology of the transplanted eye. Results: 15 of 22 rats survived the surgical procedure with the maintenance of visual transparency of the anterior eye as evidenced by slit lamp examination. Some peripheral corneal neovascularization was seen in all eyes. OCT confirmed transparency of the cornea and lens, preservation of the retina, and blood flow to the eye. Gdenhanced MRI revealed the presence of transplanted eye aqueous humor dynamics and intact blood-ocular and aqueous-vitreous barriers. Histology confirmed corneal neovascularization and preserved retinal integrity, with the exception of retinal nerve fiber layer and ganglion cell layer thinning. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: We have established a viable orthotopic model for vascularized whole eye transplantation in the rat. Maintenance of structural integrity, viability and aqueous humor dynamics were confirmed. The model is excellent for studying viability, functional return and immunology in WET. Figure 1: A., B. & C. Donor hemi-face flap D. Long term survival of the WET transplanted recipient Program Number: 4758 Poster Board Number: D0203 Presentation Time: 11:00 AM–12:45 PM Revision of failed external dacyrocystorhinostomy with endoscopic-guided balloon dilation. Christopher Lo, Payal Patel, Carisa Petris, Richard Lisman. department of ophthalmology, nyu, New York City, NY. Purpose: Various approaches to revising primary dacyrocystorhinostomy (DCR) have been presented without consensus on technique. We performed a retrospective, observational study of a single surgeon’s experience that introduces a novel minimally invasive approach to revise failed external DCR that is safe, repeatable and avoids an external scar. The technique requires limited endoscopic manipulation and the surgeon may become proficient without advanced training. Methods: An institutional chart review of a single surgeon’s experience with six patients with recurrent epiphora. All patients were status-post external DCR, and had documented recurrence of epiphora and reflux upon irrigation. Study patients subsequently underwent endoscopic-guided balloon DCR using 3 and 5 mm balloon catheters. Surgical success was defined by a patent surgical ostium demonstrated by absence of subjective epiphora and irrigation of saline through nasolacrimal system at 1 week, 1 month and 3 month visits. Results: All (100%) patients had subjective epiphora and documented reflux of saline upon irrigation of the nasolacrimal system following an external DCR. Average length of time between primary and revision DCR was 55.2 months. Intraoperative steroid injection around the osteotomy scar was used in 50% of study patients. All six patients completed at least 3-months followup. Surgical success was achieved in all secondary endoscopic revisions. All (100%) patients had improvement of epiphora at 1 week, 1 month, and 3 month visits. Five (83.3%) patients described complete resolution of epiphora; one (16.7%) patient described 50% improvement of symptoms. All study patients had patent irrigation of saline through nasolacrimal system at post-operative visits. Conclusions: Secondary external DCR to revise failed DCR can be surgically challenging, require invasive manipulation, and lead to increased scarring. Although primary endoscopic DCR requires advanced endoscopic expertise, secondary endoscopic-guided balloon DCR can be safely performed without advanced technique, provides direct visualization to ensure surgical accuracy, and avoids additional external incisions. Based on our results, this technique promises to have an excellent success rate and may be readily incorporated into surgical practice. Figure 2. OCT. Control (top row) Transplant (bottom row) Figure 3. T1-weighted images at 0-10min (left) and 60-70 min (right) after Gd administration 3 weeks after WET Commercial Relationships: Kia M. Washington, None; Yang Li, None; Bo Wang, None; Maxine R. Miller, None; Yolandi van der Merwe, None; Leon Ho, None; Michael Steketee, None; Joel S. Schuman, Zeiss (I); Kevin C. Chan, None; Vijay S. Gorantla, None Support: National Institutes of Health CORE Grant P30-EY008098; The Louis J. Fox Center for Vision Restoration of UPMC and the University of Pittsburgh; Eye and Ear Foundation of Pittsburgh, PA; An unrestricted grant from Research to Prevent Blindness, New York, NY; The VA Pittsburgh Healthcare System; Office of the Assistant Secretary of Defense for Health Affairs under Award No. W81XWH-14-1-0421 ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology ± 3 months in this group. It was noted 3 postoperative complications (10%) with this technique. Conclusions: Antegrade balloon dacryocystoplasty is an effective, non-invasive technique for treatment of partial PANDO in adults. This technique seems to be better than silicone intubation in this indication. Nevertheless, further prospective and comparative studies are needed to consolidate this promising results. Commercial Relationships: Yoann Soldermann, None; Olivier Galatoire, None; jacomet pierre vincent, None Endoscopic view of dilated balloon catheter (arrow) through fibrotic osteotomy (asterisk). Commercial Relationships: Christopher Lo, None; Payal Patel, None; Carisa Petris, None; Richard Lisman, None Program Number: 4759 Poster Board Number: D0204 Presentation Time: 11:00 AM–12:45 PM Efficacy and tolerance of balloon dacryocystoplasty in partial primary acquired nasolacrimal duct obstruction Yoann Soldermann1, Olivier Galatoire2, jacomet pierre vincent2. 1 Ophtalmology, Centre Hospitalier Lyon Sud, Lyon, France; 2 Rothschild ophtalmological fondation, Paris, France. Purpose: The main cause of tearing in adult is Primary Acquired Nasolacrimal Duct Obstruction. Stenosis is first partial, related to an inflammatory mucosal remodeling. The objective of this study is to evaluate the efficacy and the safety of antegrade balloon dacryocystoplasty in adults with a partial PANDO. Methods: This is a prospective and a single center study. 35 nasolacrimal ducts of 24 patients, unresponsive to medical treatment, were included between February 2011 to August 2014. The patients with other causes of tearing, including dry eye and eyelid malposition, were excluded. All included patients passed a dacryoscanner before treatment. The anterograde dilatation using a balloon catheter (Ophtacath®, FCI, Paris) was performed in operating room under general anesthesia. A 9 atmospheres expansion during 90 sec on the first mark and during 60 seconds on the second mark treated all the nasolacrimal duct. The endpoint was the Munk’s tearing score at 1, 3, 6, 12 and 24 months. A complete success was defined as a Munk’s score of 0 or 1.On the other hand, a retrospective analysis was performed on 29 nasolacrimal ducts of 19 patients treated with a silicone intubation for tearing due to a partial stenosis between 2007 and 2013. Results: The average age of our patients was 65 ± 2 years. The mean duration of tearing before treatment was 3 ± 0.5 years. 77% of patients were women. The procedure were achieved in 100% of cases. 30 tearing improved with this procedure : 86% of cases (30/35). Complete success was effective for 20 nasolacrimal ducts : 57% of cases (20/35). The mean follow-up was 17 ± 3 months. No recurrence of tearing was observed during the monitoring period. 4 postoperative complications were recorded (11.8%): 1 orbital emphysema, 2 periorbital hematomas and 1 epistaxis. With silicone intubation, tearing improved in 37.9% of cases and a complete resolution was found in 27.6% of cases. The mean follow-up was 29 Program Number: 4760 Poster Board Number: D0205 Presentation Time: 11:00 AM–12:45 PM Use of a self-retaining bicanalicular nasolacrimal stent for partial nasolacrimal obstruction in adults without need for general anesthesia David Silbert. Family Eye Group Vision Science Department, Lancaster, PA. Purpose: Partial nasolacrimal duct (NLD) obstruction has been a challenging problem to treat short of placing crawford tubes under general anesthesia. We perform a retrospective observational study utilizing a bicanalicular self-retaining stent in adults without general anesthesia. Methods: Kaneka Lacriflow stents were placed in the office under topical/local anesthetic or in conjunction with other eyelid surgery under conscious sedation. Ages of patients ranged from 33 to 90 years. Patients with epiphora due to punctal, canalicular or nasolacrimal stenosis were included. Irrigation was used to confirm the absense of complete obstruction. Local blocks to the infratrochlear nerve, eyelid and lidocaine gel infiltrated through the NLD were utilized. Stents were placed with a stylet to both upper and lower punctum. Stents were left in place for 3 months then removed. Improvement in epiphora was assessed one month later. An antibiotic steroid drop was used for 2 weeks after implantation and for 2 weeks following removal. Results: 27 patient were included. 14 patients had bilateral surgery and 13 had unilateral. A total of 41 NLD were included in the study. In one patient the stent could not be passed down the NLD. Stent placement was succesful in 40/41 NLD (98%) with no patient complaining of excessive discomfort. In 27 eyes stents were placed under local anesthesia while 13 were performed under conscious sedation. 24 patients completed the full 4 months of follow-up while the rest are still in followup. 22/24 patients reported improvement in epiphora one month following removal of the stents (92%). 2 patients reported continued epiphora with stents in place, but improvement following removal. 1 patient had partial dislodgment of the stent, which was removed, replaced and then left in place for the full 3 months. Conclusions: Epiphora due to partial nasolacrimal duct and canalicular obstruction has been challenging to treat. A hydrophilic polymer which makes it slippery in the NLD, a smaller intracanalicular diameter and a larger intraductal diameter allows the stent to pass easily and self retain. The Kaneka Lacriflow stent was able to be placed consistently without the need to enter the nose to recover or tie the stent. 92% of patients had significant improvement in epiphora without the need for a procedure under general anesthesia. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology development of tools to quantify the severity of MGD would allow for more objective outcome measurements. Remove stylet after placement Commercial Relationships: David Silbert, Kaneka (C), Kaneka (F) Support: Company support for study (Kaneka) Program Number: 4761 Poster Board Number: D0206 Presentation Time: 11:00 AM–12:45 PM Dynamic Intraductal Meibomian Probing (DIMP): A Novel Approach to the Treatment of Meibomian Gland Dysfunction Zeba A. Syed, Francis Sutula. Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: Meibomian gland dysfunction (MGD) is among the most common disorders treated by ophthalmologists. Warm compresses and lid hygiene usually do not provide lasting symptom relief. Meibomian gland probing has been shown to be effective in severe posterior blepharitis. Here we describe a modified technique, Dynamic Intraductal Meibomian Probing (DIMP), which has several advantages over traditional probing including greater magnification, stabilization of the patient’s head, facilitated probing against resistance, and easier identification of orifices Methods: A retrospective chart review was performed on patients undergoing DIMP by one physician between January 2013 and July 2014. Inclusion criteria were patients with symptomatic MGD (dryness, tearing, foreign body sensation, and/or irritation) and clinical signs of MGD (eyelid erythema, thickening, irregularity, and/or telangiectasias) who did not respond to conservative therapies including warm compresses, lid hygiene, and topical anti-inflammatory medications. We reviewed the electronic medical records for the presence of symptoms after DIMP treatment. During DIMP, the patient is seated supine on a surgical chair and an operating microscope is positioned over the target lid. Von Graefe fixation forceps are used to grasp the lid and apply upward traction, and a 2 mm probe is inserted to dilate each meibomian gland orifice sequentially along the lid margin. The 4 mm probe is then substituted to allow for deeper probing. After DIMP, meibum spontaneously expresses through glands along the lid margin. Results: Thirty-six eyes of 22 patients underwent DIMP treatment. The average age of patients was 59 years. Eleven patients were male and 11 were female. The majority (82%) of procedures were performed on a lower lid. Follow-up ranged from 1 to 16 weeks, with a mean of 3.5 months (± 3.1 months). Most (92% ± 4.6%) patients reported symptomatic improvement during follow-up. No major complications were noted. Rarely, small areas of bleeding were appreciated at ductal orifices. This always stopped spontaneously without need to apply pressure. Conclusions: DIMP is an effective and safe technique for symptomatic MGD that is resistant to traditional therapies. The Dynamic Intraductal Meibomian Probing (DIMP) Release of Meibum After DIMP Commercial Relationships: Zeba A. Syed, None; Francis Sutula, None Program Number: 4762 Poster Board Number: D0207 Presentation Time: 11:00 AM–12:45 PM Optical Coherence Tomography and its utility in diagnosing and managing meibomian gland disease Anupam Jayaram1, Liza M. Cohen2, Gary Lissner1, Christopher Chambers1. 1Ophthalmology, Northwestern University, Chicago, IL; 2 Feinberg School of Medicine, Northwestern University, Chicago, IL. Purpose: Optical Coherence Tomography has recently been shown to have utlity in assessing tear meniscus as well as imaging meibomian glands. The purpose of this study is to utilitze optical coherence tomagraphy to quantify meibomian gland dysfunction both before and after various methods of treatment including artificial tears, warm compresses, lid scrubs, and oral doxycycline. This objective measurement of meibomian gland dysfunction after various forms of management can give better insight into efficacy of treatment. Methods: A group of 10 healthy subjects with no signficant meibomian glad dysfunction had optical coherence tomography imaging done of their meibomian glands both at baseline and 6 weeks ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology later, and these images were used as controls. In contrast, a group of 10 subjects with documented severe meibomian gland dysfunction had ocular coherence tomagraphy taken of their meibomian glands both at baseline and again 6 weeks after various treatment modalities. An objective grading system was used to quantify the amount of meibomian gland dysfunction of each image, and the results were analyzed to try to find trends in improvment of meibomian gland dysfunction. Results: All 10 controls showed no significant meibomian gland disease both at baseline as well as at the 6 week re-evaluation mark. All 10 subjects from the experimental group showed 3-4+ meibomian gland dysfunction at baseline imaging and all showed various amounts of improvement by the 6 week re-evaluation mark. This study uses images to illustrate the amount of gland plugging in various meibomian gland dysfunction treatment modalities. Conclusions: This is the first study to show in an objective and quantitative fashion that warm compresses and lid scrubs actually do decrease meibomian gland dysfunction when done correctly. Additionally, it demonstrates the utility of optical coherence tomagraphy in diagnosing, following, and managing patients with severe meibomian gland dysfunction. Finally, the various images of this study illustrate and provide a better understanding of concepts like acinar atrophy, gland plugging, and decreased tear meniscus. Commercial Relationships: Anupam Jayaram, None; Liza M. Cohen, None; Gary Lissner, None; Christopher Chambers, None Program Number: 4763 Poster Board Number: D0208 Presentation Time: 11:00 AM–12:45 PM The Role of Goblet Cells in the development of Dacryostenosis Ameet Goyal1, Devon Dipalma2, Riya Goyal3. 1Ophthalmology, new york medical college, Rye, NY; 2Duke, Durhm, NY; 3Hofstra Medical School, Mineola, NY. Purpose: The pathogenesis of primary acquired nasolacrimal duct obstruction(PANDO) has been evaluted in past studies. These factors include use of make-up, gender, hormone levels, and viral infection(Kashkouli MB 2010). The anatomy and physiology of the epithlelial lining of the tear duct has also been well studied by Paulsen(1998, 2003, and 2008). These studies have elucidated the tear flow physiology, microbial defense strategies, and pathophysiological processes in the nasolacrimal duct system. These studies have also revealed a mucin producing Goblet cell that lines the mucosal layer of the nasal lacrimal duct. The goblet cells are involved with the maintenance of the lubrication in order for the tears to drain through the tear duct. The purpose of this study is to better understand the role of goblet cells in patients who have PANDO. Methods: All of the 22 patients were evaluted from one practice in ophthalmic plastic and reconstructive surgery. These patients were excluded if they had trauma, infection, previous nasal surgery, or history of nasal tumor. All of the patients complained of epihora. Other causes including dry eye, blepharitis, and anatomical abnormalities of the eye lid were excluded. Patients underwent an external dacrycystorhinostomy to remove the nasal lacimal duct mucosa. The tissue was sent in formalin. Hematoxylin and eosin stained slides cut from paraffin embedded formalin fixed tissues were examined from 22 lacrimal sac and nasal lacrimal duct mucosa. The histologic features in each biopsy included degree of inflammation and inflammatory cell types. All of this tissue was then analyzed by two independent pathologist at an academic institution. Results: There were 16 women and 6 men in this study. The pathologist evlauted the health of the mucosa and the number of goblet cells present in each specimen. Each one of the specimens demonstrated chronic infammation. These cell types were either lymphohistiocytic or lymphopasmacytic. There was also noted to be a complete absence of goblet cells in the female patients. The male specimens demonstrated goblet cell in the epithelial mucosa. Conclusions: This study shows that there appears to be a complete loss of Goblet cells in the lining of the nasal lacrimal duct in women. The mucin producing goblet cells are important in the flow of the tears through the tear duct. The decrease in production of mucin may be a very important component to the pathophysiology of PANDO. Commercial Relationships: Ameet Goyal, None; Devon Dipalma, None; Riya Goyal, None 479 Strabismus, II Wednesday, May 06, 2015 3:45 PM–5:30 PM Exhibit Hall Poster Session Program #/Board # Range: 5204–5230/D0209–D0235 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Clinical/Epidemiologic Research Program Number: 5204 Poster Board Number: D0209 Presentation Time: 3:45 PM–5:30 PM Quality of Life Concerns in Parents of Children with Esotropia Yolanda S. Castañeda1, Eileen E. Birch1, David A. Leske2, Sarah R. Hatt2, Laura Liebermann2, Jonathan M. Holmes2. 1Retina Foundation of the Southwest, Dallas, TX; 2Ophthalmology, Mayo Clinic, Rochester, MN. Purpose: Esotropia is a common form of childhood strabismus, but the effects of esotropia on the health related quality of life (HRQOL) of affected children and their families are poorly understood. As part of a larger research effort to develop patient-reported outcome measures for pediatric eye conditions, we interviewed parents of children with esotropia to identify the specific concerns affecting the parents HRQOL, distinct from concerns affecting the HRQOL of the children themselves. Methods: 35 children with esotropia (aged 2 to 17 years) were recruited, along with one of their parents. Esotropia types were: accommodative or partially accommodative (17; 49%), infantile (7; 20%), non-accommodative (6; 17%), consecutive (2; 6%), 6th nerve palsy (1, 3%), Duane syndrome (1; 3%), and mechanical (1; 3%). 18 (51%) had a current or previous diagnosis of amblyopia and 25 (71%) wore refractive correction. Individual semi-structured interviews were conducted with the parent of the child. Transcripts from recorded interviews were independently evaluated by 2 investigators using NVivo software. Specific HRQOL concerns were identified and coded by assigning to themes. Discrepancies were resolved by discussion. The frequency with which each theme occurred was calculated. Results: Overall 18 HRQOL themes were identified, describing the effects of specific concerns and worries on the parent’s own HRQOL. The top concern, mentioned by 31 (89%) of 35 parents, was Inconvenience, especially regarding taking time off work. 30 (86%) of 35 parents mentioned concerns of Worry regarding treatment e.g. worrying that treatment won’t work or that other options should be explored and Negative Emotions such as finding it emotionally hard or scary to deal with the condition. Having to Compensate or Adjust for their child’s eye condition e.g. extra supervision, protecting the child, making sure they sit at the front in class; and problems related to Treatment were each mentioned by 28 parents (80%). Conclusions: Parents of children with esotropia express a range of concerns affecting their own HRQOL, such as having to make adjustments to help their child, worrying about treatment and experiencing negative emotions. Identified concerns in esotropia suggest that pediatric eye disorders may have pervasive effects on ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology multiple aspects of family life, and these concerns will be used to develop a parent HRQOL instrument. Commercial Relationships: Yolanda S. Castañeda, None; Eileen E. Birch, None; David A. Leske, None; Sarah R. Hatt, None; Laura Liebermann, None; Jonathan M. Holmes, None Support: NIH Grants EY024333 (JMH), EY018810 (JMH), and EY022313 (EEB), Research to Prevent Blindness, and the Mayo Foundation. Program Number: 5205 Poster Board Number: D0210 Presentation Time: 3:45 PM–5:30 PM Quality of Life Concerns in Children with Esotropia Laura Liebermann1, David A. Leske1, Sarah R. Hatt1, Yolanda S. Castañeda2, Eileen E. Birch2, Jonathan M. Holmes1. 1Ophthalmology, Mayo Clinic, Rochester, MN; 2Retina Foundation of the Southwest, Dallas, TX. Purpose: Esotropia is a common form of childhood strabismus, but there are few data on effects on health related quality of life (HRQOL) in children with esotropia. As part of a larger research effort to develop patient-reported outcome measures for pediatric eye conditions, we interviewed esotropic children and, as a proxy, one of their parents. Methods: 35 children with esotropia (aged 2 to 17 years) were recruited. Esotropia types were accommodative or partially accommodative (17; 49%), infantile (7; 20%), non-accommodative (6; 17%), consecutive (2; 6%), 6th nerve palsy (1; 3%), Duane syndrome (1; 3%), and mechanical (1; 3%). Individual semistructured interviews were conducted with children aged 5-17 years (n=23). One parent was also interviewed for each child (for children <5 years only the parent was interviewed). Transcripts from these recorded interviews were independently evaluated by 2 investigators using NVivo software. Specific HRQOL concerns were identified from both child and parent interviews and coded by assigning to themes. Discrepancies were resolved by discussion. The frequency of each theme was calculated. Results: Overall, 21 themes were identified. From child interviews (n=23), the top concerns (each mentioned by 18 [78%] of 23) were Negative Emotions such as feeling bad, scared, or nervous, and problems related to Treatment (e.g., glasses, patching or atropine). Vision concerns, including poor vision, poor depth perception, and double vision were mentioned by 17 children (74%). In proxy interviews, most frequently mentioned concerns by parents (n=23) regarding their child’s HRQOL were problems with Treatment (18; 78%), followed by Activities, Sports, or Hobbies (15; 65%), and Negative Emotions (15; 65%). For children <5 years old where only the parent proxy interview was conducted (n=12), top concerns perceived as affecting the child were problems with Treatment (11 [92%] of 12), Negative Emotions (7; 58%), and Discomfort or Ocular Sensations (7; 58%). Conclusions: Children with esotropia experience a range of HRQOL concerns but there are differences according to whether they are reported by the child themselves or by the parent as a proxy for the child. Identified concerns will be used to develop child and proxy HRQOL instruments. Commercial Relationships: Laura Liebermann, None; David A. Leske, None; Sarah R. Hatt, None; Yolanda S. Castañeda, None; Eileen E. Birch, None; Jonathan M. Holmes, None Support: NIH Grants EY024333 (JMH), EY018810 (JMH), and EY022313 (EEB), Research to Prevent Blindness, and the Mayo Foundation. Program Number: 5206 Poster Board Number: D0211 Presentation Time: 3:45 PM–5:30 PM The Effects of Pediatric Primary Brain Tumors on Vision and Quality of Life Jason Peragallo1, Supharat Jariyakosol1, 2, Beau B. Bruce1, Nancy J. Newman1, Valerie Biousse1. 1Emory University, Atlanta, GA; 2 Chulalongkorn University, Bangkok, Thailand. Purpose: Brain tumors are the leading cause of death from childhood cancer. Improvements in detection, therapy, and surveillance have improved survival. Permanent sequelae of the tumor and its treatment may cause severe impairment and reduced quality of life (QOL). We reviewed the literature and initiated a quality improvement (QI) project evaluating visual impairment and its effects on QOL. Methods: Patients ≤18 yo & ≥6 months post primary brain tumor (PBT) diagnosis, excluding primary intrinsic anterior visual pathway tumors, underwent neuro-ophthalmologic examination. In the QI project, patients and parents completed Health-related QOL (HRQOL) [PedsQL Brain Tumor Module] and Vision-related QOL (VR-QOL) questionnaires [children <8yo: Children’s Visual Function Questionnaire; 8-18yo: EYE-Q]. Demographic data, driving status, schooling, and use of low-vision aids were recorded. Patients were classified as normal, visually impaired, or legally blind. We reviewed recent studies (2000-2014) of ophthalmologic sequelae, long-term disability, and QOL in pediatric PBT patients. Results: 32 PBT patients were evaluated (24 supra-, 8 infratentorial). 3/32 (9.3%) were legally blind; 15/32(46.9%) had visual impairment; 15/31(48.4%) had significant visual field defects, 16/32(50%) had strabismus, cranial nerve palsies, or nystagmus. Patients’ median HR-QOL was 68.6 (range 28.1-95.8). Parents’ HRQOL scores for their children were 0.82x (SE±0.25) their children’s score(R2=0.59;p<0.001). VR-QOL median score was 3.35 (range 0.38-4.0). HR-QOL scores were not significantly correlated with visual function. EYE-Q was -3.0 points lower (SE±0.64;p<0.001) in those with severe visual impairment vs. those with none. Twelve studies met our criteria for review. Prevalence of visual dysfunction ranged from 8-79%. 3/12 studies reported frequency of bilateral blindness (3-16%). HR-QOL was significantly lower in PBT patients compared to normal controls in most studies. VR-QOL was not addressed in recent pediatric PBT studies. Conclusions: Children with PBT and their parents have similar perceptions of HR-QOL. VR-QOL loss was associated with visual dysfunction in PBT patients in our center’s experience. “Cured” pediatric PBT patients may have severely affected vision, HR-QOL, and VR-QOL. Systematic neuro-ophthalmologic examinations of pediatric PBT patients may improve long-term visual outcomes and QOL through earlier intervention. Commercial Relationships: Jason Peragallo, None; Supharat Jariyakosol, None; Beau B. Bruce, None; Nancy J. Newman, None; Valerie Biousse, None Support: Supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by NIH/NEI core grant P30-EY06360 (Department of Ophthalmology). Dr. Jariyakosol receives support from Chulalongkorn University (Bangkok, Thailand). Dr. Bruce receives research support from the NIH/NEI (K23-EY019341). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5207 Poster Board Number: D0212 Presentation Time: 3:45 PM–5:30 PM Association of Specific Symptoms with Reduced Health-Related Quality of Life in Children with Intermittent Exotropia David A. Leske, Sarah R. Hatt, Laura Liebermann, Jonathan M. Holmes. Ophthalmology, Mayo Clinic, Rochester, MN. Purpose: To evaluate the relationship of specific intermittent exotropia (IXT) symptoms with health-related quality of life (HRQOL) in children with IXT and their parents. Methods: The Intermittent Exotropia Questionnaire (IXTQ) was administered to a cohort of 35 children (aged 5-13 years) with IXT, without previous surgery, and their parents (Child, Proxy, Parent Psychosocial, Parent Function, and Parent Surgery subscales). All IXTQ questionnaires were Rasch scored using an established lookup table and converted to a 0-100 scale. Children also completed a 22-item symptom survey, rating symptoms as “not at all,” “sometimes,” or “a lot” for 5- to 7-year olds, or “never,” ‘almost never,” “sometimes,” “often,” or “almost always” for 8- to 17-year olds, yielding a score of 0 to 4 per item. Relationships between IXTQ scores and symptom scores were analyzed by univariate linear regression, and symptoms associated with poor HRQOL (P≤ 0.1) were fit to a stepwise multivariate linear regression model. Results: Lower (worse) Child IXTQ HRQOL scores were associated with symptoms of difficulty focusing eyes (P=0.0007), double vision (P=0.007), eyes hurting (P=0.006), and problems with eyes in the sun (P=0.06)(model r-square=0.64). Lower Proxy IXTQ scores were associated with child symptoms of eyes feeling funny (P=0.02) and eyes going in and out (P=0.06)(model r-square=0.27). Parent Psychosocial IXTQ scores were associated with eyes going in and out (P=0.02) and difficulty staring at things (P=0.03)(model r-square=0.23). Parent Function IXTQ scores were only associated with symptoms of eyes going in and out (P=0.04)(model r-square 0.12). No relationships were found between child symptoms and Parent Surgery IXTQ scores. Conclusions: In Children with IXT, reduced child HRQOL is predicted by the specific symptoms of difficulty focusing eyes, double vision, eye pain, and problems with eyes in the sun. In contrast to child HRQOL, poor proxy or parental HRQOL are less explained by child symptoms, but are associated with the child experiencing symptoms of the eyes going in and out, eyes feeling funny, and difficulty staring at things. For clinical and research applications, a revised shortened symptom survey could be based on the questions we found to be associated with reduced HRQOL. Commercial Relationships: David A. Leske, None; Sarah R. Hatt, None; Laura Liebermann, None; Jonathan M. Holmes, None Support: NIH Grants EY024333 (JMH) and EY018810 (JMH), Research to Prevent Blindness, and the Mayo Foundation. Program Number: 5208 Poster Board Number: D0213 Presentation Time: 3:45 PM–5:30 PM Vision In Preschoolers - Hyperopia In Preschoolers (VIP - HIP) Study: Effect of Uncorrected Hyperopia on Early Literacy Marjean T. Kulp. College of Optometry, Ohio State University, Columbus, OH. Purpose: To determine whether uncorrected hyperopic (≥3 to ≤6 diopters (D)) 4- or 5-year-old children without strabismus or amblyopia perform worse on an assessment of literacy (Test of Preschool Early Literacy [TOPEL]) than comparable emmetropic children. Methods: Children aged 4 or 5 who were attending preschool or kindergarten and who had not previously worn correction for refractive error were enrolled. Children with an Individualized Education Program (IEP) for development, educational, or behavioral issues were excluded. Vision examination with cycloplegic refraction was performed to confirm the presence of either hyperopia (≥3.0D to ≤6.0D in the most hyperopic meridian of at least one eye with astigmatism ≤1.5D and anisometropia ≤1.0D) or emmetropia (hyperopia ≤1.0D, astigmatism <1.0D, anisometropia <1.0D, and myopia <1.0D). Threshold visual acuity and cover testing were performed to rule out presence of amblyopia or strabismus. The TOPEL, composed of Print Knowledge, Definitional Vocabulary, and Phonological Awareness subtests, was administered by trained examiners. Results: Four hundred ninety-two children (244 hyperopes and 248 emmetropes) participated (mean age 58 months; mean±SD spherical equivalent refractive error +3.47D±0.81 in hyperopes and +0.37D±0.50 in emmetropes). The majority of children (89%) were in Head Start. The overall mean±SD TOPEL raw score was 86.6±23.2. The mean TOPEL score in hyperopic children was significantly lower than in emmetropic children (-5.9, 95% confidence interval [-10.0, -1.8], p=0.005). After adjustment for age, race/ethnicity, and parent/caregiver’s education the mean difference between hyperopes and emmetropes was -4.3 (-7.7, -0.89),(p=0.01) for TOPEL overall,-2.4 (-4.1, -0.6), (p=0.007) for Print Knowledge, -1.6 (-3.3, 0.2), (p=0.08) for Definitional Vocabulary, and -0.3 (-1.1, 0.4), (p=0.39) for Phonological Awareness. For children with moderate hyperopia (+3.0 to 6.0D), the magnitude of hyperopia was not related to the TOPEL score (p=0.75). Conclusions: Uncorrected hyperopia in 4- to 5-year-old children enrolled in preschool or kindergarten is associated with significantly worse performance on a test of early literacy (TOPEL). In addition to remedial educational intervention, these children may benefit from preventive correction of refractive error, however, the effect of this intervention has not yet been evaluated. Commercial Relationships: Marjean T. Kulp, None Support: NIH/NEI R01EY021141 Program Number: 5209 Poster Board Number: D0214 Presentation Time: 3:45 PM–5:30 PM Disinvestment of population-wide eye screening at age 14-24 months in the Netherlands Frea Sloot1, Aya Sami1, 2, Hatice Karaman2, 1, Sjoukje E. Loudon1, Janine Benjamins3, Hein Raat4, Huibert J. Simonsz1. 1Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands; 2Orthoptics, University of Applied Sciences, Utrecht, Netherlands; 3Public Health Service Icare, Meppel, Netherlands; 4Public Health, Erasmus Medical Center, Rotterdam, Netherlands. Purpose: Dutch children are eye-screened 7 times at Child Health Care Centers that screen 97% of all children for general health disorders. Omission of eye screening at age 6-9 months (ARVO 2014) did not seem to reduce referrals and detection of amblyopia; referral was based mostly on conspicuous strabismus noted by parents or screening physicians. We now assessed the screening examinations at age 14 and 24 months. Methods: Preverbal screening (cover test, Hirschberg test, eye movements, cornea and pupillary reflexes) was omitted in the second of two sequential birth cohorts. All children were screened at 1-2 and 3-4 months, but at 14 and 24 months only children in the control group (born July-December 2011) were eye screened. Children in the intervention group (born January-June 2012) did attend consultations for all other basic screening and vaccinations, but eye screening, was performed only in case of positive family history, something noted by the parents or a visually apparent eye disorder. Data was collected from screening records, anonymous questionnaires and on-site observations. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Results: 112 out of 6188 children (1.8%) in the control group and 76 out of 5623 children (1.4%) in the intervention group were referred to an orthoptist or ophthalmologist. Visually apparent eye disorders or conspicuous strabismus noted by the parents or screening physician led to referral in 79 children (1.3%) versus 66 children (1.2%). Twenty-seven children in the control and six in the intervention group were referred because of specific eye screening. The latter six children were examined because of a positive family history (1), smaller eye (1) or for unknown reasons (4). In the questionnaires screening physicians had indicated that they found examination of children at age 14-24 months difficult, especially the cover test. During the observations, cover test, motility and pupillary reflexes were not always performed correctly. Hirschberg test was almost always performed correctly. Conclusions: At the age of 14-24 months most children are referred because of a visually apparent eye disorder or conspicuous strabismus. Although still a minority, specific eye screening led to more referrals at the age of 14-24 months than at 6-9 months. Commercial Relationships: Frea Sloot, None; Aya Sami, None; Hatice Karaman, None; Sjoukje E. Loudon, None; Janine Benjamins, None; Hein Raat, None; Huibert J. Simonsz, None Clinical Trial: NCT01675193 Program Number: 5210 Poster Board Number: D0215 Presentation Time: 3:45 PM–5:30 PM Symptoms in Children with Intermittent Exotropia Sarah R. Hatt, David A. Leske, Laura Liebermann, Jonathan M. Holmes. Ophthalmology, Mayo Clinic, Rochester, MN. Purpose: Children with intermittent exotropia (XT) may experience symptoms related to their eye condition. Nevertheless, the frequency and type of symptoms have not been rigorously studied. The aim of this study was to identify the types of symptoms experienced by children with intermittent XT and to report their frequency. Methods: 24 children (aged 5 to 17 years) with intermittent XT underwent individual semi-structured interviews to elicit concerns related to their eyes. Interview transcripts were reviewed and specific symptoms identified. Based on the interview transcripts, 22 specific symptom questions were formulated and compiled as a symptoms questionnaire. Symptom questionnaires were then administered to a separate cohort of 35 children (aged 5-13 years) with intermittent XT, who had not undergone previous surgery. Response options were: “not at all”, “sometimes” or “a lot” (5-to 7-year olds) or “never”, ‘almost never”, “sometimes”, “often” or “almost always” (8- to 17year olds). For analysis purposes, responses of “not at all”, “never” or “almost never” were considered consistent with not having the symptom. The overall frequency of symptoms was then calculated. Results: The mean number of specific symptoms reported by each child was 7 (range 2 to 19). The most frequently reported symptom was rubbing the eyes (29 [83%] of 35), followed by problems with eyes in the sun (22, 63%), the eyes feeling tired (22, 63%), having to shut one eye (17, 49%), awareness of panoramic vision (17, 49%) and having to blink to control the eyes (15, 43%). Conclusions: Children with intermittent XT frequently report symptoms such as having to rub their eyes and having problems with their eyes in the sun. Results from this study could be used to develop a shorter symptom survey for children with intermittent XT. Formal assessment of symptoms may be important for understanding how intermittent XT affects children and for optimizing management. Commercial Relationships: Sarah R. Hatt, None; David A. Leske, None; Laura Liebermann, None; Jonathan M. Holmes, None Support: NIH Grants EY024333 (JMH) and EY018810 (JMH), Research to Prevent Blindness, and the Mayo Foundation. Program Number: 5211 Poster Board Number: D0216 Presentation Time: 3:45 PM–5:30 PM True Congenital Esotropia Anthony Manassero1, Marie-Andrée Espinasse-Berrod1, PierreAntoine Aymard1, 2, Charlotte Creux1, 2, Matthieu Robert1, 2. 1 Ophthalmology, Necker Hospital, Paris, France; 2Université Paris Descartes, Paris, France. Purpose: Classically, “congenital esotropia” designated “early-onset esotropia”. The latter replaced the former as esotropia is virtually never seen at birth but appears over the first months of life. In rare instances, however, true constant esotropia is said to be seen at birth. Only then, when seen in the very first days of life, could it be called true congenital esotropia (CE). Here we tested the hypothesis that CE does exist and that it is a radically distinct entity from early-onset esotropia. Methods: Retrospective study of all cases of neonates referred to the pediatric neuro-ophthalmology clinic between October 2010 and 2014 for a constant esotropia seen at birth and formally assessed. In addition to follow-up appointments and systematic complete general pediatric examination, two systematic ophthalmologic examinations were achieved: the first one within the three first weeks of life looked for prenatal and perinatal history, an ophthalmologic malformation, and any associated pathology; it assessed the diagnosis and the nature of esotropia; the last one at 8 months included an ophthalmologic and an orthoptist examination assessing visual function, binocular vision (Lang test) and esotropia evolution. Results: Ten patients were included. Among them, 70% of patients had a franc abduction limitation of the right eye and 30% of the left eye. Esotropia regressed completely in 9/10 cases. The median time of disappearance was 4 weeks (3 – 9 weeks). The patient who did not have a complete regression was subsequently diagnosed as Duane retraction syndrome (DRS). There was no consanguinity, no prematurity among these patients; four had had a difficult delivery: two needed instrumental delivery (forceps), one was a breech delivery, and one had a wrapped umbilical cord. One patient had a prenatal history of toxoplasmosis seroconversion at three months that had resulted in a treatment (Spiramycin). No patient had any sign of amblyopia and all had a positive Lang test. Conclusions: True CE does exist and can be defined as a constant esotropia in a healthy newborn with a complete spontaneous regression in 100% of cases. The clinical characteristics and evolution of true CE are the ones of a congenital abducens nerve palsy, which would regress early enough to allow for a realignment of the visual axes during the critical period for visual development. It would therefore result in orthophoria with normal retinal correspondence, as opposed to early-onset esotropia. Commercial Relationships: Anthony Manassero, None; MarieAndrée Espinasse-Berrod, None; Pierre-Antoine Aymard, None; Charlotte Creux, None; Matthieu Robert, None Program Number: 5212 Poster Board Number: D0217 Presentation Time: 3:45 PM–5:30 PM Preliminary Evaluation of a Mobile App for Strabismus Screening Shrinivas Pundlik1, Matteo Tomasi1, 2, Kevin Houston1, Gang Luo1. 1Ophthalmology, Harvard Medical School, Schepens Eye Research Institute, Mass Eye and Ear, Boston, MA; 2EyePhone LLC, Cambridge, MA. Purpose: An automated Hirschberg Test using photographic analysis of the corneal reflection has been suggested as a method to screen for strabismus. However, cost to develop and maintain a dedicated device can hinder accessibility. Smartphones offer a platform to dispense inexpensive and widely accessible eye-care solutions. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology We have developed a mobile app with the goals of obtaining rapid, convenient, and quantifiable strabismus measurements. We present the results of a preliminary evaluation experiment to determine the accuracy of the app. Methods: When using the app, an examiner asks the patient to fixate at a particular point and simply points the phone camera to the patient’s face. Real time eye detection is shown on the screen, after which a snapshot can be taken with the flash on. The app then localizes the iris center, the corneal reflection, and computes the eye deviation according to the offset of the corneal reflection from the iris center. To evaluate the accuracy of the app, four subjects without strabismus fixated binocularly at 11 points at various eccentricities from -5.8° to 5.8° (a total of about 20Δ range). Eye deviations with respect to the center point (0°) were computed for the left and right eyes separately, and compared with the ground truth. In a case study, one subject with known left exotropia was tested with the cover test and by the app. In this case, the app measured the difference in the deviations of the two eyes. Results: The app measurements for the 8 eyes closely matched the ground truth, with a slight over estimation (line fitting slope=1.08, R2=0.99). The mean measurement error was 1.1 ± 0.9Δ.There was no difference between right and left eyes (p=0.18). In case of the patient with known strabismus, the cover test and the app found left exotropia of 24 ± 3.6Δ and 28.5 ± 3.5Δ, respectively. Conclusions: Preliminary results indicate that the strabismus app can accurately measure a wide range eye deviations and further clinical testing of the app is warranted. Strabismus Measurement App. Before image capture the display shows the area of interest (green box) and detected eyes (red). Strabismus Measurement App. After image capture the display shows the iris detection, corneal reflection, and the computed eye deviation values. Commercial Relationships: Shrinivas Pundlik, None; Matteo Tomasi, EyePhone LLC (I); Kevin Houston, EyePhone LLC (I); Gang Luo, EyePhone LLC (I) Program Number: 5213 Poster Board Number: D0218 Presentation Time: 3:45 PM–5:30 PM Development of 3D mouse-assisted Hess-Lancaster test Jong-Mo Seo1, 2, Min-Won Seo2, So Hyun Bae4, 2, Hee-Kyung Yang3, Jeong-Min Hwang1, 3. 1Ophthalmology, Seoul National University, Seoul, Korea (the Republic of); 2Electrical and Computer Engineering, Seoul National University, Seoul, Korea (the Republic of); 3Ophthalmology, Seoul National University Bundang Hospital, Seongnam-si, Korea (the Republic of); 4Ophthalmology, Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of). Purpose: Traditional Hess-Lancaster test uses nine points for diagnosing which part of the ocular muscle is paralyzed, and it uses red/green glass lenses for the inhibition of binocular fusion mechanism. This method is simple and easy to follow, but the manual examination and charting of the result decreases the reproducibility. Computerized test has been developed, but using joystick, mouse and keyboard are not so much intuitive as using pointer. To enhance the user interface and the fidelity of the computer-based test, 3D mouse was adopted and the target was revised. Methods: The software was developed on Windows 7 operating system with Application Programming Interface. And for the interactive and efficient test, 3D mouse (SpaceNavigator, 3Dconnection Inc.) was adopted. Nine reference points for the test are equally separated in distance, and the sequence of the test point is determined in pseudo-random manner, thus all points will be evaluated without duplication. Evaluation point will be displayed with empty circle with the color of red or green as a reference. And around this circle, the opposite color pair, green or red empty circle is displayed as a mobile target, so the patient should control 3D mouse in x- or y-direction to overlap the mobile circle onto the reference circle. This result reflects the deviation angle according to the gaze. On confirming the position of the second circle by clicking, reference circle will be changed to vertical bar, and the mobile circle will be changed to rotated bar, so the patient should rotate mobile bar until it is aligned to the reference bar by rotating 3D mouse. This result reflects the deviation of torsion on each gaze. By this way, all points were evaluated in terms of deviation angle and torsion. Results: 18 points of pseudo-random sequence evaluation (9 points for each eye) prevented the patient to notice which eye is being tested or which point will be displayed next time. This reduces the patient’s cheating for secondary gain. By separating circle matching and bar matching, patient’s attention can be increased in each sequence test. And by using 3D mouse, all interactions were integrated into single interface which can be used easily by the examinee. Conclusions: By using 3D mouse and the variable target, computerized Hess-Lancaster test was developed. This test might enhance the performance and the reliability of the computer-based clinical evaluation of the paralytic strabismus. Commercial Relationships: Jong-Mo Seo, None; Min-Won Seo, None; So Hyun Bae, None; Hee-Kyung Yang, None; Jeong-Min Hwang, None Support: MSIP (Ministry of Science, ICT & Future Planning), Korea in the ICT R&D program 2014, Public Welfare and Safety Program 2010-0020851 by MEST ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5214 Poster Board Number: D0219 Presentation Time: 3:45 PM–5:30 PM Spasmus nutans often reveals an underlying, potentially severe, disease Gilles Martin1, Alexandra Gavard-Perret1, Olivia Zambrowski1, Isabelle Ingster-Moati1, Nathalie Boddaert1, Pierre-Paul Vidal2, Matthieu Robert1, 2. 1Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France; 2COGNAC-G, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France. Purpose: Spasmus nutans is a type of nystagmus that has been known for years to be benign, while recent studies have shown that it sometimes reveals serious neurological or retinal disease. We tested the hypothesis that spasmus nutans is most often not benign and idiopathic. We performed a retrospective, observational study to better understand the conditions associated with spasmus nutans-type nystagmus, as well as the incidence of these conditions. Methods: Children referred to the neuro-ophthalmology clinic between November 1, 2009 and November 1, 2014, for a spasmus nutans and having benefitted from a systematic work-up were retrospectively reviewed. Spasmus nutans was defined as a pendular nystagmus with a high beating frequency (>5Hz), a small amplitude and a phase dissociation between the two eyes. It could be intermittent, horizontal, vertical, torsional or multidirectional and dissociated to the extent of being purely monocular. It could be associated with head tilt or head nodding. The work-up included neuro-ophthalmological examination with dilated fundus, recording of the nystagmus (video, eye tracking with a child-friendly dedicated infrared photo-reflectometry eye tracker, Ober Consulting®, Poland, when possible) cerebral imaging (MRI-scan) and electroretinography (Metrovision®, France). Cases with incomplete investigations, cases with already known diagnosis and also incidentally presenting a spasmus nutans and cases with obvious associated photophobia at the first visit were excluded. The combination of these data allowed us to classify each case in one of three groups of categories of spasmus nutans (revealing a neurological disease, revealing a retinal disease, or idiopathic) and to compare their relative proportions. Results: Thirty-two children (19 males) were included. The nystagmus had been noticed at a median age of 5 months. In 53% of cases (n=17), it led to the diagnosis of another condition. Most often a neurological disease was diagnosed (34%, n=11) such as chiasmal gliomas (22%, n=7), while 13% (n=4) of the children exhibited a retinal dysfunction. In 47% (n=15) of cases, spasmus nutans was considered benign idiopathic. Conclusions: In this study, spasmus nutans-type nystagmus was, in the majority of cases, the revealing symptom of another disease, often severe, and not a benign clinical entity. A systematic work-up should be considered in any case of a child who presents with spasmus nutans. Commercial Relationships: Gilles Martin, None; Alexandra Gavard-Perret, None; Olivia Zambrowski, None; Isabelle IngsterMoati, None; Nathalie Boddaert, None; Pierre-Paul Vidal, None; Matthieu Robert, None Program Number: 5215 Poster Board Number: D0220 Presentation Time: 3:45 PM–5:30 PM Spasmus nutans: an analysis of systemic and ocular comorbidities Nechama Shoshani2, 1, Sylvia Kodsi2, 3, Steven E. Rubin2, 3. 1 Ophthalmology, Montefiore Medical Center, New York, NY; 2 Ophthalmology, NS-LIJ Medical Center, Long Island, NY; 3Hofstra University, Long Island, NY. Purpose: Spasmus nutans has often been described as a benign, selflimited disorder of childhood, yet case studies have reported systemic comorbidities in children presenting with this disorder. Previous studies have not evaluated the systemic comorbidities associated with the classic triad of nystagmus, head nodding and torticollis. We performed a retrospective chart review to evaluate whether this disorder is truly benign and self-limited. Methods: We reviewed the charts of all pediatric patients who were diagnosed with nystagmus at the pediatric ophthalmology center of a tertiary care center during the years of 2004-2014. Inclusion criteria required that the patient present with nystagmus and head nodding and/or torticollis. 20 patients were identified. Patient characteristics, and information related to age, gender, vision, refraction, strabismus, amblyopia, neuroimaging, and ocular and systemic comorbidities were recorded. Results: Initial vision was found to be reduced in one or both eyes in 30% of patients, and final vision in 47%. 55% of patients had refractive errors requiring glasses wear. 50% had amblyopia, and 50% had strabismus. There were findings on brain MRI in 5 of 15 patients for whom MRI was available; these included one each of CNS tumor, poorly formed corpus callosum, and benign external hydrocephalus, and two others with benign external hydrocephalus vs. volume loss. Systemic disease was present in 50%; these children all had a systemic disorder that could account for their nystagmus. Developmental delay was present in 40%. Overall, 14 of the 20 children (70%) had ocular, neurologic, or systemic comorbidities aside from amblyopia and strabismus. We also found there to be no resolution of nystagmus in 8 of 14 patients (57%) with last visit at age 45 months or greater (mean age 85 months); however 63% of those patients with unresolved nystagmus did have resolution of their head nodding and torticollis. Conclusions: In the majority of children presenting with the triad of spasmus nutans, the disorder does not appear to be an isolated entity, but carries serious visual and systemic implications. Given the number of patients with continuing nystagmus and underlying diagnoses, the description of spasmus nutans as a benign, self-limited entity may be inaccurate. We recommend that children presenting with features of spasmus nutans be evaluated carefully for underlying ocular, intracranial, and systemic abnormalities. Commercial Relationships: Nechama Shoshani, None; Sylvia Kodsi, None; Steven E. Rubin, None Program Number: 5216 Poster Board Number: D0221 Presentation Time: 3:45 PM–5:30 PM Regression of inferior oblique recession for unilateral congenital and acquired superior oblique palsy: 10 year review Hachemi NEZZAR4, 1, Helene DALENS1, Florian FARGUETTE1, Frederic CHIAMBARETTA1, Joyce MBEKEANI2, 3. 1ophthalmology, Auvergne University Hospital, Clermont Ferrand, France; 2 department of Surgery, North Bronx Health Network, New York, NY; 3ophthalmology and visual Science, Albert Einstein College of Medecine, New York, NY; 4king Faisal Hospital and Research Center, Riyadh, Saudi Arabia. Purpose: The superior oblique (SO) palsy is the most common isolated paralytic strabismus and the inferior oblique recession is one of the surgical techniques employed for managing this palsy.The aim of our study was to evaluate the long term efficacy of inferior oblique recession for the management of vertical deviation in congenital and acquired SO palsy Methods: This study is a retrospective chart review of 62 patients with congenital and acquired superior oblique palsy managed with inferior oblique recession. All patients were operated at the University Hospital of Clermont-Ferrand between 1999 and 2010. Demographic analysis was conducted on all 62 patients. Forty–four patients submitted to final full ophthalmic and orthoptic assessment for this study and were analyzed for post-operative results. All ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology measurements were performed using Maddox rod tests. Vertical, horizontal and cyclotortion measurements were taken pre and postoperatively, but only vertical deviations were evaluated for this study. Several criteria were considered: the first criterion was the initial angle of vertical deviation in primary gaze and the second was the angle of deviation in three postoperative periods: period (1) up to 2 years, period (2) between 2 and 5 years and period (3) more than 5 years. Quantitative data were analyzed using Student T and MannWhitney U tests and multiple groups were compared using ANOVA and Tukey Kramer tests Results: Women accounted for 41.9% of patients and men, 58.1%. The mean age of all patients when operated was 29.57years. Congenital SO palsy cases were 83.9% while 16.1% were acquired. The initial mean deviation in primary gaze position was 14.55 (± 8.2) dioptres. The average post-operative decrease in vertical deviations was by 11.6 dioptres for distance and by 9.95 dioptres for near. Surgical efficacy for vertical deviation correction at distance was 90.2% at 2 years, 76.9% between 2 to 5 years and 62% after 5 years. No significant difference in deviations was found when the initial deviations were greater than 25 dioptres Conclusions: Our study confirms the efficacy of inferior oblique recession for management of congenital and acquired superior oblique palsy and documents regression of results over time. To our knowledge this is the first study to show this decline in efficacy after 5 years of follow up Commercial Relationships: Hachemi NEZZAR, None; Helene DALENS, None; Florian FARGUETTE, None; Frederic CHIAMBARETTA, None; Joyce MBEKEANI, None Program Number: 5217 Poster Board Number: D0222 Presentation Time: 3:45 PM–5:30 PM Botulinum Toxin-Augmented Strabismus Surgery versus Conventional Surgery in the Treatment of Large-Angle Infantile Esotropia Aubrey Gilbert1, 2, Michael J. Wan2, Melanie Kazlas2, 1, Carolyn Wu2, David G. Hunter2, Iason Mantagos2, Ankoor Shah2. 1Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; 2Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, MA. Purpose: The treatment of large-angle infantile esotropia remains a challenge. Surgical treatment traditionally has involved either three-muscle surgery or supra-maximal medial rectus recessions, but both methods have significant drawbacks including risk of over- or undercorrection. An alternative is to use botulinum toxin to weaken the medial rectus muscles, but multiple treatments are often required and the success rate for large deviations is poor. It has been suggested that the best approach may be to combine these treatments. No previous study has directly compared botulinum toxin-augmented surgery to conventional surgery alone. Methods: A retrospective, comparative study was completed evaluating baseline characteristics and outcomes of consecutive patients with large-angle infantile esotropia (55 prism diopters(Δ) or greater) who underwent either conventional or botulinum toxinaugmented strabismus surgery. The primary outcome measure was post-operative deviation and need for retreatment within one year of initial intervention. Success was defined as a deviation <10Δ and no retreatment at 1 year after the initial intervention. Results: The record review identified 38 patients meeting inclusion criteria, of whom 14 had been treated with botulinum toxinaugmented surgery and 24 with bilateral medial rectus recessions. Prior to surgery, the augmented group had a larger median angle of deviation (65 versus 60Δ, p = 0.006) and less recession of the medial rectus muscles was performed (5.5 versus 6.0 mm, p = 0.005). The augmented group had greater success at 1 year (70% versus 30%, p = 0.035). The augmented group also had a significantly smaller median angle of deviation at 1 year (0 versus 18Δ, p = 0.026). There were no serious complications in either group. Conclusions: Botulinum toxin can significantly augment the effect of medial rectus recessions and improve the success of strabismus surgery in patients with large-angle infantile esotropia. Commercial Relationships: Aubrey Gilbert, None; Michael J. Wan, None; Melanie Kazlas, None; Carolyn Wu, None; David G. Hunter, None; Iason Mantagos, None; Ankoor Shah, None Program Number: 5218 Poster Board Number: D0223 Presentation Time: 3:45 PM–5:30 PM Effect of Superior Oblique Posterior 7/8ths Tenectomy on Anomalous Head Positioning in Patients with Brown Syndrome Meredith H. Remmer1, Milan P. Ranka1, 2, Mark A. Steele1, 2. 1 Ophthalmology, NYU School of Medicine, New York, NY; 2 Pediatric Ophthalmic Consultants, New York, NY. Purpose: Brown Syndrome, or superior oblique (SO) tendon sheath syndrome, is characterized by overaction of the SO tendon, seen clinically as a restriction of elevation above midline in adduction. Surgical management is necessary in patients who demonstrate a significant vertical deviation in primary gaze or an anomalous head positioning (AHP) in order to maintain binocular fusion. Classical treatment includes complete SO tenectomy, recession, and spacer tenotomy. These procedures are limited by inconsistent results including scarring, under-elevation in adduction and persistent diplopia. The use of SO posterior 7/8ths tenectomy has shown to be effective in minimizing complications such as loss of torsional function and SO palsy. The purpose of this study is to evaluate the effect of SO posterior 7/8ths tenectomy on AHP in patients with Brown Syndrome. Methods: Retrospective chart review was conducted from 2003 to 2014 for patients with Brown Syndrome and an anomalous head positioning who underwent ipsilateral SO posterior 7/8ths tenectomy. Brown Syndrome was confirmed intra-operatively through forced duction testing. Results: A total of 8 patients (3 male) met inclusion criteria. The mean age at surgery was 43 +/- 21 months (median 37, range 17 to 79 months). Of the 8 patients, 6 had simultaneous horizontal muscle surgery. All had SO overaction with the inability to elevate past midline in adduction. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Mean pre-operative vertical deviation in primary gaze was 6.4 prism diopters (PD) +/- 4.4, range 2 to 16 PD. At the most recent postoperative visit, 6 patients (75%) had complete resolution of their AHP (5 following initial surgery and 1 following reoperation). Two patients had mild persistent AHP, but were improved from preoperative evaluation. No patient had restored elevation past midline in adduction. Mean post-operative vertical deviation in primary gaze was 1.0 PD +/- 2.8. (p <0.01) Average post-operative follow-up was 32 months. No surgical complications were noted. Conclusions: Our study demonstrates that SO posterior 7/8ths tenectomy is an effective procedure for improving both AHP and vertical deviation in primary gaze in Brown syndrome. All patients improved from their initial AHP. This approach should be considered to potentiate binocular fusion in these patients. SO Posterior Tenectomy A. Isolated SO tendon B. Posterior tenectomy C. Remaining anterior 1/8 tendon Commercial Relationships: Meredith H. Remmer, None; Milan P. Ranka, None; Mark A. Steele, None Program Number: 5219 Poster Board Number: D0224 Presentation Time: 3:45 PM–5:30 PM Role of Strabismus Surgery in the Treatment of Adult-Onset Esotropia Sara Grace, Kara M. Cavuoto, Hilda Capo, Wei Shi. Ophthalmology, Bascom Palmer Eye Institute, Miami, FL. Purpose: Our study aims to describe a large cohort of patients with adult-onset esotropia of diverse etiologies in terms of their presurgical characteristics, operative data and surgical outcomes. Methods: A retrospective chart review was conducted for 249 patients that underwent strabismus surgery for adult-onset esotropia within the past 15 years at a large academic center. Primary outcome measures were resolution of diplopia and a deviation less than 10 PD at distance and near in primary position. Results: Mean age at esotropia diagnosis was 52 years (18-87). The most common diagnosis overall was cranial nerve six palsy (36%), followed by thyroid eye disease (18%) and divergence insufficiency (15%). Pre-operative diplopia was experienced in 94% of patients. Approximately half (46%) of patients utilized prism preoperatively, and 13% had undergone prior strabismus surgery for adult-onset esotropia. Adjustable sutures were employed in 79%, with onethird adjusted on the day of surgery. At 2 months post-operatively, 79.4% and 82.9% of patients measured ≤ 10 PD at distance and near, respectively. At 2 months post-operatively, significant differences in resolution of diplopia were found across all diagnoses for the unilateral recess/resect procedure and the vertical muscle transposition procedure. At last visit, there was not a significant difference in diplopia resolution for all diagnoses between all surgeries. Non-significant differences were seen in dose-effects per 1 mm of surgery across the three main diagnoses. Conclusions: Multiple surgical approaches yielded successful results. To determine if significant differences exist for specific surgeries amongst individual diagnoses, larger subgroups are needed, however the simple averages for dose effect may suggest this possibility. DI patients may not follow standard surgical algorithms. Commercial Relationships: Sara Grace, None; Kara M. Cavuoto, None; Hilda Capo, None; Wei Shi, None Program Number: 5220 Poster Board Number: D0225 Presentation Time: 3:45 PM–5:30 PM Surgical correction of strabismus in monkeys: I. Longitudinal evaluation of eye alignment and eye movements Brittany A. Degler1, Mehmet N. Agaoglu1, David K. Coats2, Vallabh E. Das1. 1College of Optometry, University of Houston, Houston, TX; 2 Ophthalmology, Baylor College of Medicine, Houston, TX. Purpose: Strabismus surgery is well documented in both the literature and in practice with varying levels of success and permanence. Our goal is to characterize longitudinal changes in eye alignment and movements in monkey models for strabismus following strabismus correction surgery. Methods: The study included 1 rhesus monkey (M1) with exotropia. Strabismus had previously been induced using an optical prismviewing paradigm from birth until 4 months to disrupt binocular vision during their critical period for visual development. A recession/resection surgery was performed at 6 years of age to weaken the lateral rectus and strengthen the medial rectus of the left eye only. Strabismus angle, saccade performance, smooth pursuit performance, fixation stability and nystagmus were analyzed before surgery, immediately (1-3 days) after surgery and 6 months after surgery. Similar analysis of a second strabismic monkey is planned. Results: Strabismus angle with the right (untreated) eye viewing was ~31°XT (pre), ~11°XT (immediate post), ~18°XT (1wk post), and ~20°XT (6 months post), and with the left eye viewing was ~20°XT, ~10°XT, ~9°XT, and ~18°XT, respectively. Saccade gain showed significant changes in both eyes when viewing immediately after surgery, but attained pre-surgical values by 6 months postsurgery. Saccade peak velocity with the left eye viewing increased immediately after surgery and remained increased after 6 months in both eyes in both horizontal directions. There were small, idiosyncratic changes in saccade latency. Smooth pursuit velocity gain showed significant post-surgical changes in the covered eye, regardless of which eye was viewing. Naso-temporal asymmetry during monocular smooth-pursuit increased only with the right eye viewing immediately after surgery, but attained pre-surgical values by 6 months. Conclusions: Similar to outcomes in human surgical treatment for strabismus, strabismus angle in M1 showed a decrease immediately after surgery, followed by a steady progression back towards the monkey’s pre-surgery angle. The most notable post-surgical dynamic change in eye movements was a change in smooth-pursuit and saccade eye velocity in both the treated and untreated eye. We hypothesize that these static and dynamic changes are due to a combination of central neural adaptation and extraocular muscle remodeling that occurs as a consequence of the surgical procedure. Commercial Relationships: Brittany A. Degler, None; Mehmet N. Agaoglu, None; David K. Coats, None; Vallabh E. Das, None Support: NIH R01 EY022723; P30 EY007551 Program Number: 5221 Poster Board Number: D0226 Presentation Time: 3:45 PM–5:30 PM Surgical correction of strabismus in monkeys: II. Longitudinal evaluation of neuronal responses in the Oculomotor nucleus Mythri Pullela1, Mehmet N. Agaoglu1, Anand C. Joshi1, Sevda Agaoglu1, David K. Coats2, Vallabh E. Das1. 1College of Optometry, University of Houston, Houston, TX; 2Opthalmology, Baylor College of Medicine, Houston, TX. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Purpose: Strabismus surgery is well documented in both the literature and in practice with varying levels of success and permanence. Potentially, muscle remodeling and/or central neural adaptation affects the final state of misalignment after treatment. Our goal was to assess central adaptation by examining responses of medial rectus motoneurons (MRMN) in the oculomotor nucleus of strabismic monkeys following surgical correction. Methods: The study included one rhesus monkey with an exotropia (strabismus angle: OD: ~30°, OS: ~15°) that was induced in infancy using an optical prism-viewing paradigm. Surgical treatment when animal was ~6years old involved recession of the lateral rectus (LR) and resection of the medial rectus (MR) of the left eye only. We recorded from 21 MRMNs prior to treatment and from 70 MRMNs over the first 6 months following treatment. MRMN firing rates (FR) and horizontal eye position and velocity acquired during a horizontal smooth pursuit task (0.3Hz, ±15°) were used to identify regression coefficients in a first-order model (FR = K*Epos + R*Evel + C). K and C coefficients were then used to compute the population MR neuronal drive (ND) necessary to produce static deviation of the nonfixating eye before surgery (pre), <1 month after surgery (post1), ~6 months after surgery (post6). Results: Strabismus angle (SA) was reduced by ~35% at post1. SA during OS view gradually increased back to its pre-surgery value while SA during OD view was still reduced by ~28% of its presurgery value at post6. Analysis of MRMN in the left OMN showed that the ND to the MR of the treated left eye was decreased although the strabismus angle was reduced at post1 (pre:67 ±45 sp/s, post1:25 ±40 sp/s). Analysis of MRMN in the right OMN indicated that the ND to the MR of the untreated right eye was increased at post1 (pre:56 ±25spk/s, post1:109 ±42 spks/s). At post6, the ND to both MR approached pre-surgery values (Lt OMN: 66 ±54 spks/s; Rt OMN: 44 ±33 spk/s). Conclusions: The reduced ND to the treated eye at post1 effectively counters the desired outcome of surgery; post1 increase in ND to the untreated right eye is consistent with Hering’s law. The longitudinal (post6) changes in NDs to both treated and untreated eyes (approaching pre-surgical values) suggest a significant role of neuronal adaptation in addition to muscle remodeling in setting the steady-state strabismus angle. Commercial Relationships: Mythri Pullela, None; Mehmet N. Agaoglu, None; Anand C. Joshi, None; Sevda Agaoglu, None; David K. Coats, None; Vallabh E. Das, None Support: NIH R01 EY022723; P30 EY07551 Program Number: 5222 Poster Board Number: D0227 Presentation Time: 3:45 PM–5:30 PM Surgical correction of strabismus in monkeys: III. Longitudinal evaluation of neuronal responses in the Abducens nucleus Mehmet N. Agaoglu1, 3, Myhtri Pullela1, Anand C. Joshi1, Sevda Agaoglu1, 3, David K. Coats2, Vallabh E. Das1. 1College of Optometry, University of Houston, Houston, TX; 2Department of Ophthalmology, Baylor College of Medicine, Houston, TX; 3Department of Electrical and Computer Engineering, University of Houston, Houston, TX. Purpose: Strabismus correction surgery is well documented in both the literature and in practice with varying levels of success and permanence. Potentially, muscle remodeling and/or central neural adaptation affects the final state of misalignment after treatment. Our goal was to assess central adaptation by examining Abducens neuron (ABN) responses in strabismic monkeys following surgical correction. Methods: The study included one rhesus monkey with an exotropia (strabismus angle: OD: ~30°, OS: ~15°) that was induced in infancy using an optical prism-viewing paradigm. Surgical treatment when animal was ~6years old involved recession of the lateral rectus (LR) and resection of the medial rectus (MR) of the left eye only. We recorded from 75 ABNs prior to treatment and from 92 ABNs over the first 6 months following treatment. ABN firing rates (FR) and horizontal eye position and velocity acquired during a horizontal smooth pursuit task (0.3Hz, ±15°) were used to identify regression coefficients in a first-order model (FR = K*Epos + R*Evel + C). K and C coefficients were then used to compute the population LR neuronal drive (ND) necessary to produce static deviation of the non-fixating eye before surgery (pre), <1 month after surgery (post1), ~6 months after surgery (post6). Results: Strabismus angle (SA) was reduced by ~35% at post1. SA during OS view gradually increased back to its pre-surgery value while SA during OD view was still reduced by ~28% of its presurgery value at post6. Analysis of Left ABN cells showed that the ND to the LR of the treated left eye did not change at post1 although SA was reduced significantly (pre: 177±81 sp/s, post1: 173±79 sp/s). Analysis of Right ABN cells indicated that the ND to the LR of the untreated right eye was reduced at post1 (pre: 115±78 sp/s, post1: 80±57). At post6, the ND from Left ABN showed a significant drop (138±47 sp/s); the ND from Right ABN reverted to pre-surgery levels (107±26 sp/s). Conclusions: The unchanged ND to the treated eye immediately after surgery suggests that alterations in muscle strength of the treated eye determined the improvement in strabismus angle; post1 reduction in ND to the untreated eye simply reflects Hering’s law. The post6 changes in the NDs to both treated and untreated eyes suggest a significant role of neural adaptation in addition to muscle remodeling in setting the steady-state strabismus angle. Commercial Relationships: Mehmet N. Agaoglu, None; Myhtri Pullela, None; Anand C. Joshi, None; Sevda Agaoglu, None; David K. Coats, None; Vallabh E. Das, None Support: NIH R01 EY022723; P30 EY07551 Program Number: 5223 Poster Board Number: D0228 Presentation Time: 3:45 PM–5:30 PM Quantitative measurement of the angle of ocular movements in patients with horizontal strabismus Han Woong Lim1, Jung Wook Lee1, Heeyoon Cho1, Yumi Song2, Moon sang won3, Byung Ro Lee3, Sei yeul oh4. 1Ophthalmology, Hanyang University Guri Hospital, Guri, Korea (the Republic of); 2Hong Ik Hospital, Seoul, Korea (the Republic of); 3Hanyang university hospital, Seoul, Korea (the Republic of); 4Sungkyunkwan university samsung hospital, Seoul, Korea (the Republic of). Purpose: To measure the maximum angle of horizontal versions in patients with comitant horizontal strabismus. Methods: One hundred two subjects with comitant exotropia and Fifty-two subjects with comitant esotropia were included. Photographs were obtained in the cardinal positions of gaze and the images were processed using Photoshop. The images were analyzed using the Image J program to measure the angle of version (Fig 1). The maximum angle of horizontal versions (dextoversion and levoversion) was quantified using a modified limbus test. Results: The mean angle of adduction (38.1±7.2°) was smaller than that of abduction (46.6±8.5°) in patients with exotropia (P < 0.001) (Fig 2). In patients with esotropia, the mean angle of abduction (45.4±6.3°) was smaller than that of adduction (48.1±8.3°) (P = 0.039). There was a significant negative correlation between the angle of adduction and the prism diopter of exotropia in patients with exotropia (R = -0.367, P = 0.001). The angle of abduction and the prism diopter of esotropia showed no correlation in patients with esotropia (R = -0.215, P = 0.065). ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Conclusions: The angle of adduction and abduction on horizontal versions were asymmetric in patients with horizontal strabismus. These findings suggest that assessment of the angle of ocular movements is required for better understanding of inequality of the conjugate eye movements in horizontal strabismus. Figure 1. Image processing by Photoshop and Image J for quantitative measurement of the ocular movement. A, Semitransparent image of depression was overlapped with primary position image using Photoshop. B, The overlapping image was converted to identify the margin of limbus using Photoshop. C, Geometrical analysis with Image J showing degrees of ocular rotation of the limbus. Figure 2. Case. Composite images as an outcome of overlapping with the layer of the primary position and processing by Photoshop. The angle of adduction is lower than that of abduction on both dextroversion (47.6° vs. 50.8°) and levoversion (35.5° vs. 43.1°) in this patient. Commercial Relationships: Han Woong Lim, None; Jung Wook Lee, None; Heeyoon Cho, None; Yumi Song, None; Moon sang won, None; Byung Ro Lee, None; Sei yeul oh, None Program Number: 5224 Poster Board Number: D0229 Presentation Time: 3:45 PM–5:30 PM Surgical outcomes of exotropia in patients aged under 4 years Hye Shin Jeon, Jae Ho Jung, Hee-Young Choi. Ophthalmology, Pusan National university hospital, Busan, Korea (the Republic of). Purpose: To investigate surgical outcomes in children with intermittent exotropia who were operated before 4 years old. Methods: Three hundred forty one patients who had been operated for intermittent exotropia were included in this study. All of the patients were followed up for more than 1 year. Pre and post operative angle of deviation, type of surgery, surgical success rate, stereopsis at final follow up and factors related to success were evaluated. Surgical success was defined as binocular deviation was less than 10 prism diopter(PD) at 1 year after surgery. Results: Patients were divided into two groups whether operated before 48 months (younger group) or after 48 months (older group). Preoperative horizontal deviation was 31.58 +- 8.43 PD in the younger group and 26.41 +- 8.05 PD in the older group which was significantly larger in the younger group. 36 (61.0%) of 59 patients in younger group achieved surgical success, 1 (1.70%) had overcorrection and 22 (37.3%) had recurrence. In older group, 177 (62.8%) of 282 patients were successfully aligned, 105 (37.2%) had recurrence. Surgical success rate was not significantly different between two groups. (p=0.883, Chi-square test) Success rate was significantly higher when the primary horizontal deviation is smaller than 35 PD in the younger group (p=0.036, Chi-square test) and initial esotropia was more prominent at 1 week after surgery. (p=0.034, Mann-whitney U test) Success rate was not significantly different whether deviation is below or above 35 PD in the older group. Conclusions: Comparable surgical outcome was achieved in patients with intermittent exotropia between the younger and older group. Surgical outcome is likely less favorable when horizontal deviation is larger than 35PD in patients under 4 years old. Commercial Relationships: Hye Shin Jeon, None; Jae Ho Jung, None; Hee-Young Choi, None Program Number: 5225 Poster Board Number: D0230 Presentation Time: 3:45 PM–5:30 PM Surgical strabismus in Down syndrome patients Jeffrey Hollander, Luai Eldweik, Danielle Ledoux. Ophthalmology, Boston Children’s Hospital, Boston, MA. Purpose: There is an increased incidence of acquired strabismus in the Down syndrome population, more commonly resulting in esotropia than other deviations. We performed a retrospective chart review of the Down syndrome population with esotropia who had strabismus surgery to better understand the types of esotropia seen and the surgical outcomes. Methods: We performed a seven year (2007–2014) retrospective chart review of all patients with a diagnosis of Down syndrome who had surgery for strabismus at a single, tertiary care center. Data including indications for surgery, preoperative and postoperative sensorimotor exam, presence of anomalous head posture, and type of surgery were recorded. Postoperative exam was at least one month after surgery. Surgical success was defined using three criteria: i) orthotropia to an esotropia of less than, or equal to 8 prism diopters in primary position, ii) improvement of anomalous head posture, and iii) no further indication for surgery. Results: 16 patients were identified who had Down syndrome and were surgically treated for esotropia. Of these 1 was excluded due to follow-up of only two weeks. Preoperative findings of the remaining 15 patients included 8 (53%) with an A-pattern, 1 (7%) with a V-pattern, 1 (7%) with a head tilt dependent esotropia, 2 (13%) who had no assessment of pattern, and 3 (20%) with no pattern of esotropia. Anomalous head postures were appreciated in 5 (33%) patients preoperatively, resolved in 4 patients postoperatively, and persisted in 1. In addition, 2 other patients had anomalous head postures not appreciated preoperatively. Of the 8 patients with an A-pattern esotropia, 4 were treated with only a bilateral medial rectus recession, 3 (75%) of who required a second surgery. Ultimately, 7 of the 8 patients achieved successful surgical outcomes. Overall surgical success in this study was 87% (13/15). 2 patients were deemed ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology surgical failures due to persistence of anomalous head posture and esotropia. Conclusions: Surgical success was achieved in 87% of patients with Down syndrome and esotropia. We identified an increased incidence of A-pattern strabismus in the Down syndrome population, a finding not previously noted. All 3 patients who required reoperation had A-patterns that were not addressed at the time of surgery. Ultimately, 88% of patients with A-pattern strabismus achieved successful surgical outcomes. Recognition of patterns preoperatively may help guide the surgical plan. Commercial Relationships: Jeffrey Hollander, None; Luai Eldweik, None; Danielle Ledoux, None Program Number: 5226 Poster Board Number: D0231 Presentation Time: 3:45 PM–5:30 PM Minimally invasive adjustable suture marginal tenotomy and plication for correction of incomitant vertical strabismus and torsion Melinda Chang, Stacy Pineles, Federico Velez. Ophthalmology, Jules Stein Eye Institute, Los Angeles, CA. Purpose: To evaluate the effectiveness of minimally invasive adjustable suture marginal tenotomy and plication of vertical rectus muscles in correcting incomitant vertical strabismus and torsion. Methods: Retrospective review of all patients who underwent marginal tenotomy or marginal plication of a vertical rectus muscle for correction of incomitant vertical strabismus or torsion by a single surgeon at a single Eye Institute from July 2013 to September 2014. Patients were excluded if they did not complete at least 6 weeks of follow-up. Results: A total of 10 patients were identified. Two patients underwent monitored anesthesia care, and eight patients had general anesthesia. Marginal plications were performed on five patients, two of whom had incomitant vertical strabismus, one of whom had cyclotorsion without incomitant vertical strabismus, and two of whom had both. Marginal tenotomies were performed on five patients to correct both incomitant vertical strabismus and cyclotorsion. Two patients were adjusted postoperatively. Marginal plications corrected a mean of 10 prism diopters (range 4 to 14 prism diopters) of incomitant deviation, from a mean of 10.75 prism diopters (range 4 to 14 prism diopters) preoperatively. Marginal plications corrected a mean of 2 degrees of cyclotorsion (range 4 degrees increase in torsion to 8 degrees decrease in torsion), from a mean preoperative torsion of 8 degrees (range 11 degrees incyclotorsion to 8 degrees excyclotorsion). Marginal tenotomies corrected a mean of 4.7 prism diopters (range 2 to 9 prism diopters) of vertical incomitance, from a mean of 5 prism diopters (range 2 to 9 prism diopters) preoperatively. Marginal tenotomies corrected a mean of 3.7 degrees of cyclotorsion (range 0.5 degrees increase in torsion to 9 degrees decrease in torsion) from a mean preoperative torsion of 7.3 degrees (range 5 to 10 degrees excyclotorsion). Nine of 10 patients had resolution of vertical and torsional diplopia postoperatively. Conclusions: Minimally invasive marginal tenotomy and marginal plication surgeries are effective in reducing or eliminating incomitant vertical strabismus. Their effect on torsion is more variable. They are advantageous compared to surgery on oblique muscles, especially the inferior oblique, because they can be performed under monitored anesthesia care with intraoperative and/or postoperative adjustment. Commercial Relationships: Melinda Chang, None; Stacy Pineles, None; Federico Velez, None Program Number: 5227 Poster Board Number: D0232 Presentation Time: 3:45 PM–5:30 PM Comparing refractive error distribution in children with Intermittent Exotropia from the Chinese and American NonChinese ethnicity Mellisa Hege1, Jason CS Yam2, Simon Ko3, Gabriela Chong3, Jeremy Kwok3, Laila Mossa-Basha4, Shanshan Li5, Jingyun Wang1. 1Opthalmalogy, Glick Eye Institute-IUSM, Indianapolis, IN; 2Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China; 3Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China; 4 Marian University College of Osteopathic Medicine, Indianapolis, IN; 5School of Public Health, Indiana University Purdue University at Indianapolis, Indianapolis, IN. Purpose: Children with Intermittent Exotropia (IXT) in the West are often emmetropic or low hyperopic (Abrahamsson et al, 1992). However, the prevalence of myopia has been reported to be higher in Chinese ethnicity (Pan et al, 2012). It is possible that Chinese children with IXT are more myopic than children with IXT in the western countries. This study compared the refractive error distribution at the age of detection in children with IXT in Hong Kong to children with IXT in Indiana, USA. Methods: Retrospective cohort study of children with IXT from Hong-Kong (Chinese ethnicity) and Indiana (American NonChinese ethnicity: 85% Caucasian and 15% of other races, excluding Chinese). Eligibility criteria included: 3 to 15 years old, diagnosed with IXT, no prior surgery, no Down syndrome or other systematic or genetic conditions, and birth age >36 weeks. Cycloplegic refractive errors at the age of detection culled from medical records were converted to a spherical equivalent (SEQ) in diopters (D). Astigmatism was estimated by the magnitude of cylinder (CYL). Both SEQ and CYLwere analyzed for two age subgroups: a 3- to 7-year-old subgroup and an 8- to 15-year-old subgroup. To compare the SEQ difference between the two groups, an independent t-test was used. Due to the general similarity of refractive error in both eyes in children with IXT, only the results from the right eye were reported. Results: The study included 156 patients. On average, SEQ is more myopic in the Chinese group than in the American non-Chinese group. The SEQ of Chinese children in two age subgroups were all significantly more myopic than that of American non-Chinese Children (p<0.05, see Table 1). In both Chinese and Non-Chinese groups, the mean SEQ was significantly more myopic in the 8-15 year-old subgroup than in the 3-7 year-old subgroup (P<0.01, Table 1). However, there was no significant difference on the CYL between groups (p=0.6). Conclusions: Compared to American Non-Chinese children with IXT, Chinese children with IXT are more myopic. Also, older children tend to be more myopic. Such distribution may be associated with the high prevalence of myopia in Chinese ethnicity. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Jan Roelof Polling, None; Willem Tideman, None; Vincent Jaddoe, None; Albert Hofman, None; Caroline C. Klaver, None Commercial Relationships: Mellisa Hege, None; Jason CS Yam, None; Simon Ko, None; Gabriela Chong, None; Jeremy Kwok, None; Laila Mossa-Basha, None; Shanshan Li, None; Jingyun Wang, None Program Number: 5228 Poster Board Number: D0233 Presentation Time: 3:45 PM–5:30 PM Refractive error determines type of strabismus: The Generation R study Jan Roelof Polling3, 2, Willem Tideman3, Vincent Jaddoe1, Albert Hofman1, Caroline C. Klaver1. 1Epidemiology, Erasmus MC, Rotterdam, Netherlands; 2Orthoptics & Optometry, University of Applied Sciences, Faculty of Health, Utrecht, Netherlands; 3 Ophthalmology, Erasmus MC, Rotterdam, Netherlands. Purpose: Previous studies suggest that the prevalence of strabismus subtypes is related to ethnicity, with exotropia being more frequent in Asian populations and esotropia in Caucasian populations. This predilection may be determined by refractive error. We investigated the relationship between strabismus subtype and refractive error in a large population-based cohort of young children. Methods: The Generation R Study is a multi-ethnic population-based birth-cohort study in Rotterdam, the Netherlands, which includes 6690 children. LogMAR visual acuity (LEA charts) was determined at age 6, and those with LogMAR acuity > 0.1 or those receiving ophthalmic care were evaluated for ocular alignment and cycloplegic refraction. Strabismus subtype was determined by the treating orthoptist according to a national classification system. Results: Mean age of children was 6.2 (SD ±0.5) years., N=110 (1.6%)children were identified with a manifest strabismus. Of these convergent strabismus was most common (n = 74, 1.1%), with accommodative esotropia (n = 55, 0.82%) as nost common subtype, followed by constant esotropia (n = 15, 0.2%) and infantile esotropia (n = 4, 0.06%). Exotropia was detected in n=25 (0.4%) children; n=10 (0.1%) children had special forms of strabismus such as congenital trochlear palsy, Duane, congenital fibrosis and acquired palsy. Mean spherical equivalent was +4.67D (SD ±1.94) in accommodative esotropia and +0.04D (SD 2.17; P<0.01) in exotropia. Conclusions: Type of strabismus appears to be associated to refractive error; exotropic children are more myopic, whereas esotropic children are more hyperopic. The increasing prevalence of myopia worldwide may determine the relative increase of exotropia and may be the cause of the ethnic variation in strabismus subtypes. Program Number: 5229 Poster Board Number: D0234 Presentation Time: 3:45 PM–5:30 PM Acquired Brown’s Syndrome in children: MRI abnormalities of the superior oblique tendon-trochlea complex Christina Gerth-Kahlert1, Veit Sturm2, Werner Wichmann3. 1 Ophthalmology, University Hospital Zurich, Zurich, Switzerland; 2 Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; 3Neuroradiology, University Hospital, Zurich, Switzerland. Purpose: To characterize and demonstrate structural abnormalities in the rare instance of acquired Brown’s syndrome in children. Methods: Retrospective chart review of pediatric patients with the diagnosis of non- congenital Brown’s syndrome. Blinded reevaluation of available MR imaging was performed. Results: Three patients (2 female, 1 male) with an age at onset of first symptoms of 6.2, 8.2 and 8.5 years were identified. Signs and symptoms at onset were diplopia, abnormal head posture (AHP) and strabismus. 2/3 children had a documented normal orthoptic examination prior to the acute onset of vertical strabismus. All children lacked other neurological signs. MRI performed between 10 days and 8 weeks after first diagnosis showed contrast enhancement of the superior oblique tendon in 2/3 and thickening in the area of the trochlea- tendon complex in 2/3 cases. Clinical follow up demonstrated improved motility with consecutive reduction of diplopia and extent of AHP in 2/3 cases after 0.4 to 1.4 years. Conclusions: Acquired Brown’s syndrome might be caused by a localized inflammation of the superior oblique tendon/ trochlea complex. Despite the good clinical outcome, MR imaging in patients with an acute onset is recommended to exclude other etiologies. Commercial Relationships: Christina Gerth-Kahlert, None; Veit Sturm, None; Werner Wichmann, None Program Number: 5230 Poster Board Number: D0235 Presentation Time: 3:45 PM–5:30 PM Clinical Characteristics of Exodeviated Patients from Accomodative Esotropia and Hyperopia Sang H. Rah, Soo Han Kim. Ophthalmology, Wonju Severance Christian Hospital, Wonju, Korea (the Republic of). Purpose: To evaluated the characteristics of exodeviated patients form accomodative esotropia and hyperopia. Methods: Chart review of patients from Jan 1st 1997 to DEC 31st 2013. Patients developed exotropia from accommodative esotropia and hyperopia. Patient whom received surgery for strabismus were excluded. Results: 13 patient was recognized. Initially patient was referred at mean 4.1years old. Cycloplegic refraction mean +5.58 Diopter (D) at initial. 10 Patients(76.9%) had accommodative esotropia with mean 24.75 Prism Diopter (PD) at near gaze. 7 patient (53.8%) had bilateral amblyopia with average visual acuity of 0.3 and spherical equivalent of +5.74D. 6 patients (46.15%) had monocular amblyopia with visual acuity of 0.25 at amblyopic eye and 0.55 at dominant eye. Spherical equivalent of amblyopic eye was +5.93D and +4.79D in dominant eye. Exodeviation was first appeared at average 9.2 years of age. Spherical equivalent was +4.50D in bilateral amblyopic patients. In patients with monocular amblyopia spherical equivalent was +3.60D in amblyopic eye and +2.17D in dominant eye. Exodeviation was average 13.1PD but ranged from small exotropia to 16 PD ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology exotropia. Patient with residual hyperopia(83.8%), exotropia was successfully decreased with spectacle correction. Conclusions: All patients who developed exotropia form accomodative esotropia and hyperopia had bilateral or unilateral amblyopia. Observation is needed in case of accommodative esotropia and hyperopia, since exodeviation could develop. Exotropia was successfully managed with spectacle correction. Further study is needed for possible surgical intervention. Commercial Relationships: Sang H. Rah, None; Soo Han Kim, None 511 Optic neuritis / Optic nerve Thursday, May 07, 2015 8:30 AM–10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 5528–5560/B0099–B0131 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Contributing Section(s): Biochemistry/Molecular Biology, Clinical/ Epidemiologic Research, Visual Neuroscience Program Number: 5528 Poster Board Number: B0099 Presentation Time: 8:30 AM–10:15 AM Neuroprotective Effects of Amnion-derived Cellular Cytokine Solution (ACCS) in Experimental Optic Neuritis Reas Sulaimankutty1, Kimberly Dine1, Helayna Brown1, Larry R. Brown2, Kenneth S. Shindler1. 1Ophthalmology, Univ of Pennsylvania, Scheie Eye Inst, Philadelphia, PA; 2Stemnion Inc, Pittsburgh, PA. Purpose: Optic neuritis is a demyelinating inflammation of the optic nerve that often occurs in multiple sclerosis (MS) patients. Loss of retinal ganglion cells (RGCs) and their axons also occurs in optic neuritis, and correlates with permanent vision loss. ACCS is a novel biologic mixture of growth factors and cytokines secreted from Amnion-derived Multipotent Progenitor (AMP) cells, that exhibits anti-inflammatory and neuroprotective properties in a variety of disease models. The ability of ACCS to suppress optic neuritis in the experimental autoimmune encephalomyelitis (EAE) model of MS was examined. Methods: EAE was induced in C57/BL6 mice by immunization with myelin oligodendroglial glycoprotein peptide. Mice were treated daily with one drop (6 uL) of ACCS intranasally beginning before or after onset of optic neuritis. Visual function was assessed by optokinetic responses (OKR) at baseline, then weekly until sacrifice 6 weeks post-immunization. Retinas and optic nerves were isolated. RGCs were immunolabeled with Brn3a antibodies to quantify RGC survival. Inflammation was assessed by H&E and Iba1 (macrophage/ microglia marker) staining, demyelination by luxol fast blue staining, and axonal loss by neurofilament staining of optic nerve sections. Results: Progressive decreases in OKR occurred in vehicle-treated EAE mice, along with significant RGC loss, consistent with prior studies showing onset of optic neuritis occurring 12-15 days after EAE induction. Daily intranasal ACCS treatment beginning on day 0 (day of immunization), 15, 22, or 30, significantly reduced the level of vision loss, and treatment from day 0 or day 15 significantly attenuated RGC loss. ACCS also decreased the degree of demyelination and axonal loss, but had limited effects on the level of inflammation in the optic nerve. Conclusions: ACCS treatment attenuates RGC loss, preserves OKR responses, and reduces demyelination and axonal loss during experimental optic neuritis in EAE mice. ACCS exerts effects with treatment initiated before and after onset of optic neuritis, suggesting it may be useful as a preventative or abortive therapy. Results suggest ACCS is a potential treatment for optic neuritis that warrants further study. Furthermore, potent effects seen after intranasal administration suggest this may be a novel drug delivery method for optic neuritis. Commercial Relationships: Reas Sulaimankutty, None; Kimberly Dine, None; Helayna Brown, None; Larry R. Brown, Stemnion Inc (I); Kenneth S. Shindler, Stemnion Inc (F) Support: NIH Grant EY019014 Program Number: 5529 Poster Board Number: B0100 Presentation Time: 8:30 AM–10:15 AM Experimental optic neuritis induced by the microinjection of lipopolysaccharide into the optic nerve Marcos Luis Aranda, Damian Dorfman, Pablo Sande, Ruth E. Rosenstein. Human Biochemistry, University of Buenos Aires /Sch of Medicine, Buenos Aires, Argentina. Purpose: Optic neuritis (ON) is a condition involving primary inflammation, demyelination, and axonal injury in the optic nerve which leads to retinal ganglion cell (RGC) loss, and visual dysfunction. We investigated the ability of a single microinjection of bacterial lipopolysaccharide (LPS) directly into the optic nerve to induce functional and structural alterations compatible with ON. For this purpose, optic nerves from male Wistar rats remained intact or were injected with vehicle or LPS. Methods: The effect of LPS was evaluated at several time points post-injection in terms of: i) visual pathway and retinal function (visual evoked potentials (VEPs) and electroretinograms, (ERGs), respectively), ii) anterograde transport from the retina to its projection areas, iii) consensual pupil light reflex (PLR), iv) optic nerve histology, v) microglia/macrophage reactivity (by Iba1- and ED1-immunostaining), vi) astrocyte reactivity (by glial fibrillary acid protein-immunostaining), vii) axon number (by toluidine blue staining), vii) demyelination (by myelin basic protein immunoreactivity and luxol fast blue staining), viii) optic nerve ultrastructure, and ix) RGC number (by Brn3a immunoreactivity). Results: LPS induced a significant and persistent decrease in VEP amplitude and PLR,without changes in the ERG. In addition, LPS induced a deficit in anterograde transport, and an early inflammatory response consisting in an increased cellularity, and Iba-1 and ED1immunoreactivity in the optic nerve, which were followed by changes in axonal density, astrocytosis, demyelination, and axon and RGC loss. Conclusions: These results suggest that the microinjection of LPS into the optic nerve may serve as a new experimental model of primary ON. Commercial Relationships: Marcos Luis Aranda, None; Damian Dorfman, None; Pablo Sande, None; Ruth E. Rosenstein, None Support: CONICET-PIP0446, ANPCyT-PICT0610, FUNDACION FLORENCIO FIORINI, UBA Program Number: 5530 Poster Board Number: B0101 Presentation Time: 8:30 AM–10:15 AM Impaired axonal transport in a rodent model of optic neuritis due to NMO spectrum disorder Yoshiko Matsumoto1, Akiyasu Kanamori1, Sho Nobuyoshi1, Ichiro Nakashima2, Makoto Nakamura1. 1Department of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan; 2 Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan. Purpose: We previously reported that exposure of serum from patients with seropositive neuromyelitis optica spectrum disorders (NMOSDs) led to astrocytic damage at 7 days. However, axonal loss was not detected at that time (Matsumoto Y, et al. Exp. Eye Res. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 2014). The purpose of this study was to evaluate whether axonal transport is impaired in a rodent model of optic neuritis in NMOSDs. Methods: We collected serum from patients with idiopathic or NMO-optic neuritis or from normal subjects. Using male SpragueDawley rats (200-300g), we exposed the rat optic nerve to the collected serum as previously reported. The treated rats were divided into those exposed to aquaporin 4 (AQP4) autoantibody-positive serum (AQP4+) or those exposed to AQP4 antibody-negative serum (AQP4-). Seven days (7D) and 14 days (14D) after treatment, rats were sacrificed and the optic nerves were excised. Cryosections of the optic nerves were subjected to immunohistochemistry against neurofilament (NF) and kinesin1-kif5b (Kif5b). Real-time polymerase chain reaction (RT-PCR) analyses were also conducted to evaluate Kif5b gene expressions. Results: Linear Ki5b immunoreactivity (IR) was co-localized with NF expression in the optic nerves. Aggregated IR of Kif5b was scattered in the optic nerves of the AQP4+ group at 7D. The number of the aggregated Kif5b IR in the AQP4+ group was statistically increased than that in the AQP4- group (n=8 each, unpaired t-test; p=0.02). The gene expression of Kif5b was significantly decreased in the AQP4+ group at 14D compared with controls (n=6 each, unpaired t-test; p=0.02), but not in the AQP4- group. Conclusions: Given that kinesin1-Ki5b plays a critical role in the anterograde axonal transport, the present study suggested that axonal transport is impaired in the optic nerves of rodent models of NMOSDs before detectable axonal loss. Commercial Relationships: Yoshiko Matsumoto, None; Akiyasu Kanamori, None; Sho Nobuyoshi, None; Ichiro Nakashima, None; Makoto Nakamura, None Support: JSPS KAKENHI, The Uehara Memorial Foundation Program Number: 5531 Poster Board Number: B0102 Presentation Time: 8:30 AM–10:15 AM Phosphatase and Tensin Homolog (PTEN) Knockout in Retinal Ganglion Cells (RGCs) Rescues Optic Neuritis in Experimental Autoimmune Encephalomyelitis (EAE) Mice Venu Talla1, Vince Chiodo2, Vittorio Porciatti1, Sanford L. Boye2, William W. Hauswirth2, John Guy1. 1Ophthalmology, Bascom Palmer Eye Institute, Miami, FL; 2Department of Ophthalmology, University of Florida, Gainesville, FL. Purpose: To rescue visual loss and optic neuropathy in EAE mouse model using ssAAV2Cre-GFP mediated knockout (KO) of floxed PTEN (PTEN fl/fl), a negative regulator of mTOR (mammalian target of rapamycin) pathway involved in optic nerve axonal regeneration in RGCs. Methods: EAE was induced in floxed-PTEN mice (n=11) and littermates (n=8) by subdermal injection of 0.1 ml homologous spinal cord emulsion in complete Freunds adjuvant in the nuchal area. EAE sensitized floxed-PTEN mice received an intravitreal injection of ssAAV-Cre-GFP into both eyes whereas EAE littermates received scAAV-mCherry as an injection control. Unsensitized littermates with or without scAAV-mCherry injections acted as additional controls (n=16). Visual function was assessed by recording pattern electroretinograms (PERG). Spectral domain OCT evaluated the thickness of the inner plexiform layer to the nerve fiber layer at 1, 4 and 9 months post injection (MPI). Expression of the Cre-GFP in the RGCs and ONs were evaluated in live mice by confocal scanning laser ophthalmoscope (CSLO) imaging at 5 and 9 MPI. Retina and ON tissues were dissected and Tuj1 labeled RGCs and ON axons were evaluated by immunofluorescence. Results: Expression: CSLO imaging at 5 and 9MPI in live EAE floxed-PTEN mice revealed expression of Cre-GFP in RGC layer. Rescue: PERG analysis at 1M, 4M and 9MPI showed a 25%, 37% and 41% reduction in amplitude of EAE-mCherry mice compared to mCherry/control mice (p<0.005). The PERG latencies were also delayed by 7%, 17% and 27% in EAE-mCherry at 1M, 4M (p<0.05) and 9MPI (p<0.05). Interestingly, knockout of PTEN in EAE mice RGCs by AAV2-Cre-GFP injection rescued the amplitudes by 51, 54 and 77% (p<0.005) at 1, 4 & 9MPI. However, the latencies were not significantly rescued compared to EAE-mcherry. OCT images of the EAE-mCherry mice showed a significant thinning (p<0.005) in RNFL/RGC/inner plexiform layers while the OCT images of the PTEN (KO) EAE mice were 150% (p<0.0001) & 122% (p<0.0001) thicker compared to control at 5 & 9 MPI. Quantitative analysis of Tuj1 positive cells revealed 57% rescue of RGCs in PTEN (KO) mice compared to EAE mice (p<0.05). Conclusions: PTEN is involved in intrinsic axonal growth arrest and knocking out the PTEN in RGCs is a strategy that may be useful for treating the 8% of optic neuritis patients experiencing permanent loss of vision. Commercial Relationships: Venu Talla, None; Vince Chiodo, None; Vittorio Porciatti, None; Sanford L. Boye, None; William W. Hauswirth, AGTC (F); John Guy, None Support: R01EY07892, EY017141, EY012355, EY019077, NIH center grant P30-EY014801, unrestricted grant to Bascom Palmer Eye Institute from Research to Prevent Blindness, Inc. Program Number: 5532 Poster Board Number: B0103 Presentation Time: 8:30 AM–10:15 AM Changes of CXCL12, CXCL14 and PDGF levels in the brain of patients with idiopathic demyelinating optic neuritis and neuromyelitis optica Tingjun Chen. neuro ophthalmology, Beijing, China. Purpose: The CXC chemokines (CXC-motif ligand 12 and CXCmotif ligand 14) and platelet-derived growth factor are suggested to modulate remyelination in the course of many demyelinating diseases. The present study compared the difference in the brain levels of these chemokines between patients with idiopathic demyelinating optic neuritis (IDON) and neuromyelitis optica (NMO) by measuring concentrations of these chemokines in the cerebrospinal fluid using an enzyme linked immunosorbent assay. Methods: In this study, PDGF, CXCL12 and CXCL14 levels in the CSF of IDON and NMO patients were measured by ELISA and compared, and non-inflammatory neural disease (NIND) patients were used as negative control as reported by others . Results: Our data indicate that the prognosis of neuritis depends on the remyelinating process that is impaired due to decreased chemokines. The much lower levels of chemokines would specifically indicate the severe neuritis, such as NMO. Conclusions: In conclusion, the present study strongly suggests that chemokines, PDGF, CXCL12 and CXCL14, may alone and/or together associate with these two types of ON. The former two would serve to stimulate the maturation of OPCs, and the last one is a possible OPC maturation inhibitor. Commercial Relationships: Tingjun Chen, None Support: Chinese Postdoctoral Science Foundation (No.2013M542249) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5533 Poster Board Number: B0104 Presentation Time: 8:30 AM–10:15 AM Color cone contrast testing adds predictive value of visual function in combination with low-contrast testing in multiple sclerosis Hao Yiu, Samuel Arnow, Jeffrey Gelfand, Christopher Songster, Denise Bolivar, Ari Green. Neurology, University of California, San Francisco, San Francisco, CA. Purpose: Low contrast visual function has been validated as an important clinical outcome measure in both observational and therapeutic investigational studies in multiple sclerosis. Computerized tests of visual performance provide convenient measures of visual function in the clinic. Subjects with multiple sclerosis frequently have structural injury to the retina that can be assessed via spectral-domain optical coherence tomography. Recent advances in software algorithms allow segmentation and quantification of individual retinal layers. Methods: We performed Rabin cone contrast testing (CCT), computerized low contrast threshold testing (LCT), and Heidelberg Spectralis spectral-domain optical coherence tomography (SD-OCT) in 52 people with multiple sclerosis (MS) (102 eyes, 71% female, 18 with a history of a prior optic neuritis). Linear mixed-models were used to analyze the association between cone-contrast and lowcontrast visual function and retinal layer thickness, adjusting for age, sex, history of optic neuritis, and accounting for intra-subject intereye correlations. Results: Red, Blue, and Green CCT scores were positively correlated with macular ganglion cell / inner plexiform layer (GCIPL) thickness (p<0.001), but were not significantly associated with the thickness of other retinal layers. Linear mixed-effect regression models predicting GCIPL thickness showed significant improvement with the addition of LCT scores (change in deviance of 79.0 and 81.0 in models with and without CCT, respectively). The addition of CCT had a lower magnitude but significant effect on model deviance even when low contrast vision was included as a predictor in the model (change in deviance of 33.6 and 27.4 on models with and without LCT, respectively). Conclusions: Color cone contrast testing is correlated with GCLIP thickness in MS and provides added predictive value of visual pathway injury in combination with low-contrast testing in MS patients. Commercial Relationships: Hao Yiu, None; Samuel Arnow, None; Jeffrey Gelfand, Journal Watch Neurology (Massachusetts Medical Society) (R), Medical Legal Consulting (C); Christopher Songster, None; Denise Bolivar, None; Ari Green, Accorda (C), Biogen (C), Biogen/Idec/Applied Clinical Intelligence (R), Novartis (C), Prana Bioscience (C), Roche (C) Program Number: 5534 Poster Board Number: B0105 Presentation Time: 8:30 AM–10:15 AM Visual outcome predictors in acute optic neuritis Sangah Kim, Samin Hong, Chan Yun Kim, Gong Je Seong. Ophthalmology, Yonsei University College of Medicine, Seoul, Korea (the Republic of). Purpose: To find the visual outcome predictors in patients who received intravenous steroid pulse therapy (ISPT) due to acute optic neuritis (AON). Methods: A retrospective, observational, clinical study. A total of 33 AON patients received ISPT (methylprednisolone, 250 mg, four times a day, 3 days) and had follow-up checkups for at least 3 months after the therapy were included in this study. Patients were divided into two groups, those who finally recovered their vision over LogMAR 0.3 (Group 1, n=25) vs. those who didn’t (Group 2, n=8). We evaluated the demographics and clinical characteristics and tried to determine which factors had affected the visual outcome. Results: The presence of a relative afferent pupillary defect (RAPD) and a pattern of visual field (VF) defect at presentation, and the degree of visual loss at the 3 month and 1 year after treatment were associated to the final visual outcome. While, age, gender, bilaterality, moving pain, headaches, and the degree of vision and color sense loss were not related to the final visual outcome. The presence of disc swelling and retinal nerve fiber layer (RNFL) defect, the abnormal responses on visual evoked potential (VEP), the abnormal level of erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) were also not associated with the final visual outcome. Conclusions: At presentation, the RAPD and VF defect excluding visual loss were associated with the final visual outcome in AON patients who had received ISPT. Regarding vision, the visual acuity at 3 months and 1 year after treatment were associated with the final visual outcome. Commercial Relationships: Sangah Kim, None; Samin Hong, None; Chan Yun Kim, None; Gong Je Seong, None Program Number: 5535 Poster Board Number: B0106 Presentation Time: 8:30 AM–10:15 AM Retinal Sensitivity Reduced in Patients with Neuromyelitis Optica Spectrum Disorder with no History of Optic Neuritis Ryutaro Akiba1, Hirotaka Yokouchi1, Takayuki Baba1, Toshiyuki Oshitari1, Setsu Sawai2, Masahiro Mori2, Satoshi Kuwabara2, Shuichi Yamamoto1. 1Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan; 2Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan. Purpose: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory autoimmune disease that can cause severe optic neuritis (ON) and myelitis. The results of previous studies have suggested that early structural changes of retina were present in patients with multiple sclerosis (MS) who have no history of ON. However, there has been very few reports of functional or structural changes in patients with NMOSD who have no history of ON. The purpose of this study was to determine the retinal sensitivity by microperimetry and retinal structure by spectral-domain optical coherence tomography (SD-OCT) in patients with NMOSD who have no history of ON. In addition, we compared the early functional and structural changes of the retina of patients with NMOSD to that of healthy controls. Methods: Twelve eyes of 6 patients with NMOSD who had no history of ON were studied, the NMOSD group. We determined the retinal sensitivity of the central 100 (37 points) and central 20 (13 points) by macular integrity assessment (MAIA). We also measured the best-corrected visual acuity (BCVA) expressed in logarithm of minimum angle of resolution (logMAR) units and retinal structure by SD-OCT. We quantified the mean thickness of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) from the OCT images. Twenty-five eyes of 13 volunteers who had no high myopia, glaucoma, or other macular disorders were included in the HC groups. Results: There was no significant difference in the BCVA (P=0.168), age (P=0.321), and refractive error (P=0.549) between the NMOSD and HC groups. The retinal sensitivity of the central 100 (NMOSD, 27.65±1.75 dB; HC, 29.12±0.85 dB) and 2 degrees (NMOSD, 27.68±1.96 dB; HC,29.41±1.12 dB) were significantly lower in the NMOSD group (P=0.015 and P=0.015 respectively, Mann-Whitney U-test). The RNFL thickness (NMOSD, 109.5±14.6 μm; HC, 107.2±7.4 μm), and GCL thickness(NMOSD, 94.7±12.0 μm; HC, ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 97.5±5.2 μm) were not significantly different between the two groups (P=0.527, P=0.557 respectively, Mann-Whitney U-test). Conclusions: These results indicate that the retinal sensitivity is impaired even before the development of ON in NMOSD patients, and also that the functional impairments precede the structural impairments. Although further investigations are needed, microperimetry appears useful to determine subclinical change of retina in eyes with NMOSD Commercial Relationships: Ryutaro Akiba, None; Hirotaka Yokouchi, None; Takayuki Baba, None; Toshiyuki Oshitari, None; Setsu Sawai, None; Masahiro Mori, None; Satoshi Kuwabara, None; Shuichi Yamamoto, None Program Number: 5536 Poster Board Number: B0107 Presentation Time: 8:30 AM–10:15 AM Evaluation of ganglion cell complex after optic neuritis by OCT Annalisa Costa1, Christian Cordano2, Antonella Panizzi1, Laura Landi1, Federico Bisio1, Alessandro Bagnis1, Carlo E. Traverso1, antonio uccelli2, Antonio Ferreras3, Michele M. Iester1. 1DINOGMI, University of Genoa Eye Clinic, Genova, Italy; 2DiNOGMI, University of Genoa, Clinica Neurologica, Genova, Italy; 3University eye clinic, Zaragoza, Spain. Purpose: To compare the macular assessment and RNFL thickness by using two different OCTs: a time domain (TD) and a spectral domain (SD) OCT, in patients with unilateral optic neuritis. Methods: This is a retrospective study. 34 multiple sclerosis (MS) subjects with a single unilateral optic neuritis (ON) were included in the study. An ophthalmological examination, TD OCT and SD OCT were performed. The following parameters were selected: Superior max, Inferior max, Inferior average thickness, Superior average thickness, Average thickness and Foveal thickness from TD OCT and Average ganglion cell complex, superior ganglion cell complex, inferior ganglion cell complex, focal loss ganglion cell complex, global loss ganglion cell complex, average full retina, superior full retina, inferior full retina, focal loss full retina, global loss full retina, average outer retina, superior outer retina, inferior outer retina,focal loss outer retina, global loss outer retina from SD OCT. Student’s t-test was used to compare the two sets of data when the distribution of the data was normal. Mann–Whitney test coefficient was utilized to compare the two sets of data when they did not follow a normal distribution. The statistical power of the study ranged between 76.2 and 94.2% with an alpha of 0.05 and a beta of 0.5. Bonferroni correction was applied to Student’s t-test because otherwise we would have a significant chance of 40.1% of our finding. Results: In the affected eye group a reduction of the average thickness of retinal nerve fibre layer (RNFL) was found using TD OCT and the reduction was of 22.78% and the difference was statistically significant (P<0.001) between the two groups in almost all the investigated retina areas. Similar results were found when eyes were analysed with SD OCT, also when the ganglion cell layer (GCC) was considered: a reduction of 18.08% of GCC average thickness was found. No significant difference was found when the outer retina was considered. Conclusions: In MS patients both OCT systems were able to detect difference between eyes with an outcome of optic neuritis and those without optic neuritis. Commercial Relationships: Annalisa Costa, None; Christian Cordano, None; Antonella Panizzi, None; Laura Landi, None; Federico Bisio, None; Alessandro Bagnis, None; Carlo E. Traverso, None; antonio uccelli, None; Antonio Ferreras, None; Michele M. Iester, None Program Number: 5537 Poster Board Number: B0108 Presentation Time: 8:30 AM–10:15 AM Intravitreal injection of erythropoietin in late-stage optic neuropathy Bekir Kucuk1, Uğur Acar1, Koray Sevinc2, Seçkin Aykas2, Mesut Erdurmus1, Gungor Sobaci1. 1Ophthalmology, Hacettepe University, Ankara, Turkey; 2Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. Purpose: Recent clinical findings have showed that erythropoietin(EPO) has both neuroprotective and neuroregenerative capabilities for axonal degenerative disease of the optic nerve. In this retrospective interventional study, we evaluated if intravitreal EPO administration has any neuroregenerative effect in patients with latestage optic neuropathy, or not. Methods: Twelve eyes of 12 patients with optic atrophy[(defined as overall thinning(90 mm)in the retinal nerve fiber layer(RNFL)] from definite demyelinating optic neuritis history were included. Patients who had both minimum 6-months medical history and light perception vision in the affected eye, were enrolled into the study. Using pars plana approach, 2000IU/0.2ml EPO(Eprex4000IU/0.4ml, Janssen-Cilag AG,Switzerland) was administered intravitreally with a 30-gauge needle on a tuberculin syringe. Injections were administered 3-times with 6-weeks intervals. Clinical [Best corrected visual acuity(BCVA) and opthalmoscopic and laboratory(OCT measurements, electrodiagnostic tests)] examinations were repeated at regular intervals, and final visit was performed 3-months after the third intravitreal EPO injection. The primary outcome parameters, BCVA and RNFL thickness and secondary outcome parameters, visual evoked potentials(VEP) and electroretinography(ERG) at initially and at final visit were analyzed. Results: No inflammatory, immunological or proliferative response was detected. The median BCVA of the patients with optic atrophy was 1.71±1(0.5-3.1)logMAR at initially and 1.69±1(0.5-3.1) logMAR at final visit. No one obtained minimum 0.2 logMAR BCVA improvement (success criteria). RNFL value was 49.1±22(22-88)mm before injections, and 48.6±20(25-81)mm after injections. The mean amplitude values of combined response in ERG(N35-P50, P50-N95) were 5.68±2(2.9-10.2)mV, 6.91±3(3.7-14.9)mV before the injections and 5.45±2.1(2.6-9.6)mV, 6.73±2.5(3.7-12)mV after the injections, respectively. The mean amplitude and latancy values of response in VEP 121.25±19.5(90-153) msn and 3.75±2.7(1.4-12)mV before the injections and 114.8±15(93-134)msn and 3.96±3.1 (0.7-12.4)mV after the injections, respectively. Conclusions: Intravitreal EPO injections has no neuroregenerative effect on the optic nerve when it was administered in the late period (>6months) of optic neuropathy. Meantime, we did not find any adverse effects of this administration on visual parameters and retinal microstructures. Commercial Relationships: Bekir Kucuk, None; Uğur Acar, None; Koray Sevinc, None; Seçkin Aykas, None; Mesut Erdurmus, None; Gungor Sobaci, None Program Number: 5538 Poster Board Number: B0109 Presentation Time: 8:30 AM–10:15 AM The design of a randomized clinical trial on the neuroprotective properties of erythropoietin in optic neuritis: Treatment of Optic Neuritis with Erythropoietin (TONE) Wolf Lagrèze1, Ricarda Diem2. 1Ophthalmology, University of Freiburg, Freiburg im Breisgau, Germany; 2Neurology, University Heidelberg, Heidelberg, Germany. Purpose: After successful completion of the VISION PROTECT pilot trial (NCT00355095) providing the first morphologic OCT-based evidence for neuroprotection with erythropoietin in ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology optic neuritis, the German government has recently approved a subsequent, full-scale, nationwide randomized controlled clinical trial (NCT01962571), whose design we intend to present here. Methods: A power analysis based on publications on the natural course and thinning of the peripapillary retinal nerve fiber layer after optic neuritis yielded a number of 47 patients in each treatment arm of a placebo-controlled, randomized, double-blind clinical trial to demonstrate a treatment effect of 50% reduction of nerve fiber loss with an α of 0.05 and β of 0.80. Results: Recruitment of TONE has commenced in December 2014. Patients are randomized on either i.v. placebo or intravenous 33.000 IU i.v. erythropoietin as an add-on to a 3 day course of i.v. megadose methylprednisolone. Primary outcome measure is the peripapillary retinal nerve fiber layer thickness determined with the NSITE 6.0 software of the Spectralis®-OCT. Secondary analyses comprise retinal layer segmentation. Functional measures are ETDRS-chart based visual acuity at 2.5% and 100% contrast, contrast sensitivity, volumetric analysis of the visual field defect determined by the German Adaptive Threshold Estimation (GATE) algorithm, VEPlatencies and vision-related quality of life. Results are expected after completion presumably in 2017. A 1.5 year open label follow-up shall provide further insights of erythropoietin effects with regard to MSprogression. Conclusions: A positive outcome of the TONE-Trial would not only provide new treatment options for patients with optic neuritis, but might promote further clinical research in multiple sclerosis. Commercial Relationships: Wolf Lagrèze, None; Ricarda Diem, None Support: BMBF (German Ministry of Education and Research) Clinical Trial: NCT01962571 Program Number: 5539 Poster Board Number: B0110 Presentation Time: 8:30 AM–10:15 AM Early treatment of recombinant human granulocyte colony stimulating factor (G-CSF) in the rat model of anterior ischemic optic neuropathy (rAION) reveals a beneficial neuroprotective effect Rong-Kung Tsai1, 2, Yao-Tzeng Wen1, Chung Hsing Chang3. 1Institute of Eye Research, Buddhist Tzu-Chi Medical Center, Hualien, Taiwan; 2Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; 3Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Purpose: Our previous report demonstrated that immediate administration of recombinant human granulocyte colony-stimulating factor (G-CSF) had neuroprotective effects in a rat model of anterior ischemic optic neuropathy (rAION). This study is aim to investigate whether delayed treatment of G-CSF is as effective as early treatment after rAION induction. Methods: The rAION rats were subcutaneously injected G-CSF starting at day 0, 7, and 14-post rAION induction for 5 consecutive days. Survival rate of retinal ganglion cells (RGCs) was determined by using retrograde labeling of Fluorogold. Apoptosis in RGCs layer and inflammation at optic nerve (ON) were measured by TUNEL assay and immunohistochemical (IHC) staining of ED1 respectively. Visual function was assessed by photoptic flash visual evoked potentials (FVEP). Results: G-CSF treatment started at day 0-post rAION induction had significant better survival rate of RGCs than treatments at day 7 and 14-post infarct both in central and mid-peripheral retinas (p<0.05). Treatment with G-CSF at day 0-post rAION induction resulted in significantly lower number of apoptotic cells in RGCs layer of retinas and significantly lower level of inflammation at ON than treatment at day 7 and 14-post rAION induction (p<0.05). Rats received G-CSF treatment at day 0-psot rAION induction preserved better latency and amplitude of the p1 wave in FVEP than rats treatment with G-CSF at day 7 and 14-post rAION induction (p<0.05). Conclusions: Early treatment with G-CSF has significantly better neuroprotective effects on RGCs and optic nerve than the delayed treatment starting at 1 or 2 weeks post-infarct. Commercial Relationships: Rong-Kung Tsai, None; Yao-Tzeng Wen, None; Chung Hsing Chang, None Support: 103-2314-B-303 -007 -MY3 from Ministry of Science and Technology of Taiwan Program Number: 5540 Poster Board Number: B0111 Presentation Time: 8:30 AM–10:15 AM The Presence of Calcium Significantly Enhanced Annexin-VLabelling of Degenerating Axons after Experimental Anterior Ischemic Optic Neuropathy Gun Ho Lee1, M Ali Shariati1, Ming-Hui Sun1, 2, Yaping J. Liao1. 1 Stanford University, Cupertino, CA; 2Chang Gung Memorial Hospital - LinKou, LinKou, Taiwan. Purpose: Annexin-V binds to exposed phosphyltidylserine on the extracellular membrane in a calcium-dependent fashion and has been shown to label degenerating retinal ganglion cell axons and soma after experimental anterior ischemic optic neuropathy (AION). Because the labeling of degenerating axons with annexin-V is relatively labile, in this study, we determine whether inclusion of calcium in different experimental steps helps to enhance axonal labeling. Methods: We induced optic nerve head ischemia in adult C57BL/6 mice using laser-assisted photochemical thrombosis. After one week, we performed intravitreal injection of annexin-V-A488 and imaged the retina 2-3 hours later using confocal scanning laser ophthalmoscopy (cSLO) and optical coherence tomography (OCT). Then, we prepared retinal whole mount in calcium-free or 2.5 mM CaCl2 conditions and imaged the retinae using fluorescence microscopy for up to 7 days after mounting. Results: On the day of annexin-V-A488 labeling, degenerating axons were easily seen in both Ca2+-containing (N = 30) and Ca2+-free (N = 10) conditions. Annexin-V-A488 labeling of degenerating axons one week after ischemia correlated well with the presence of optic nerve swelling on day-1 as measured by OCT. No annexin-V-A488 labeling of axons was seen in the control eyes (N = 6), which showed no swelling on OCT. Inclusion of Ca2+ to the fixative, wash, and mounting solutions significantly improved the persistence of annexinV-A488 signal one to seven days after labeling. In contrast to the difficulty of preserving axonal labels, bright annexin-V-A488 signal on degenerating soma was easily seen even one week after labeling. We used these brightly labeled soma to test the lability of annexinV-A488 labeling over 5, 10, and 20 min of light exposure and found a dramatic, time-dependent decrease in fluorescence signal, consistent with the relative lability of the annexin-V-A488 signal. Conclusions: Annexin-V-A488 brightly labels degenerating retinal ganglion cell axons one week after experimental anterior ischemic optic neuropathy, and the presence of 2.5 mM Ca2+ during retinal tissue preparation helps preserve this relatively labile label. During microscopy, even minutes of bright light exposure can quench annexin-V-A488 signal, and every effort should be made to shield the tissue from bright light during experimentation. Commercial Relationships: Gun Ho Lee, None; M Ali Shariati, None; Ming-Hui Sun, None; Yaping J. Liao, None Support: Stanford Undergraduate Advising and Research Grant, Vice Provost for Undergraduate Education Grant ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5541 Poster Board Number: B0112 Presentation Time: 8:30 AM–10:15 AM Rapamycin rescues the innate immune/inflammatory response in the retina of the Ndufs4 mouse Alfred K. Yu1, Lanying Song1, Karl Murray2, Gino Cortopassi1. 1Vet Med: Molecular Biosciences, University of California, Davis, Davis, CA; 2Center for Neuroscience, University of California, Davis, Davis, CA. Purpose: Mitochondrial complex I dysfunction has been shown to lead to vision loss via the loss of function of retinal ganglion cells (RGCs), however the mechanism of which that occurs in unclear. A recent study has shown that rapamycin treatment of Ndufs4 deficient mice alleviates mitochondrial disease and prolongs the life expectancy of these mice by reducing mTOR signaling. The goal of this study is to see the effects of rapamycin treatment in the retina of these mice by evaluating innate immune and inflammatory transcripts that we have already seen to increase in the Ndufs4 KO mouse. This will be valuable in developing therapeutics for mitochondrial visual diseases, such as Leber’s hereditary optic neuropathy (LHON) and Autosomal dominant optic atrophy (ADOA). Methods: Two Ndufs4 KO and two wild type controls received intraperitoneal injection (IP) of rapamycin (8mg/kg) daily for nine days starting from P22. Additionally, two Ndufs4 KO and two wild type controls received IP injection of vehicle. Experiments were conducted in compliance with the ARVO Statement for the Use of Animals in Ophthalmic and Visual Research. After nine days of treatment the nice were sacrificed and the retinas were surgically removed and placed in RNALater. Total RNA was extracted from the retinas and cDNA was synthesized for evaluation by qRT-PCR. The primers tested include: Fas, Tlr4, Ccl5, Ccl12, C1ra, Tlr3, Mmp12, Icam1, Cxcl9, Aif1, Tlr2, Cd68, C1qc, B2m, and Cxcl10. Analysis was done by calculating the delta delta Ct and statistical significance was determined by student’s t-test (2 tailed; equal variance). Results: Of the inflammatory transcripts tested, 16 out of 16 transcripts showed mean elevation compared to wild type controls, as was previously seen. Treatment with rapamycin inhibited the inflammatory response and the mean levels of all 16 transcripts rebounded and returned to values similar to wild type control, indicating that rapamycin suppresses inflammation that is downstream of mitochondrial dysfunction and may prevent neurodegeneration. Conclusions: In the Ndufs4 retinal, mitochondrial complex I deficiency leads to vision loss, which is mediated by an innate immune and inflammatory response. Systemic treatment with rapamycin rescues this innate immune and inflammatory response and may prevent RGC death-mediated vision loss. This will provide therapeutic insight in mitochondrial diseases such as LHON and ADOA Commercial Relationships: Alfred K. Yu, None; Lanying Song, None; Karl Murray, None; Gino Cortopassi, None Support: NH Grant EY012245 Program Number: 5542 Poster Board Number: B0113 Presentation Time: 8:30 AM–10:15 AM Microglial activation in a rat model of NAION Anne-Laure Remond1, Audrey Fel1, Manuel SIMONUTTI2, Ivana IVKOVIC2, Jose A. Sahel2, Phuc LeHoang1, Bahram Bodaghi1, Serge A. Picaud2, Valerie Touitou1. 1Ophthalmology, Pitie Salpetriere, Paris, France; 2Vision Institut, Paris, France. Purpose: Non arteritic anterior ischemic optic neuropathy (NAION) is the most common optic neuropathy over 50 years and its pathophysiology remains controversial. Activation of retinal microglial cells (RMC) is known to contribute to retinal ganglion cell (RCG) death after optic nerve injury. The purpose of this study was to investigate early microglial activation and the effect of minocycline on this activation in a rat model of NAION (rNAION). Methods: We used a rNAION model to generate axonal ischemic infarct by rose Bengal dye laser photoactivation. NAION was induced in the right eye (RE) of each animal. One group of animals received minocycline (22 mg/kg) intraperitoneally and a second group received a sham injection of saline, 3 days before induction till sacrifice. Animals were euthanazied at day 1, 3 and 7 after laser photoactivation. Immunohistochemistry and quantitative stereology of RCG (Brn3a positive cells) and RMC (IBA-1positive cells) were performed on flat-mounted retina. Expression levels of IBA-1, apoptosis-related genes (Bax, caspase 3) and vascular growth factor related genes (VEGF-a) were measured by qPCR. Results: A significant increase in the number of RMC was observed with stereology on flat-mounted retina in eyes with NAION, at day 1, 3 and 7 after induction. The expression of Iba-A, a microglia/ macrophage-specific calcium-binding protein, measured by qPCR, was statistically increased in the eyes with NAION, at day 3 for both groups (minocycline and saline) and at day 7 for the group treated with minocycline (p<0,05). This expression was higher with minocycline at day 3 and 7. The expression of caspase was significantly increased (p <0.05) in NAION eyes at day 3 in the group treated with minocycline and VEGF-A tended to have an increased expression in the group with saline at day 3 and 7 (p>0.05). There was no difference in the expression of Bax between the two groups. Conclusions: Our results demonstrate that microglia is activated early in the course of NAION and contribute to retinal ganglion cell death after NAION. The presence of an increased number of activated microglial cells in the eyes with NAION of animals treated with minocyclin is unexpected considering the supposed effect of minocyclin. However, microglial cells include a broad spectrum of populations and minocycline could modulate one of these subpopulations with a protective effect on ganglion cells after the stroke thus promoting RGC survival. Commercial Relationships: Anne-Laure Remond, None; Audrey Fel, None; Manuel SIMONUTTI, None; Ivana IVKOVIC, None; Jose A. Sahel, None; Phuc LeHoang, None; Bahram Bodaghi, None; Serge A. Picaud, None; Valerie Touitou, None Program Number: 5543 Poster Board Number: B0114 Presentation Time: 8:30 AM–10:15 AM Lucentis is Not Neuroprotective in a Primate Model of NonArteritic Anterior Ischemic Optic Neuropathy (NAION) Mary A. Johnson1, Neil R. Miller2, Steven L. Bernstein1. 1Ophthal and Vis Science, Univ of Maryland Sch of Medicine, Baltimore, MD; 2 Ophthalmology, Johns Hopkins Univ. Sch. Med., Baltimore, MD. Purpose: Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) is the most common cause of acute optic nerve-related vision loss in people over 50. There is no treatment. A retrospective study (Saati et al., 2013) and 2 small case studies (Bennett et al., 2007; Bajin et al., 2011) suggested that a single intravitreal (IVT) injection of ranibizumab protects against vision loss in NAION. A Genentech-supported clinical trial was completed in 2012; the results have not been announced. The relatively rare nature of the disorder and the 40% incidence of spontaneous improvement (IONDT, 1995) are challenges for NAION clinical studies. For this reason, we tested the efficacy of a single IVT injection of ranibizumab (Lucentis) in our primate model of NAION (pNAION). Methods: Four normal male rhesus monkeys (8 - 12kg) were given a single IVT injection of Lucentis (1.25mg in 0.05ml) immediately following induction of experimental NAION (Chen & Johnson et al., 2008) in one eye. Four weeks later the fellow eye was induced and ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology injected with a single IVT dose of vehicle. Spectral-domain OCT (Heidelberg, Inc), flash electroretinograms (ERGs), and simultaneous pattern ERG (pERG) and pattern visual evoked potentials (VEPs) were recorded, and fundus photography and fluorescein angiography (FA) were performed on each animal before and at 1 day, 1 week, 2 weeks, 4 weeks and 8-12 weeks after induction of pNAION. Animals were sacrificed within 2 weeks of final assessment. Differences in the retinal ganglion cell (RGC) numbers in each eye were estimated by stereological analysis of optic nerve axons. Optic nerve axons, myelin and inflammatory cells were evaluated using immunohistochemistry. Results: Lucentis conferred no advantage to the treated eye in development or resolution of macular (p = 0.45) or peripapillary edema (by OCT), in retention of VEP (p = 0.19) and pERG (p = 0.28) amplitudes, in the time course of optic nerve leakage and fluorescein dye staining, or in preservation of RGCs, compared with vehicle controls. Three of the 4 Lucentis-treated eyes showed more peripapillary leakage and eventual atrophy than the vehicle-treated eyes. Conclusions: IVT administration of Lucentis showed no evidence of neuroprotection in a primate model of NAION, despite maximal dosing and immediate treatment post-induction. This finding suggests that VEGF inhibition is likely to be ineffective in clinical NAION treatment. Commercial Relationships: Mary A. Johnson, None; Neil R. Miller, None; Steven L. Bernstein, None Support: NIH Grant EY019529 Program Number: 5544 Poster Board Number: B0115 Presentation Time: 8:30 AM–10:15 AM Characterization and application of a nonhuman primate model of non-arteritic anterior ischemic optic neuropathy for therapeutic screening Matthew S. Lawrence1, Jordan Attwood1, Alex Lewis1, Rohn Brookes1, Vernard Woodley1, Meghan Tucker1, Wenzheng Hu1, Robin J. Goody1, Sean Callanan2, Demetrios Vavvas3. 1Research, RxGen, Hamden, CT; 2 Ross University, Basseterre, Saint Kitts and Nevis; 3Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: To characterize the nature and time course of optic nerve and retinal pathology following induction of non-arteritic anterior ischemic optic neuropathy (NAION) by focal photothrombotic insult to the optic nerve head (ONH) in African green monkeys, and to evaluate the effect of candidate neuroprotective agents in reducing the elicited pathology. Methods: Fifteen adult monkeys received unilateral ONH laser treatment (wavelength 532mm; power 100mW; spot size 500mm; duration 9 seconds x 4), immediately following intravenous administration of rose bengal (0.1 ml/kg of 25 mg/kg) to induce oxidative endothelial injury of ONH microvasculature. Eyes were evaluated by slit lamp exam, color fundus photography, fluorescence angiography, optical coherence tomography (OCT) and electroretinography (ERG) at baseline and days 1, 7, 14, 28, 56 and 84 post-laser. Apoptosis and necrosis inhibitors or vehicle were administered intravitreally immediately following laser treatment. Results: Photothrombotic injury to the ONH employing the applied laser parameters consistently triggered the onset and evolution of a pathology very similar to clinical NAION, with ONH edema within 24 hours, followed by retinal venous stasis, peripapillary hemorrhages, and optic nerve fiber layer (ONFL) thickening over the ensuing week, which gradually resolved, leaving residual ONH pallor and ONFL thinning. Electrophysiological changes were correlated with ONFL changes detectible by OCT. Terminal histology findings were additionally correlated with in-life exam findings. Intervention with pan-caspase and receptor interacting protein 1 kinase inhibitors at the doses explored positively modulated endpoints, although demonstration of statistically significant therapeutic effect was limited by sample size. Conclusions: Photothrombotic NAION in the green monkey exhibits pathological changes very similar to the human condition with early onset ONH and retinal edema followed by ONFL thinning with associated ERG changes indicative of functional deficit, all of which can be evaluated in a quantitative, longitudinal manner. This supports application of the model as a test system to further understand the pathophysiology of NAION and the evaluation of candidate therapies, the utility of which as been demonstrated in our initial exploration of the therapeutic effect of cell death pathway inhibitors. Commercial Relationships: Matthew S. Lawrence, RxGen (F); Jordan Attwood, RxGen (F); Alex Lewis, RxGen (F), RxGen (F), RxGen (F); Rohn Brookes, RxGen (F); Vernard Woodley, RxGen (F); Meghan Tucker, RxGen (F); Wenzheng Hu, RxGen (F); Robin J. Goody, RxGen (F); Sean Callanan, None; Demetrios Vavvas, None Support: NEI 1 R43 EY023867-01 Program Number: 5545 Poster Board Number: B0116 Presentation Time: 8:30 AM–10:15 AM Risk factors associated with nonarteritic anterior ischemic optic neuropathy in young patients at a reference center in Mexico City SECTION: Eye Movements/Strabismus/Amblyopia/Neuroophthalmology (EY) Mariana A. Flores, Laura Andrea Torrado, Mayra F. Camargo. Ophthalmology, Instituto de Oftalmologia, Mexico City, Mexico. Purpose: Nonarteritic anterior ischemic optic neuropathy remains a diagnosis for people older than 50 years old. We aim to describe the demographic characteristics and risk factors associated with nonarteritic anterior ischemic optic neuropathy in patients younger than 50 years old in a reference center in Mexico City. Methods: Retrospective analysis of the medical records of all the patients diagnosed with nonarteritic anterior ischemic optic neuropathy from September 2007 to November 2014 in a reference center in Mexico City. We include age, sex, best-corrected visual acuity and comorbilities associated. We exclude those patients with an incomplete record. Results: We found 1967 medical records with the diagnosis of nonarteritic anterior ischemic optic neuropathy. 177 patients were younger than 50 years old (ranged: 2 -49 years-old). 110 females 67 males. 23.16% presented dyslipidemia (41 patients), 22.60% with diabetes mellitus type 2 (40 patients) and 19.77% primary systemic hypertension (35 patients). Thirteen patients (7%) presented with a history of trauma, 4.51% (8 patients) with hemorrhagic or ischemic cerebral vascular event and 2.8% with a cerebral tumor (5 patients). In the group of patients younger than 30 years old a repetitive antecedent of neonatal hypoxia was found (12 patients, 6.7%) and only one case with hereditary optic neuropathy. Conclusions: In this study we found that the comorbidity such as dyslipidemia, diabetes mellitus and hypertension represented the most significant risk factors for presenting with nonarteritic ischemic optic neuropathy. This is the first information obtained in latinamerican population. We believe that the Mexican diet and lifestyle could have an important impact in its development and more studies need to be done. Commercial Relationships: Mariana A. Flores, None; Laura Andrea Torrado, None; Mayra F. Camargo, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5546 Poster Board Number: B0117 Presentation Time: 8:30 AM–10:15 AM 50% of Non-Arteritic Anterior Ischemic Optic Neuropathy Occurs between 40-55 Years Old Ming-Hui Sun1, 2, Yaping J. Liao1, M Ali Shariati3. 1Ophthalmology, Byers Eye Institute Stanford University, Palo Alto, CA; 2 Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Kweishan, Taoyuan, Taiwan; 3Ophthalmology, Stanford University school of Medicine, Palo Alto, CA. Purpose: Non-arteritic ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in those older than 50. and young onset NAION has been reported in 4-23% of patients. The aim of our study is to investigate the age of onset of NAION and correlation with risk factors. Methods: We performed a retrospective review at a single institution of consecutive patients with the diagnosis of NAION (2009-2014) who had neuro-ophthalmic evaluation, automated static perimetry, and optical coherence tomography (OCT). Results: We studied 50 NAION eyes in 32 patients (24 male, 8 female; unilateral: 14 patients, bilateral: 18 patients). The average age of first events was 54.6±2.4 years (median 54 years; ≤50: 11 (33.7%) patients, >50: 20 (66.3%) patients; range 24-80 years). In fact, 50% of patients presented with their first event between ages 40-55. In all ages, AION led to significant visual field loss (mean deviation AION: -14.1±1.5 dB; control: -1.6±0.5 dB; P<0.001, Mann-Whitney) and significant thinning of thickness of the retinal nerve fiber layer (AION: 66.0±3.9 mm; control: 89.9±4.6 mm; P<0.001) and macular ganglion cell complex as measured by OCT (AION: 61.7±1.8 mm; control: 82.4±3.4 mm, P<0.001). In terms of AION risk factors, all age groups had small optic disc area (mean optic disc area 1.65± 0.30 mm2, N = 43 eyes), obstructive sleep apnea (≤50: 82%, average AHI 27.9±7.9; >50: 80%, average AHI 24.6±7.7), and vascular risk factors (hypertension, diabetes, hyperlipidemia). Treatment for obstructive sleep apnea did not prevent future events but was associated with delayed onset of new events (treated: 63.5±54.9 months, median 10 months; not treated: mean 21.6±16.4 months, median 5 months; P=0.2). The presence of optic disc drusen was associated with earlier onset of AION by 2 decades (N=2 patients, 3 affected eyes), but all affected eyes had final visual acuity of 20/20. Consistent with this finding, age may be an important factor in visual prognosis, since those ≤50 years old at first event had a trend of better final visual acuity, visual field mean deviation, and OCT retinal thickness measurements than those >50. Conclusions: Fifty percent of NAION patients had onset of first event at 40-55, so age greater than 40 should be considered the common presentation of NAION. Age may also be an important factor in NAION prognosis, since younger patients had better visual outcome. Commercial Relationships: Ming-Hui Sun, None; Yaping J. Liao, None; M Ali Shariati, None Program Number: 5547 Poster Board Number: B0118 Presentation Time: 8:30 AM–10:15 AM Nocturnal Diastolic Blood Pressure decrease under 50mmHg is a risk factor for Nonarteritic Anterior Ischemic Optic Neuropathy in elderly patients thibaut Chapron1, 2, Fouzia Mantout1, Sylvie Feldman1, marie helene errera3, Laurence Du Pasquier1, Isabelle Rossignol1, Rabah Benrabah1, Emmanuel Heron1. 1Internal medicine, Hopital Quinze Vingt, Paris, France; 2Université Paris Descartes, Paris, France; 3 Ophthalmology 4, Hopital Quinze Vingt, Paris, France. Purpose: To analyze 24-hours Arterial Blood Pressure (ABP) recordings in elderly patients with Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) compared with other retinal vascular diseases. Methods: Over a 7-year period, 49 NAION patients and 27 control subjects with sudden visual loss due to arterial, venous or diabetic retinal vascular acute episodes, all aged 70 or more, underwent 24-hours ABP recordings. Our main outcome was the number of patients with one or more nocturnal diastolic ABP fall under 50 mmHg. Number of patients with one or more nighttime systolic ABP fall under 90 mmHg, mean systolic and diastolic ABP during 24-hours, daytime and nighttime, as well as standard NAION risk factor were also studied. Results: Nocturnal diastolic ABP values ≤50 mmHg were observed in 20 (41%) NAION and 4 (15%) control subjects (P=0.02). Nocturnal systolic ABP values ≤90 mmHg were observed in 5 (10%) NAION and 4 (15%) control subjects (p=0,55). Mean systolic(SD)/ diastolic(SD) 24-hour ABP was 134(17)/70(9) mmHg in NAION and 135(20)/71(10) mmHg in control subjects (P=0.78). No statistic difference was observed regards of mean systolic and mean diastolic ABP whether in daytime or nighttime recordings. 23 (46%) NAION and 19 (70%) control subjects took hypotensive drug therapy (p=0.04). Sex ratio, body mass index, and the frequency of diabetes and dyslipidemia were not different. Conclusions: Nocturnal diastolic ABP fall under 50mmHg, a risk factor for cerebral hypoperfusion, is significantly more frequent in elderly patients with acute visual loss due to NAION compared with other vascular retinal etiologies, and appears to be a specific risk factor for this disease. Commercial Relationships: thibaut Chapron, None; Fouzia Mantout, None; Sylvie Feldman, None; marie helene errera, None; Laurence Du Pasquier, None; Isabelle Rossignol, None; Rabah Benrabah, None; Emmanuel Heron, None Program Number: 5548 Poster Board Number: B0119 Presentation Time: 8:30 AM–10:15 AM MMP19 Expression in the Human Optic Nerve Ralph Hazlewood1, 2, Kathy Miller1, 2, Robert F. Mullins1, 2, Markus H. Kuehn1, 2, Lee M. Jampol3, John H. Fingert1, 2. 1Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA; 2Stephen A. Wynn Institute for Vision Research, Iowa City, IA; 3Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL. Purpose: We previously linked MMP19 mutations with a congenital malformation in which the optic disc is deeply excavated known as cavitary optic disc anomaly (CODA). The purpose of this study was to investigate the expression of MMP19, a secreted matrix metalloproteinase, within the optic nerve. Methods: MMP19 protein expression in the optic nerve was evaluated by immunohistochemistry in sagittal and en face sections of optic nerves obtained from normal human donor eyes. Sections were co-labeled with antibodies directed against glial cells (GFAP), ganglion cell axons (βIII Tubulin), and microglia (CD45). All experiments were conducted in triplicate using three different human donor eyes. Results: MMP19 immunolabeling was observed throughout the optic nerve including the optic nerve head. Expression was highest in the prelaminar region and laminar region, with much lower levels in the retrolaminar region. Differential MMP19 labeling was also observed in the cross-sections of the optic nerve, with increased signal in the periphery or edges towards the scleral canal and pia mater. Additionally, no significant co-localization was observed between MMP19 and markers of glial cells, ganglion cell axons, or microglia. Conclusions: Immunohistochemical analysis shows that MMP19 is strongly expressed in the optic nerve head of human donor eyes, the primary site of pathology in CODA patients. No obvious ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology co-localization was observed with markers for cell types that populate the optic nerve, suggesting that MMP19 accumulates primarily within extracellular spaces in the optic nerve. Moreover, the lateral localization of MMP19 within the optic nerve suggests that dysregulation of its enzymatic function might undermine the adhesion between the optic nerve and the scleral canal and promote formation of an excavated optic nerve head – the key feature of CODA. Commercial Relationships: Ralph Hazlewood, None; Kathy Miller, None; Robert F. Mullins, None; Markus H. Kuehn, None; Lee M. Jampol, None; John H. Fingert, None Support: NIH (Grants R21 EY24621, R01EY018825, R01EY023512) to J.H.F and the Dean’s Graduate Fellowship, the University of Iowa to R.J.H. Program Number: 5549 Poster Board Number: B0120 Presentation Time: 8:30 AM–10:15 AM Artificial Intelligence Methods are robust and useful techniques to classify optic nerve fibers using its morphometric parameters Joaquin De Juan1, Jose L. Girela2, David Gil3, Noemi Martínez-Ruiz2, Jorge Azorin3, Bassima Boughlala2. 1Biotechnology, Universidad de Alicante, San Vicente del Raspeig, Spain; 2Biotechnology, Universidad de Alicante, Alicante, Spain; 3Computer Technology, Universidad de Alicante, Alicante, Spain. Purpose: The rat optic nerve axons come from the retinal ganglion cells. Only a few of them have their origin in the pretectal area. The diameters of the optic nerve axons are far from being a homogeneous population. There are at least three main groups of ganglion cells in rat retinas and three different axon types in the rat optic nerve. The morphometric study of optic nerve fibers is a useful tool to research the function, development, aging and pathological conditions of them. Thus, classification of the optic nerve axons is crucial in order to make experimental comparisons. The aim of this work is to classify the optic nerve axons by analyzing their ultrastructural parameters with Artificial Intelligence (AI) methods. Methods: Adult albino Wistar rats were anesthetized, transcardially perfused and its optic nerves removed and processed for ultrastructural microscopy studies. Optic nerve axons were analyzed with a computer-linked planimeter. Several parameter, were obtained for each axonal cross-section using a computer program. The parameters were: axon diameter, axon area, myelin sheath thickness, G-Ratio, microtubule number (MTn), neurofilament number (NFn) and R-proportion (R = NFn/[NFn+MTn]). Data were processed with a set of AI methods, two supervised techniques, Multilayer Perceptron (MLP) and Decision Trees (DT), and other unsupervised one, K-Means clustering. All the computations of the decision tree were developed using the WEKA software (Machine Learning Group at the University of Waikato). Results: Using k-means clustering analysis we were able to identify three different groups of fibers in the optic nerve, which are consistent with the results obtained in functional studies. The main parameters that allowed us the classification of optical nerve fibers were axon diameter, G-Ratio, and R-proportion. Using these parameters, we analyzed the classification accuracy of MLP and DT, as tools to develop an automated system. In both cases, the Classification Accuracy was above 95%, being higher with the MLP technique that reached a 98.9% of accuracy. Conclusions: Results show that morphometric parameters can be used to identify different populations of nerve fibers, with a high accuracy when AI methods are used. Only a limited number of parameters are needed to produce a consistent classification. The MLP technique is the most useful. Commercial Relationships: Joaquin De Juan, None; Jose L. Girela, None; David Gil, None; Noemi Martínez-Ruiz, None; Jorge Azorin, None; Bassima Boughlala, None Support: Vicerrectorado de Innovación, University of Alicante, Spain (Vigrob-137) Program Number: 5550 Poster Board Number: B0121 Presentation Time: 8:30 AM–10:15 AM Lamina Cribrosa Position Changes with the Valsalva maneuver Keegan Harkins1, Sachin Kedar1, Yasir J. Sepah1, Mohammad A. Sadiq1, Justin West2, Deepta Ghate1. 1Ophthalmology, University of Nebraska Medical Center, Omaha, NE; 2College of Medicine, University of Kentucky, Lexington, KY. Purpose: The Valsalva maneuver (VM) causes an increase in intraocular pressure (IOP) and intracerebral pressure (ICP). This prospective clinical study aimed to test if acute changes in ICP and IOP can cause changes in the lamina cribrosa (LC) position. Methods: The study population had 20 healthy volunteers from the University of Kentucky. VM was performed with a manometer and a mouth pressure of 30-33 cm of H2O held for 15 seconds. The Icare® tonometer was used to check IOP before and during the VM (after 15 seconds). The Spectralis OCT® was used to acquire 12 radial optic nerve head images before and during the VM (after 15 seconds). There was a 10 minutes gap between right and left eye measurements and between the IOP and OCT acquisition. 3 of the 12 radial OCT sections (selected by expert grader) were independently graded by 2 graders for anterior lamina cribrosa depth (LCD), Bruch’s membrane opening width (BMO) and cup depth from BMO plane. Any image with a measurement discrepancy>40 mm was re-graded by the expert grader. Results: The mean age was 29±4.7 years with 40 eyes analyzed There was no significant change in BMO depth (mean change -3.7±37.5 mm), cup depth (mean change -1.3±24.1 mm) and LC depth (mean change -0.3±31.4 mm) with the VM. IOP increased with the VM in all eyes (mean change3.2±2.2 mmHg, p<0.05). 20 eyes had anterior LC shift with the VM (mean LC position change -20.9±13.6 mm). 14 eyes had LC posterior shift (mean LC position change -29.2±28.2 mm). 2 eyes had no change in LC position and 4 eyes had ungradable LC. Mean IOP change was significantly (p<0.05) higher with anterior LC shift (3.65 mm Hg) versus posterior LC shift (2.93 mm Hg). There was no significant difference in IOP change with BMO widening versus shortening and in anterior and posterior cup depth shift. There was no significant association between BMO widening or shortening and anterior or posterior LC shift. There was a significant association between anterior and posterior shift of the LC and cup depth (chi square=4.37, p< 0.05). Conclusions: Despite an IOP rise in all eyes, the VM causes anterior LC shift in 50% of eyes. This anterior LC shift is associated with higher IOP change and an anterior shift of the cup depth but not with BMO width changes. The eyes with anterior LC shift presumably had a rise in ICP> IOP which would presume that the LC position changes with fluctuations in ICP. Commercial Relationships: Keegan Harkins, None; Sachin Kedar, None; Yasir J. Sepah, None; Mohammad A. Sadiq, None; Justin West, None; Deepta Ghate, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5551 Poster Board Number: B0122 Presentation Time: 8:30 AM–10:15 AM Color-Fundus-Feature-Based Prediction of Regional SD-OCTBased ONH-Volume in Optic Nerve Edema Jason Agne1, Jui-Kai Wang1, Randy H. Kardon2, 3, Mona K. Garvin2, 1. 1 Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA; 2Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA; 3 Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA. Purpose: Optic nerve edema is commonly assessed via direct funduscopic observation or digital fundus photographs using a six-stage Frisén grading scale. While 3D image-analysis of spectraldomain optical coherence tomography (SD-OCT) can provide volumetric measures of optic nerve head (ONH) swelling (Wang et al., IOVS 2012), developing automated objective quantitative measures of the degree of swelling is important in situations where SD-OCT is not commonly available, such as in emergency rooms. The purpose of this work is to develop and evaluate a machinelearning approach for the prediction of regional SD-OCT volumetric measures from color-fundus-photographic features. Methods: Our previously developed 3D image-analysis approach was used to measure regional (nasal, superior, temporal, and inferior regions within 1.73 mm of the center of the ONH) from 48 ONHcentered SD-OCT volumes (Zeiss Cirrus) of 48 patients with varying stages of optic nerve edema (Figure 1a,b). Features concerning the boundary of the ONH swelling (such as the area of the bounded region and the smoothness of the boundary), global and local texture features (such as joint entropy of various image transformations and local entropy of the area bounded by the ONH swelling), and vessel features (such as edge derivative values, and a measure of vessel discontinuity) were extracted from color fundus photographs taken on the same day (Figure 1c) using our automated approach, and used in a leave-one-patient-out random forest regression to predict the volumetric information for each region of the SD-OCT image. Results: Pearson correlation coefficients of Rnasal = 0.74, Rsuperior = 0.66, Rtemporal = 0.68, and Rinferior = 0.67 were obtained between our fundus-based predicted measures and the actual SD-OCT-based regional measures. Scatter plots are shown in Figure 2. Conclusions: Regional 3D volumetric information can be predicted from 2D fundus information and demonstrates the feasibility of objectively and quantitatively measuring optic nerve edema from fundus photographs alone. From top to bottom: (a) Example 3D rendering of top surface from SD-OCT image with the primary region indicated. (b) Computed volumetric measures of ONH displayed on a thickness map. (c) Corresponding fundus image. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Results: There was a correlation between the amplitude of the mfPhNR and Central Lineal Visual Sensitivity in the inferior (R=0.456, P=0.012). On the other hand, there was no correlation between the amplitude of the mfPhNR and Central Lineal Visual Sensitivity in the superior (R= 0.332, P= 0.068). Conclusions: We presented previously that there was a strong correlation between the amplitude of mfPhNR and Lineal Visual Sensitivity in about 20 degrees. There was less correlation between the amplitude of mfPhNR and Lineal Visual Sensitivity in about 10 degrees. Commercial Relationships: Ari Kamei, None; Eiichiro Nagasaka, None The volume for each sub-region as predicted from this method plotted against the volume for each sub-region as computed with a segmentation of SD-OCT images Commercial Relationships: Jason Agne, None; Jui-Kai Wang, None; Randy H. Kardon, Acorda (C), Department of Veterans Affairs Research Foundation, Iowa City, IA (S), Fight for Sight Inc (S), Novartis (C); Mona K. Garvin, The University of Iowa (P) Support: R01 EY023279 Program Number: 5552 Poster Board Number: B0123 Presentation Time: 8:30 AM–10:15 AM Multifocal Photopic Negative Response (mfPhNR) and Central Lineal Visual sensitivity in Patients with Optic Nerve Lesions Ari Kamei1, Eiichiro Nagasaka2. 1Ari Eye Clinic, Oshu-Mizusawa, Japan; 2Mayo Corp., Inazawa, Japan. Purpose: To evaluate the interrelation of mfPhNR and Central Lineal Visual Sensitivity in superior and inferior in patients with optic nerve lesions. Methods: Thirteen eyes of thirteen volunteers with normal vision and eighteen eyes of nine patients with optic nerve lesions including normal tension glaucoma (NTG) were tested. The mfPhNR was recorded with the VERIS Science System 5.0.4. The visual stimulus was made up of 37 hexagons in an approximately 40-degree visual field, Pseudo-randomly alternating between black (5cd/m2) and white (200cd/m2) on the CRT monitor. Burian-Allen ERG Electrodes, Adult-bipolar or Pediatric-bipolar, were used for this testing. The recording time was approximately 8 min. with dilated pupils having the best-corrected visual acuity. The band pass filter of the amplifier was set from 1 to 100 Hz. The amplification and stimulus frequency were set to 10000 and 9.41 Hz (8 frames) respectively. Each trace of the mfPhNR found in superior and inferior regions was analyzed in about 10 degrees. The static visual field was examined with a central 30-2 SITA Standard program using a Humphrey Field Analyzer. The mean deviation (dB) in 10 degrees was converted to lineal visual sensitivity (1/Lambert) to apply for the analysis. Program Number: 5553 Poster Board Number: B0124 Presentation Time: 8:30 AM–10:15 AM OPTIC ATROPHY IN CLASSICAL METHYLMALONIC ACIDEMIA JOYCE MBEKEANI2, 1, Hachemi Nezzar3, 4, Ola Al Ali5, Zahra Al Sahlawi5, Abdelmoneim Eldali6, Mohammed Al Owain5. 1 Ophthalmology & Visual Sciences, Albert Einstein College of Medicine, Bronx, NY; 2Surgery, North Bronx Health Network, Bronx, NY; 3Ophthalmology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 4Ophthalmology, Centre Hospitalier Universitaire, Clermont Ferrand, France; 5Medical Genetics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 6 Biostatistics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. Purpose: Methylmalonic acidemia (MMA) is an autosomal recessive disorder resulting in failure to process various amino acids and lipids. The classical form results in methylmalonyl CoA mutase deficiency, preventing the Vit B12-dependent conversion of methylmalonyl CoA to succinyl CoA, required in Krebs cycle. Patients typically present in early infancy with lethargy, vomiting, dehydration and failure to thrive. Long-term complications include renal failure (CRF), encephalopathy and pancreatitis. 4 cases of optic atrophy (OA) have been reported in classical MMA on appropriate dietary restrictions. The exact etiology is unknown but likely is multi-factorial. With improved survival of patients offered advanced treatment, OA needs to be identified so that prophylactic/therapeutic intervention, when available, can be incorporated into management protocols. The purpose of this observational study is to identify and determine the prevalence of OA in a small cohort of patients with classical MMA. Methods: 22 patients clinically diagnosed and genetically confirmed to have classical MMA were assessed with full history, neuroophthalmic exam, fundus photos and visual evoked potentials (VEP). Diagnosis of OA was determined by a combination of visual acuity, pupil reactions, optic nerve appearances, OCT and VEP. Associations of tabulated data were determined using Mann-Whitney U, Kruskal-Wallis, Chi-squared and Fisher’s exact tests.Statistical significance was set at p<0.05. Patients with proprionic acidemia and intracellular cobalamin metabolism disorders, which have clinical features of MMA were excluded. Results: 8 patients were female and 14, male. Age range was 7 to 27yrs (median=14;IQR=11-16).13 patients (59%) had OA; 85% of these were bilateral. 6 (46.15%) reported decreased vision and 7 (53.85%) were asymptomatic.12 patients had CRF (median=16;IQR=14.5-20). Age was not significantly associated with OA (p=0.17) but significantly related to CRF (p=0.0067). Patients with OA were more likely to have CRF than those without OA (p=0.0058). Conclusions: Optic atrophy is a frequent finding in classical MMA and most commonly is bilateral and sub-clinical. A positive correlation with CRF, known independently to be associated with ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology OA, suggests a contributing causal relation. These findings have important clinical and management implications: early and periodic ophthalmic exams including VEP and OCT should be performed in all, including asymptomatic patients with MMA. Commercial Relationships: JOYCE MBEKEANI, None; Hachemi Nezzar, None; Ola Al Ali, None; Zahra Al Sahlawi, None; Abdelmoneim Eldali, None; Mohammed Al Owain, None Program Number: 5554 Poster Board Number: B0125 Presentation Time: 8:30 AM–10:15 AM Optic Nerve Atrophy in Methylmalonic Acidemia (MMA) Laryssa Huryn1, Irini Manoli2, Elizabeth Harrington2, Jennifer Sloan2, Brian P. Brooks1, Charles Venditti2, Wadih M. Zein1. 1National Eye Institute, Bethesda, MD; 2National Human Genome Research Institute, Bethesda, MD. Purpose: To investigate the topographic pattern of retinal nerve fiber layer thickness (RNFL) of patients with isolated MMA caused by methylmalonyl-CoA mutase deficiency using spectral domain optical coherence tomography (SD-OCT). Methods: Twenty- three patients with isolated MMA (15 mut, 5 cblB and 3 cblA deficiency) admitted through a dedicated natural history protocol at the National Institutes of Health (NCT00078078) underwent comprehensive ophthalmic evaluations. Visual acuity, color vision and Cirrus optical coherence tomography (Carl Zeiss Meditec, Inc) data was analyzed. For patients under 18 years of age, normative data published in the literature was used. Two patients were removed from the analysis because of lack of adequate OCT scans due to age and reduced cooperation. Results: Age at presentation for ophthalmic examination ranged from 10 to 31 years (20.1y +/- 6.9y). Visual acuity at baseline examination ranged from 20/12.5 to 20/800. Seventeen patients presented with at least 20/25 visual acuity in one eye; of these, seven had demonstrable RNFL thinning. Of the eighteen patients that had documented color vision examinations at presentation, only two had abnormal results; one of these patients presented with 20/25 visual acuity. Two patients developed significant vision loss and optic atrophy with thinning of the superior and inferior portions of the optic nerve. Of the patients with optic nerve atrophy and no vision loss, the superior and inferior quadrants of the optic nerve were most often involved. Conclusions: Optic nerve atrophy is a well-known feature of mitochondrial disease. Many mechanisms for the pathogenesis of mitochondrial optic neuropathy have been proposed including bioenergetic failure, oxidative stress and glutamate toxicity. The atrophy in MMA patients presents primarily in the superior and inferior quadrants of the optic nerve as measured by OCT which differs from other optic neuropathies. It is recommended that patients undergo regular eye examinations, including OCT to monitor for changes in retinal nerve fibers. Future studies with OCT measurements may help shed light on changes that occur over time as well as highlight the earliest signs of change and a potential therapeutic window in this disease process. Commercial Relationships: Laryssa Huryn, None; Irini Manoli, None; Elizabeth Harrington, None; Jennifer Sloan, None; Brian P. Brooks, None; Charles Venditti, None; Wadih M. Zein, None Support: NIH Intramural Research Program Clinical Trial: NCT00078078 Program Number: 5555 Poster Board Number: B0126 Presentation Time: 8:30 AM–10:15 AM Optic nerve morphology as a marker for disease severity in cerebral palsy of perinatal origin Deepta Ghate1, Veda Vedanarayanan2, James Corbett2, Abdulbaset Kamour3, Sachin Kedar1. 1Ophthalmology, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE; 2Neurology, university of Mississippi Medical Center, Jackson, MS; 3University of Kentucky, Lexington, KY. Purpose: It has been hypothesized that a large cup in premature children is associated with period of gestation (POG) > 28 weeks. Early prognostication in children with POSE will result in early rehabilitation with improved functional outcomes. Recognition of the association of POSE and large cups will prevent unnecessary examinations under anethesia for glaucoma.Our study aims to correlate optic nerve head (ONH) pallor and cupping to period of gestation (POG) at birth and severity of neurological damage in children with perinatal onset static encephalopathy (POSE). Methods: 54 consecutive patients with POSE were enrolled. Exclusion criteria included genetic, metabolic or congenital structural brain abnormalities not related to perinatal complications; intraocular disease (ROP/glaucoma/cataract) and hydrocephalus. ONH morphology (pallor and cup to disc ratio-CDR) was assessed independently by 2 fellowship-trained ophthalmologists by dilated examination using direct and indirect ophthalmoscopy. ONH were labeled as pale or large cup (cup/disc ratio≥0.5) only if the 2 ophthalmologists agreed. Inter-rater reliability was >0.8 for all parameters . A pediatric neurologist determined eligibility, age of onset of POSE, neurological deficit and reviewed available neuroimaging. Results: Mean age was 11.88±6.53years; period of gestation at birth: 33.26±4.78weeks. 33/54 (61%) showed ONH pallor or cupping. Of 17 patients with ONH pallor, 88% were quadriplegic and 82% nonambulatory. Mean cup/disc ratio was 0.45±0.22; 50% patients had large cup. Multivariate logistic regression models showed that disc pallor was significantly associated with non-ambulatory status (OR: 12.5; p=0.03) and quadriplegia (OR: 21.7; p=0.0025) and large cup was associated with age at examination (OR 1.15; p=0.025). Cup/disc ratio and age showed positive correlation (r=0.42; p=0.002). ONH parameters were not statistically associated with POG at birth. Conclusions: ONH changes are common in POSE and are not associated with POG. Optic disc pallor, a bedside clinical finding is a prognostic indicator for severe neurological insult in high-risk children with perinatal complications that should prompt early referral for rehabilitation. Optic disc cupping is correlated with the age at examination which may indicate that the cupping worsens with age. Commercial Relationships: Deepta Ghate, None; Veda Vedanarayanan, None; James Corbett, None; Abdulbaset Kamour, None; Sachin Kedar, None ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5556 Poster Board Number: B0127 Presentation Time: 8:30 AM–10:15 AM The Site of Inflammation in the Artery Wall in Temporal Arteritis Angeline Wang, Krishna Surapaneni, Daniel M. Albert. Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI. Purpose: Temporal arteritis is an ophthalmic emergency and requires prompt treatment to prevent vision loss. The gold standard for diagnosis is the temporal artery biopsy. Current literature describes a positive biopsy as revealing chronic granulomatous inflammation at the level of the internal elastic lamina. The purpose of this study was to verify the location of most severe inflammation within a positive temporal artery and study other characteristics of our series in comparison to previous reports. Methods: The list of patients with biopsy-proven temporal arteritis was generated by searching the University of Wisconsin Eye Pathology Laboratory database for the terms “giant cell arteritis” and “temporal arteritis.” Charts and pathology slides for patients from the last 15 years (1999 to present) were reviewed (n = 32). Cases with indeterminate diagnoses were excluded, as were cases where clinical information was unavailable. Results: The average age of onset was 76.2 years, with 81% (26/32) of positive cases diagnosed in women. Patients were treated with oral steroids for an average of 4.25 days prior to biopsy. Unilateral temporal artery biopsies were submitted in 91% of cases (29/32); the remaining biopsies were bilateral. Both arteries were positive in two of the bilateral cases; one was positive and the other negative in the third case. The average artery sample length was 20 mm. Histopathologic features of the positive biopsies included intimal hyperplasia (32/32), lymphocytes (32/32), epithelioid cells (32/32), giant cells (29/32), fragmented internal elastic lamina (29/32), lumen narrowing (18/32), and concomitant Monckeberg’s arteriosclerosis (15/32). Skip areas were noted in 9% (3/32) of cases. The most severe inflammation was at the level of the media and adventitia in 37% of biopsies (12/32); the remaining had full thickness inflammation. No biopsies had inflammation isolated at or centered on the internal elastic lamina. Conclusions: In contrast to the current literature, biopsies of patients with temporal arteritis reveal the principal focus of chronic granulomatous inflammation to be at the level of the media and adventitia or throughout the layers of the artery, not at the level of the internal elastic lamina. Other findings are generally consistent with previous reported series. Our findings lead us to hypothesize that the muscularis and adventitia may play an inciting role in the pathogenesis of temporal arteritis. Commercial Relationships: Angeline Wang, None; Krishna Surapaneni, None; Daniel M. Albert, None Support: Department of Ophthalmology and Visual Sciences CORE Grant (UW – Madison); Financial Support from Ocular Services on Demand (OSOD) Program Number: 5557 Poster Board Number: B0128 Presentation Time: 8:30 AM–10:15 AM Final Diagnosis in Headache Patients Following Temporal Artery Biopsy Marie Somogyi, Sarah Hale, David K. Yoo, Yasmin Shayesteh. Ophthalmology, Loyola University Medical Center, Maywood, IL. Purpose: Giant cell arteritis (GCA) is a diagnosis made based on a combination of signs, symptoms and laboratory evidence (1). Temporal artery biopsy is the gold standard for the diagnosis of GCA and a referral for biopsy is commonly encountered entity in oculoplastic surgery practice (2). Our review investigates the final diagnosis and clinical course of headache patients undergoing temporal artery biopsy with the suspicion of giant cell arteritis (GCA). To our knowledge, this series of 143 patients is the largest study to date evaluating the final diagnosis in temporal artery biopsy patients from a single institution. Methods: Retrospective chart review of 143 patients who underwent a temporal artery biopsy from January 2006 to April 2014 by vascular surgery, plastic surgery and oculoplastic surgery at our institution. Results: Of 143 patients, 15 had positive biopsies (10.5%) and 128 had negative biopsies. Among the patients with negative biopsies, 41 patients (28.7%) ultimately were given the diagnosis of a benign headache. Biopsy-negative GCA was diagnosed when the American College of Rheumatology classification (7) criteria were met, symptoms improved within 3 days of corticosteroid therapy and no other diagnosis relevant to the patient’s presenting symptoms was diagnosed. 30 patients (20.9%) were ultimately diagnosed with biopsy-negative GCA. Of the remaining negative biopsies, 7 (4.9%) were found to have non-arteritic anterior ischemic optic neuropathy, 3 (2.1%) had isolated polymyalgia rheumatic, 3 (2.1%) with systemic vasculitis, 3 (2.1%) with acute angle closure, 3 (2.1%) with hypertensive urgency, 2 (1.4%) with posterior ischemic optic neuropathy, and 2 (1.4%) with granulomatosis with polyangiitis. Conclusions: Even though only 15 patients (10.5%) had positive temporal artery biopsies, a total of 45 patients (31.5%) were ultimately treated for giant cell arteritis. Although the majority of patients (41 patients or 28.7%) undergoing temporal artery biopsy were diagnosed with benign headache, it is important to consider other vision and life threatening entities when presented with a patient with suspected GCA. Final Diagnoses Following Temporal Artery Biopsy Commercial Relationships: Marie Somogyi, None; Sarah Hale, None; David K. Yoo, None; Yasmin Shayesteh, None Program Number: 5558 Poster Board Number: B0129 Presentation Time: 8:30 AM–10:15 AM Acute ischemic stroke in monocular vision loss of vascular etiology Lucy Zhang1, Richard Kim3, Danielle Rudich4, Robert Lesser1, 2, David Greer2, Hardik Amin2. 1Ophthalmology and Visual Sciences, Yale University, New Haven, CT; 2Neurology, Yale University, New Haven, CT; 3Yale University School of Medicine, New Haven, CT; 4 The Eye Care Group, New Haven, CT. Purpose: To evaluate the rate of co-occurrence of acute ischemic stroke and monocular vision loss of vascular etiology, as diagnosed by magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Two recent retrospective studies have shown that ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology patients with monocular vision loss of ischemic origin are also more likely to have acute brain infarcts; however, these studies did not exclude patients with concurrent focal neurologic deficits (totaling 13-15% of their study populations). The goal of our study is to evaluate the likelihood of subclinical acute stroke identified on DWI in patients presenting with isolated monocular vision loss. Methods: A retrospective analysis was performed using medical records from February 2013 through August 2014 at Yale-New Haven Hospital of patients who were diagnosed with monocular vision loss. Patients whose vision loss was likely related to a vascular etiology (such as amaurosis fugax or central or branch retinal vascular occlusion) and who underwent brain MRI within a seven day period were included. We determined the proportion of patients with monocular vision loss and acute stroke on brain MRI. Results: A total of 448 records were reviewed. Of these, 293 patients had monocular vision loss of suspected or confirmed vascular etiology. Seventy-four patients were excluded due to the presence of other focal neurologic symptoms. Of the remaining 219 patients, 54 underwent MRI of the brain within seven days of the onset of symptoms, and 13 (24%) were found to have evidence of acute ischemic stroke based on restricted diffusion. Conclusions: Patients with monocular vision loss due to amaurosis fugax, CRAO, or BRAO may have up to 24% risk of ischemic stroke as a result of thromboembolic phenomena. This study provides further evidence that ophthalmologists should refer monocular vision loss patients for neurologic evaluation and brain MRI with DWI even when vision loss is the isolated symptom. Commercial Relationships: Lucy Zhang, None; Richard Kim, None; Danielle Rudich, None; Robert Lesser, None; David Greer, None; Hardik Amin, None Program Number: 5559 Poster Board Number: B0130 Presentation Time: 8:30 AM–10:15 AM Chiasmal syndrome: clinical features in mexican patients, a 5 year review Aline Astorga-Carballo, Juan Carlos Serna-Ojeda, Mayra F. Camargo. Instituto de Oftalmologia Fundación Conde de Valencia I.A.P., Mexico City, Mexico. Purpose: To evaluate the ocular manifestations of intracranial pathology producing a chiasmal syndrome, for those initially diagnosed or referred to an ophthalmologic institution. Methods: An observational and retrospective study was performed with review of the records of all the patients with a diagnosis of chiasmal syndrome at an ophthalmologic reference center in a 5-year period. The variables analyzed included: demographic data, reason for consultation, visual acuity, visual field defect in Goldmann’s perimetry, afferent pupillary defect, changes in the color vision test, characteristics of the optic nerve and cranial imaging. Results: 104 patients were included with a median age of 52 years (range 4 – 86 years). 54 patients (51.9%) were initially diagnosed because of the ophthalmologic examination, and 50 (48.07%) were referred with the presumptive diagnosis of an intracranial tumor. The median visual acuity at the time of diagnosis was 20/60 in the eye with worst vision, with 41 patients with a vision in one eye severely affected (worst than 20/400). The main symptoms were decreased central vision in 57 patients (54.8%) and changes in the peripheral visual field in 20 (19.2%); other aggregated manifestations like headache and systemic signs for elevated pituitary hormones were present in 10 (9.61%) and 18 cases (17.3%) respectively. Nine patients had a misdiagnosis of glaucoma for years. The most common visual field defect was bitemporal hemianopsia in 59 (56.73%). 54 patients (51.92%) had relative afferent pupillary defect, and in 65 (62.5%) the color vision test was affected. The optic nerve presented changes in 64.4% of the population. Cranial imaging confirmed the presence of an intracranial tumor in 23 cases (22.11%), being the most common pathology a pituitary adenoma. Conclusions: Ophthalmologic examination could imply the initial diagnosis of intracranial pathology as the ocular manifestations are varied. Decreased vision is a common reason for consultation in patients with chiasmal syndrome, and other neurologic and systemic findings can be present. Complimentary study findings of intracranial pathology include bitemporal hemianopsia in Goldmann’s perimetry, altered color vision test and diagnostic cranial imaging. Commercial Relationships: Aline Astorga-Carballo, None; Juan Carlos Serna-Ojeda, None; Mayra F. Camargo, None Program Number: 5560 Poster Board Number: B0131 Presentation Time: 8:30 AM–10:15 AM Proposing a new mechanism for chiasmal visual field loss in an unusual case of junctional scotoma: the degree of stretch of the anterior optic chiasm closely relates to the pattern of visual loss in a patient Yevgeniy Sychev, Raghu C. Mudumbai. University of Washington, Seattle, WA. Purpose: To report a case of an unusual junctional scotoma in a patient produced via a stretching of an anterior aspect of the optic chiasm. Methods: A single case report describing a patient with an unusual mechanism of junctional scotoma is presented. Results: We present a case of an unusual junctional scotoma resulting from compression of the anterior optic chiasm by a pituitary macroadenoma. A patient presented complaining of unilateral vision loss in the left eye. Automated Humphrey visual field demonstrated dense temporal hemianopia in the left eye and only trace visual field change in the left eye. Magnetic Resonance Imaging demonstrated a macroadenoma under the anterior aspect of the optic chiasm resulting in marked stretch of the chiasm in the horizontal coronal axis. Following surgical decompression the visual field deficit has resolved. (see figure) Postoperative imaging demonstrated marked reduction in the degree of chiasm stretch. Conclusions: The visual field deficit observed in the presented case cannot be explained by the classic theory that states that dysfunction of visual axons stems from their compression at the chiasm. The deficit observed is neither a bitemporal hemianopia, nor a typical junctional scotoma seen in syndromes of the middle and anterior chiasm compression respectively. Instead, the presented visual field defect implies involvement of predominantly the nasal fibers of the left optic nerve with sparing of the left temporal fibers and the right optic nerve. Pure compressive forces on the chiasm does not easily explain this pattern of visual loss. Close correlation between the degree of chiasm stretch and development of the temporal scotoma in this patient suggests that stretch of nerve fibers likely played an important role. The perpendicular relationship of the uncrossed fibers of the left optic nerve to the tumor with minimum lateral stretch forces at the chiasm may have lead to their relative protection. The crossing fibers may have been injured because of their partially parallel course to the horizontal stress forces in the anterior chiasm from the tumor. This mechanism of optic neurologic dysfunction may also be important contributor in other cases of bitemporal and junctional scotomas. ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology 529 Visual pathways Thursday, May 07, 2015 12:00 PM–1:45 PM 4CD Mile High Blrm Paper Session Program #/Board # Range: 5855–5861 Organizing Section: Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Commercial Relationships: Yevgeniy Sychev, None; Raghu C. Mudumbai, None Program Number: 5855 Presentation Time: 12:00 PM–12:15 PM Retinal Development in Achromatopsia: A Prospective Study of Infants and Young Children using Optical Coherence Tomography Helena Lee1, Ravi Purohit1, Viral Sheth1, Rebecca J. McLean1, Gail Maconachie1, Susanne Kohl2, Bart P. Leroy3, 4, Michel Michaelides5, Frank A. Proudlock1, Irene Gottlob1. 1Ophthalmology, University of Leicester, Leicester, United Kingdom; 2Insitute for Ophthalmic Research, Molecular Genetics Laboratory, Universitätsklinikum Tübingen, Tübingen, Germany; 3Dept of Ophthalmology & Ctr for Medical Genetics, Ghent University, Ghent, Belgium; 4Div of Ophthalmology & Ctr for Cellular & Molecular Therapeutics, The Children’s Hospital of Philadelphia, Philadelphia, PA; 5UCL Institute of Ophthalmology, London, United Kingdom. Purpose: To characterize postnatal retinal development in infants and young children with achromatopsia using hand-held spectral domain optical coherence tomography (HH-SDOCT) and to investigate whether retinal changes are progressive. Methods: Forty-one mixed cross-sectional and longitudinal HHSDOCT images were obtained from eight infants and young children with achromatopsia (mean age 3.3 years; range 0-8.3 years) and compared with 82 age-matched control examinations. All patients had homozygous mutations in either CNGA3 (n=2) or CNGB3 (n=6). Retinal layer segmentation was performed manually using ImageJ. Differences in development of retinal layers with age between the achromatopsia and control groups were analysed using linear mixed regression modelling. The severity and progression of photoreceptor disruption was evaluated in all participants with longitudinal data (11 eyes of 6 participants; mean follow-up time 14.8 months; range 7.2-20.9 months). Results: In achromatopsia, retinal thickness increased more slowly with age and was reduced at the fovea in comparison to controls (p < 0.05). There was delayed regression of the inner retinal layers (IRLs) at the fovea and a reduction in the thickness of the perifoveal IRLs. This was especially significant for the perifoveal inner (p < 0.0001) and outer (p < 0.01) plexiform layers. Elongation of the outer retinal layers (ORLs) was diminished across the retina resulting in a significant reduction in ORL thickness, especially at the fovea (p < 0.0001). There was evidence of an increase (4 eyes), decrease (1 eye) and no change (2 eyes) in the grade of photoreceptor disruption on longitudinal assessment. Interestingly, in 4 eyes both an increase and decrease in the grade of photoreceptor disruption was observed at different time points. Conclusions: Previously, it has been thought that retinal development is arrested in achromatopsia. We demonstrate ongoing retinal development in achromatopsia in the postnatal period albeit at an altered rate and magnitude in comparison to controls. Achromatopsia appears to be a dynamic and progressive condition in infants and young children. This has potential implications for planned gene therapy, since intervention at the earliest stages of the disease may promote normal retinal development. Commercial Relationships: Helena Lee, None; Ravi Purohit, None; Viral Sheth, None; Rebecca J. McLean, None; Gail Maconachie, None; Susanne Kohl, None; Bart P. Leroy, None; ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Michel Michaelides, None; Frank A. Proudlock, None; Irene Gottlob, None Support: Medical Research Council, London, UK (grant number: MR/J004189/1), Ulverscroft Foundation, Leicester, UK and Nystagmus Network UK. Program Number: 5856 Presentation Time: 12:15 PM–12:30 PM Optical Coherence Tomography Findings in Huntington’s Disease: a Potential Biomarker of Disease Progression? Hannah M. Kersten1, Helen V. Danesh-Meyer1, Dean H. Kilfoyle2, 3, Richard H. Roxburgh2, 3. 1Department of Ophthalmology, University of Auckland, Auckland, New Zealand; 2Department of Neurology, Auckland City Hospital, Auckland, New Zealand; 3Centre for Brain Research, University of Auckland, Auckland, New Zealand. Purpose: Previous reports of ocular abnormalities in Huntington’s disease (HD) have detailed eye movement disorders. Mitochondrial dysfunction is a feature of HD, and diseases affecting mitochondrial function frequently manifest neuro-ophthalmic signs and symptoms including optic neuropathy. However, these changes have not been reported in HD. The objective of this case-control study was to investigate optic nerve and macular morphology in HD using optical coherence tomography. Methods: A total of 26 HD patients and 29 controls underwent a thorough neuro-ophthalmic examination including digital retinal photography and spectral domain optical coherence tomography (OCT) scans of the macula and peripapillary retinal nerve fibre layer (RNFL). Genetic testing results, disease duration, HD disease burden scores and unified HD rating scale (UHDRS) motor scores were acquired for HD patients. Results: Of the 26 patients with HD, 13 were women; the mean age was 52.0 years (range 33 – 68). The control group was matched for age and gender. The range of the CAG repeat expansion size was 38-48 repeats. Amongst the 52 HD patient eyes, eight were excluded from macular and/or RNFL analysis due to poor scan quality. After statistical analysis confirmed no significant difference in the measurements from both eyes of each participant, 22 right eyes were included in OCT analysis. Temporal RNFL thickness was significantly reduced in the HD group (62.3 (± 7.3) μm vs. 69.8 (±10.8) μm, p = 0.005). There was no significant difference in total macular volume between HD patients and controls (8.57 (± 0.38) mm vs. 8.62 (±0. 31) mm), p = 0.63). There was, however, a significant negative (p < 0.05) correlation between macular volume and UHDRS motor scores (R2 = -0.56), and disease duration (R2 = -0.57). Conclusions: The temporal RNFL is preferentially thinned in HD patients. This could implicate mitochondrial dysfunction as the temporal RNFL is reduced in other conditions where mitochondrial function is impaired, including Leber’s hereditary optic neuropathy. The correlation between the decrease in macular volume and increasing motor disability suggests that ocular coherence tomography may be a useful biomarker for disease progression in HD. Larger, longitudinal studies are required in order to corroborate these findings. Commercial Relationships: Hannah M. Kersten, None; Helen V. Danesh-Meyer, None; Dean H. Kilfoyle, None; Richard H. Roxburgh, None Program Number: 5857 Presentation Time: 12:30 PM–12:45 PM Very Preterm Neonatal Retinal Nerve Fiber Layer Thickness is a Biomarker of Brain Anatomy and Neurodevelopmental Health Adam Rothman1, Monica B. Sevilla1, Mays El-Dairi1, 3, Joshua Shimony4, Kathyrn Gustafson3, Carolyn Pizoli3, Amy Tong1, Sina Farsiu2, 1, Sharon Freedman1, 3, Cynthia A. Toth1, 2. 1Ophthalmology, Duke University School of Medicine, Durham, NC; 2Biomedical Engineering, Duke University Pratt School of Engineering, Durham, NC; 3Pediatrics, Duke University School of Medicine, Durham, NC; 4 Radiology, Washington University of St. Louis School of Medicine, St. Louis, MO. Purpose: To assess retinal nerve fiber layer (RNFL) thickness measurements at term equivalent age (TEA, 37-42 weeks postmenstrual age, PMA) in very preterm (VPT, <32 weeks gestational age) infants and to compare these measurements to maturity, brain magnetic resonance imaging (MRI) findings, and neurodevelopment. Methods: In a prospective cohort study, VPT infants and full term controls were imaged with handheld spectral domain optical coherence tomography (Bioptigen, Inc., Research Triangle Park, NC) in the nursery. A custom MATLAB script (Mathworks, Inc., Natick, MA) segmented the RNFL, and graders corrected segmentation and marked the fovea and optic nerve center. From these coordinates, a second script created an organizing fovea-optic nerve axis and calculated mean RNFL thickness for the papillomacular bundle (PMB), extending from -15° to +15° to the organizing axis, at a radial distance of 1.5 mm from the optic nerve center. For VPT infants, clinical brain MRI scans obtained in the nursery were scored for structural abnormalities based on scaling of Kidokoro et al. (Am J Neuroradiol, 2013, 2208-14). In addition, Bayley Scales of Infant and Toddler Development were assessed at 18-24 months corrected age, by evaluating cognitive, language, and motor skills. Expert MRI and Bayley evaluators were masked to eye imaging data. We assessed the relationships between mean RNFL thickness and Bayley scores or MRI scores using linear regression. Results: Mean ± standard deviation RNFL thickness at the PMB was greater for term (n=50, 72 ± 13 μm) versus VPT infants (n=57, 61 ± 17 μm, P<0.001), respectively. Retinal nerve fiber layer thickness inversely correlated with MRI scores while in the nursery (signifying more extensive global lesions (n=14, R2=0.37, P=0.02)) as well as cognitive (n=29, R2=0.19, P=0.015) and motor scores (R2=0.21, P=0.009) at 18-24 months follow-up. Retinal nerve fiber layer thickness did not correlate with language scores (P=0.67). Conclusions: Thinner RNFL at the PMB in TEA VPT infants correlates with worse cognitive and motor skills at 18-24 months corrected age and with worse abnormalities on brain MRI. Retinal nerve fiber layer thickness measured at the infant bedside provides insight into VPT infants’ brain and neurodevelopment. Commercial Relationships: Adam Rothman, None; Monica B. Sevilla, None; Mays El-Dairi, None; Joshua Shimony, None; Kathyrn Gustafson, None; Carolyn Pizoli, None; Amy Tong, None; Sina Farsiu, Duke University (P); Sharon Freedman, None; Cynthia A. Toth, Alcon (F), Bioptigen (F), Duke University (unlicensed) (P), Genentech (F), National Institute of Health (F), Research to Prevent Blindness (F), Retina Research Foundation (F), The Andrew Family Foundation (F), The Hartwell Foundation (F) ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 5858 Presentation Time: 12:45 PM–1:00 PM NAION: Analysis of the cellular immune response and treatment targeting Steven L. Bernstein1, 2, Yan Guo1, Valerie Touitou3, Zara Mehrabyan1. 1 Ophthalmology, Univ of Maryland Sch of Medicine, Baltimore, MD; 2 University of Maryland, Anatomy and Neurobiology, Baltimore, MD; 3Neuro-Ophtalmologie, hopital salpetrie, Paris, France. Purpose: We recently demonstrated that optic nerve lesion in clinical specimens and in both the primate (pNAION) and rodent (rAION) NAION models generates a strong, stereotypical cellular immune response that extends over days and weeks (Salgado and Vilson, 2012; Zhang et al 2008). Cellular macrophage responses can be either M1 (classical neurodegenerative) or M2 (alternative-neuroprotective). We wanted to use the rAION model to: 1) Evaluate the specific M-type response in the primary and secondary optic nerve damage regions; 2) Determine whether we could switch the M-type response by pharmacological means. Methods: We utilized Sprague-Dawley male rats and induced rAION in one eye; the second eye was left as a control. Animals were treated post-induction with either vehicle, minocycline (30mg/kg/IP/day, or administered an intraventricular dose of IL4+TGFβ. Tissues were collected from the lamina and distal ON at a variety of times postinduction, and evaluated for M1 markers CD16/32 and iNOS, M2 markers Arginase-1 (Arg1) and Ym1, and microglia and universal immune cell markers CD11b and Iba1. Results: The primary ON lesion at the lamina in vehicle treated animals exhibited a strong M1 response by 3 days and continued to at least 7 days post-induction, with upregulation of M1 markers. . Early and late analysis of the primary lesion in treated animals revealed a only a modest M2 response, in the minocycline treatment group, with continuing M1 expression. Interestingly, Arg-1 expression was also seen. Although axons degenerate along the entire ON with oligodendrocyte death, there was minimal M1 response in the distal ON at either 7- or 30 days post-induction, in either vehicle or minocycline-treated animals. Conclusions: NAION likely induces a strong early (3-7d) M1 cellular response at the primary lesion, with minimal alteration of the M1/M2 macrophage response in regions with only secondary axonal degeneration. The lack of M2 response in animals given minocycline after induction, compared with the reported neuroprotective response in animals given minocycline prior to treatment (Fel et al, 2014), as well as the reported post-induction neuroprotection in rodents and primates using prostaglandin J2 suggests that minocycline may be ineffective when given after ON damage has commenced. Commercial Relationships: Steven L. Bernstein, None; Yan Guo, None; Valerie Touitou, None; Zara Mehrabyan, None Support: Supported by NEI RO1EY015304 to SLB of the MR images to measure the displacement of the optic tract in the pre-chiasmal, chiasmal, and post-chiasmal regions. They also subjectively assessed the degree of right-left asymmetry in the tumor. To quantify the degree and laterality of visual field loss, we utilized algorithms previously developed for the Neurological Hemifield Test. In brief, we used the pointwise pattern deviation values from each visual field to assign a score proportional to the degree of vision loss loss at each point. These pointwise scores were then summed in each quadrant of the visual field. Each right-left pair of visual fields for each patient was summarized in terms of temporal field asymmetry (right temporal field minus left temporal field), the proportion of visual field loss that was temporal, total field asymmetry (all right eye minus all left eye), and total visual field damage (sum of all 4 fields in both eyes). These visual field metrics were then compared to either the maximum displacement of the optic tract or the tumor asymmetry on MR imaging. Results: Of the 114 subjects, 64 (56%) were male and the average age was 54.6 years. Both the summation of vision loss in both eyes and the proportion of visual field loss in the temporal hemifields were statistically significantly related to the maximum displacement of the optic tract (both p < 0.001 for fit of linear regression) - Figure 1. There was no statistical relationship between the subjective assignment of tumor asymmetry on MR imaging and either the asymmetry of temporal vision loss (R-L) or the asymmetry of total vision loss (R-L) (p > 0.05 by analysis of variance) - Figure 2. Conclusions: As might be expected, the displacement of the optic tract by pituitary tumors is quantitatively associated with both the total amount of vision loss and the proportion of visual field loss that is temporal. Although there was right-left asymmetry of vision loss in some subjects, it was not related to the subjective assessment of asymmetry on MR imaging. Program Number: 5859 Presentation Time: 1:00 PM–1:15 PM Quantitative analysis of the size and asymmetry of pituitary lesions and the associated visual field loss Michael V. Boland1, In Ho Lee2, David M. Yousem2, Neil R. Miller1. 1 Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD; 2 Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD. Purpose: To understand the quantitative relationship between the size and asymmetry of pituitary tumors and the visual field loss they cause. Methods: We identified patients who had magnetic resonance (MR) imaging with a diagnosis of pituitary macroadenoma who also had reliable visual field testing. Neuroradiologists reviewed all ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Relationship between asymmetry of visual field damage and of the tumor on MR imaging. Commercial Relationships: Michael V. Boland, None; In Ho Lee, None; David M. Yousem, None; Neil R. Miller, None Support: NIH Grant EY01765 Program Number: 5860 Presentation Time: 1:15 PM–1:30 PM Prediction of visual field defects in children with perinatal arterial ischemic stroke using early DTI-based tractography of the optic radiation Yvonne Koenraads, Giorgio L. Porro, Kees P. Braun, Floris Groenendaal, Linda S. de Vries, Niek E. van der Aa. University Medical Center Utrecht, Utrecht, Netherlands. Purpose: Visual field (VF) defects are a common sequela of perinatal arterial ischemic stroke (PAIS) and can be detected using specialized VF assessments, such as the ‘behavioral visual field screening’ test (BEFIE). Conventional MRI does not always predict VF deficits. The ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology aim of this study was to investigate whether diffusion tensor imaging (DTI) based tractography of the optic radiation (OR) at 3 months of age improves the prediction of VF defects. Methods: Seventeen patients with unilateral PAIS, who underwent conventional MRI (T1/T2) and DTI at the age of 3 months and a BEFIE VF examination later in life (median age 3yrs) were included. DTI-based tractography of the bilateral OR was performed, and the average fractional anisotropy (FA), axial (λ1), radial (λ23) and mean diffusion (MD) were extracted. Asymmetry of these parameters was used as a predictor of VF defects in the 15 patients with a conclusive result of the BEFIE test, using receiver operating characteristic (ROC) analysis. Conventional MRI was used to assess myelination of both ORs and scored as symmetrical, mildly asymmetrical or severely asymmetrical and compared with the VF results. Results: Nine children had a normal VF, 6 children had a VF defect (5 hemianopia and 1 quadrantanopia) and 2 children had an inconclusive result of the BEFIE tests. ROC curve analysis revealed that VF outcome could be correctly predicted based on conventional MRI assessment in the majority of children, with an area under the curve (AUC) of 0.94 (95%CI 0.70-1.00). Prediction based on DTI parameter asymmetry indices showed an AUC of 0.98 (95%CI 0.751.00), 0.85 (95%CI 0.58-0.98), 0.96 (95%CI 0.72-1.00) and 0.94 (95%CI 0.70-1.00) for FA, λ1, λ23 and MD, respectively (see Figure 1 & Table 1). Both children who were excluded from the analysis since they had inconclusive BEFIE test results also had an inconclusive prediction of the VF according to the cut-off values of de DTI parameters based on the other 15 children. Conclusions: Asymmetry in myelination of the OR at 3 months and especially DTI-based tractography of the OR can be used to predict VF defects after PAIS. Figure 1. DTI parameter asymmetry indices of children with and without a visual field defect Table 1. Results of diagnostic values of DTI parameter asymmetry indices to predict visual field (VF) defects Commercial Relationships: Yvonne Koenraads, None; Giorgio L. Porro, None; Kees P. Braun, None; Floris Groenendaal, None; Linda S. de Vries, None; Niek E. van der Aa, None Support: ODAS Foundation, Dr. F.P. Fischer Foundation, SNOO Foundation, Rotterdamse Blindenbelangen Foundation and Vrienden van het UMCU Foundation Program Number: 5861 Presentation Time: 1:30 PM–1:45 PM Long Distance Homonymous Hemi-Macular Retrograde Degeneration of the Visual Pathway: A Comparison of Anterior and Posterior Visual Pathway Lesions Alekya Rajanala, M Ali Shariati, Yaping J. Liao. Stanford School of Medicine, Palo Alto, CA. Purpose: Trans-synaptic degeneration of the visual pathway following ablation of the striate cortex is well established in nonhuman primates and involves parvocellular retino-geniculate connections. In humans, trans-synaptic degeneration is more controversial but has been described recently. In this study, we used optical coherence tomography (OCT) to examine the severity and timing of retrograde degeneration in human visual pathway lesions. Methods: We performed a retrospective chart review of patients with homonymous visual field loss and confirm lesions of the visual pathway on brain imaging studies. Patients were categorized by location of brain lesion. We analyzed over 70 high quality OCT studies and correlated the findings with visual field loss and MRI. Results: We studied the changes in macular ganglion cell complex in 15 patients with anterior and 20 patients with posterior visual pathway lesions. There was significant hemi-macular thinning of the ganglion cell complex (GCL+IPL) in patients with anterior (abnormal: 56.2±2.5 mm, normal: 78.2±1.5 mm, N=15, P<0.0001) and posterior (abnormal: 63.6±2.3 mm, normal: 71.7±2.6 mm, N=19, P=0.01, Mann-Whitney). At one year after onset, anterior lesions led to significantly more severe GCC thinning than posterior lesions (anterior: 59.2±2.9 mm, N=10; posterior: 67.8±2.8 mm, N=6; P=0.03). At two years after onset, the rate of thinning of the anterior lesions was significantly faster and more than three times that of the posterior lesions (anterior: 4.6±1.0 mm/month, posterior: 1.2±1.1 mm/month; P=0.05). Patients with congenital or incidentally noted homonymous hemifield defects often exhibited significant hemi-macular thinning, presumably because the thinning has had years to develop. Correlation between the pattern of retinal thinning and that of visual field loss indicated that a decrease of 1 dB in visual field sensitivity predicts a decrease of 0.1543 mm in GCC thickness. Conclusions: Retrograde, homonymous, hemi-macular thinning occurred in the human visual pathway over long distance, even trans-synaptically. There was more rapid and more severe thinning in anterior visual pathway lesions (optic tract, LGN) compared with that of occipital lobe lesions. Further investigation of trans-synaptic ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2015 Annual Meeting Abstracts by Scientific Section/Group - Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology degeneration can assist regeneration therapy and efforts to restore patient vision. Commercial Relationships: Alekya Rajanala, None; M Ali Shariati, None; Yaping J. Liao, None Support: Career Award in Biomedical Sciences, Center for Biomedical Imaging at Stanford, Weston Havens Foundation, Stanford Vice Provost for Undergraduate Research, Stanford Undergraduate Major Grant ©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected].