Purpose. To describe two ipsilateral, metachronous, ocular choroidal melanoma metastases. Material and methods. A 64-year-old choroidal melanoma patient was initially treated with palladium-103 ophthalmic plaque brachytherapy which induced local control of the primary cancer. Seven years later, ophthalmic findings of a second, ipsilateral, discrete choroidal melanoma prompted restaging which revealed new hepatic and nodal metastases. Systemic immunotherapy (ipilimumab 3 mg/kg with nivolumab 1 mg/kg IV every 3 weeks 4 doses) resulted in intraocular tumor regression and was followed by maintenance nivolumab 480 mg IV every 4 weeks with follow-up ophthalmic examinations. Results. Three years after initiation of systemic immunotherapy, the patient was found to have a second ipsilateral local recurrence of choroidal melanoma. It presented with retinal detachment, uveitis, and optic neuritis. Then, due to its anterior uveal location, extrascleral tumor extension was amenable to a diagnostic biopsy. Overall, 3 years after onset of metastatic uveal melanoma and 2 months after her second ocular metastasis, the patient died. This was 10 years after the initial diagnosis of choroidal melanoma. Conclusions. Metastatic choroidal melanoma can present twice in the same eye as the primary tumor. Ophthalmic and systemic examinations allowed for immunotherapy to affect initial systemic regression, vision sparing, and globe salvage.

Introduction The prevalence of myopia and its ocular complications increases each year worldwide and the complications of myopia are predicted to become the leading cause of blindness by 2050 (Holden Ophthamology 2016). Common therapies for myopia management include low-dose atropine, bifocals or Progressive Addition Lenses (PALs), orthokeratology (OK), and multifocal contact lenses (MFCL). One potential mechanism for OK and MFCLs to reduce myopia progression is by imposing peripheral myopic defocus on the retina. MFCL wear can reduce accommodation compared with single vision contact lenses (SVCL), potentially reducing peripheral myopic defocus and causing variable efficacies of MFCLs (Gong OVS 2017). The change in accommodation with MFCL use varies between MFCL designs. Auditory biofeedback training can decrease the accommodative lag during MFCL wear in young adults (Wagner Sci Rep 2020). We assessed: Differences in accommodative lag between children using low-dose atropine, OK, and MFCLs compared to a single vision spectacle control. Differences in accommodation between different MFCL designs. Differences in accommodation between viewing through SVCLs and MFCLs. The effect of biofeedback training on accommodation in children during MFCL wear. Methods Myopic children habitually using low-dose atropine, OK, or MFCLs as well as myopic children not undergoing myopia management (spectacle control) (19 male/ 24 female) were recruited from the Pediatric and Myopia Management Clinics at the University Eye Center, SUNY College of Optometry. Low dose atropine (n = 11), OK (n = 5), and spectacle control (n = 11) subjects’ accommodative lag was measured using an infrared (IR) photorefractor, using a stimulus at 0, 2.5, 3, and 4D. For the MFCL subjects (n = 17), accommodation through SVCLs and their habitual MFCLs before, after, and 1 week following biofeedback training were measured identically to the other subjects at the same distances. Differences in accommodative lag were measured using mixed effects multiple linear regression adjusting for accommodative stimuli. Results There was no significant difference between accommodation in the low-dose atropine (p = 0.8), OK (p = 0.3), and MFCL (p = 0.3) groups compared to the spectacle control. Eyes wearing MFCLs exhibited significantly increased lag of accommodation compared with SVCLs prior to the biofeedback training (SV vs. MFCL, p < 0.05). Specifically, eyes viewing through Biofinity MFCLs showed a significantly greater lag than MiSight (p < 0.05). Biofeedback training showed a tendency to decrease lag immediately following biofeedback training (p = 0.2) and significantly decreased lag 1 week later (p < 0.01). Both immediately and one week later, subjects that showed lower pretreatment accommodation had significantly greater decreases in lag following biofeedback training (p < 0.05). Conclusions Our findings show that pediatric subjects wearing MFCLs for myopia management show an increased accommodative lag compared to wearing SVCLs. The lag of accommodation while viewing with MFCLs differs between MFCL designs. Biofeedback training can significantly decrease lag in children during MFCL wear one week later, similar to previous findings (Wagner Sci Rep 2020). Subjects who displayed the greatest accommodative lag prior to the train showed the biggest improvements in accommodation before the biofeedback training, suggesting individuals with low accommodation while viewing through MFCLs use may yield the greatest benefit from biofeedback training. Biofeedback training may be effective in increasing the amount of peripheral myopic defocus during MFCL wear and thus increase the efficacy of MFCL wear for myopia management in children.

Eosinophilic esophagitis (EoE), an eosinophil predominant, TH2-mediated condition increasing in prevalence in pediatric and adult populations, is typically treated with dietary manipulations to avoid triggering antigens. However, identifying specific dietary causes remains a persistent challenge, and restrictive diets are burdensome. Total dietary modification using amino acid-based formula does not always produce symptomatic or histologic resolution, suggesting that exposure to ingested aeroallergens drives their disease. EoE patients demonstrate symptomatic exacerbation from July to September correlating with higher grass and ragweed pollen counts. We present a 7-year-old tracheostomy- and gastrostomy-dependent girl who was found on surveillance endoscopy to have profound eosinophilic infiltration throughout the esophagus with inflammatory changes including basal cell hyperplasia on histology. She responded partially to topical corticosteroid therapy with fluticasone and had complete resolution of esophageal eosinophilic infiltrate with subcutaneous dupilumab.

Several personality traits predict future alcohol problems but also relate to demographic and substance-related variables that themselves correlate with later adverse alcohol outcomes. Few prospective studies have evaluated whether personality measures predict alcohol problems after considering current demographic and substance-related variables.

Photocathodes are employed as photodetectors for astronomy and defense applications, as well as electron sources in high energy physics technologies. Photocathodes absorb incident photons, resulting in the emission of electrons. The III-nitride material system is promising for photocathodes due to the wide and tunable band-gap energy spanning infrared to ultraviolet wavelengths. III-nitrides are air-stable, radiation hard, and possess internal polarization charge. Nitrogen polar III-nitrides photocathodes have been predicted to achieve high device quantum efficiency (QE) and effective negative electron affinity due to alignment of the polarization and depletion charges. However, fundamental challenges of p-type doping of III-nitrides, and experimental considerations of unintentional dopant incorporation at surfaces and interfaces initially inhibited repeatable high QE N-polar photocathodes. To address these challenges, a comprehensive approach was used for the development of air-stable, high QE III-nitride photocathodes, investigating the impact of polarity on Mg-dopant incorporation efficiency, distribution of unintentional impurities due to diffusion at interfaces, and on surface passivation. The impact of hillock structures commonly present on the N-polar surface on device QE was investigated, finding a 2x increase in efficiency in photocathodes grown on high hillock density templates. Atom probe tomography (APT) measurements reveal a decrease in Mg-dopant clustering and improved incorporation efficiency in the semi-polar facets of the hillocks, leading to improved optical and electrical characteristics. Building upon this finding, a selective area growth technique is used to create hexagonal pyramid structure in both the N- and Ga-polar orientations as a model to more controllably study the mechanism of Mgincorporation within the semi-polar planes of N-polar hillocks. III-nitride hetero/homo-interfaces are commonly implemented in photocathode device design. Growth of such structures may involve growth interruption and/or exposure of the interface to ambient conditions. Incorporation and diffusion of unintentional impurities including oxygen and carbon from these interfaces has been studied here by SIMS depth profiling and modeling of defect mediated diffusion mechanisms, and their impact on photocathode performance was studied. Through consideration of interface proximity to the surface, and the temperature of processes occurring post-regrowth interface, the unintentional impurity and electrostatic profile is controlled. Emission of photoexcited electrons and hence QE depends greatly on the condition of the surface/states and its impact on surface band bending. It is well known that a non-negligible surface oxide is present on the N-polar III-nitride surface. We have observed removal of the surface oxide and deposition of positive surface charge by HCl cleaning prior to measurement, leading to an order of magnitude increase in QE. However, oxide regrowth occurs following airexposure. We have studied 2D materials including graphene and h-BN as passivation layers to prevent contamination and fully stabilize the surface charge. Sustained decrease in oxygen and carbon coverage have been measured by XPS in h-BN/GaN photocathodes after air exposure on the order of days. The combined findings of the impact of material polarity on Mg-dopant incorporation efficiency, control of the unintentional impurity profile and surface passivation was utilized to optimize the photocathode electrostatic profile for optimal device characteristics, the result of which is a maximum QE of 26.6% at 6 eV photon energy was achieved for an HCl cleaned Npolar p-GaN/u-GaN cap structure grown on high hillock density GaN template without a regrowth interface between active layers. This represents the highest reported QE for a Cs-free GaN photocathode to date [1], [2]. [1] J. Marini, I. Mahaboob, E. Rocco, L. D. Bell, and F. Shahedipour-Sandvik, “Polarization engineered N-polar Cs-free GaN photocathodes,” J. Appl. Phys., vol. 124, no. 11, p. 113101, Sep. 2018, doi: 10.1063/1.5029975. [2] E. Rocco et al., “Overview and Progress Toward High-Efficiency, Air Stable, Cs-free IIINitride Photocathode Detectors,” IEEE Photonics J., vol. 14, no. 2, p. 6818312, 2022.

Purpose: The purpose of this study was to measure the effect of myopia on ON and OFF pathway asymmetries displayed between 5˚ to 30˚ of eccentricity and examine the structure-function relationship between retinal thickness and visibility of light and dark stimuli in eccentric quadrants of myopic eyes. Methods: Eighteen eyes were randomly selected from human subjects and all myopic subjects underwent testing with habitual soft contact lens correction. Subjects underwent ON-OFF perimetric testing in the test eye. The complete procedure is referenced and discussed in the body of the manuscript. Stimuli were presented at various contrasts across 30-degrees of the visual field and stimuli increased in size as a function of eccentricity. Structural and functional testing, including ultra-wide field macular optical coherence tomography (OCT), 30-2 static automated perimetry (SAP) mean sensitivity, peripheral autorefractive (AR) measurements, and axial length (AL), were also measured. All testing, except axial length measurements, were taken with subjects fully corrected in soft contact lenses. Results: There was a statistically significant positive correlation between AL and combined light and dark errors across the entire testing area of 5-30° (p=0.0019) as well as each eccentric range (5-10° p=0.0389; 11-20° p=0.0015; 21-30° p =0.0008). There was a statistically significant positive correlation between errors to light stimuli as a function of AL across the entire testing area of 5-30° (p=0.0251), 11-20° (p=0.0207) and 21-30° (p =0.0178). There was a statistically significant positive correlation between AL and dark stimuli errors across the entire testing area of 5-30° (p=0.0461), 11-20° (p=0.0424) and 21-30° (p =0.024). There was no statistically significant correlation when analyzing errors to light and dark stimuli separately at the 5-10° eccentricity. There was a statistically significant negative correlation between RE and combined light and dark errors across the entire testing area of 5-30° (p=0.0444) and a statistically significant negative correlation at the most peripheral eccentric range of 21-30° (p=0.0128). Subjects displayed higher errors to light stimuli over the entire testing area 5-30° (p=0.0166) and 21-30° (p=0.0007), but not at 5-10° or 11-20° (5-10° p=0.7043; 11-20° p=0.2572). The quadrant with the greatest average retinal thickness (IT) was associated with the lowest %errors (6.45 ± 6.56) and highest visual field mean sensitivity (VFMS, 30.9 ± 1.08 dB), whereas the quadrant with the least average retinal thickness (SN) was associated with the highest % errors (22.77 ± 15.93, p=8.91 x 10-9 for IT vs SN comparison) and among the lowest MS (29.43 ± 1.34, p=0.0020 for IT vs SN comparison). Conclusion: Higher levels of myopia are associated with greater response errors during ON-OFF perimetric testing, with higher error rates in response to light targets compared to dark targets. Both findings are most pronounced at the 21–30-degree eccentricity and have a stronger correlation with axial length compared to refractive error. Higher rates of error on ON-OFF perimetry correspond to thinner retinal thickness in the corresponding retinal quadrant. The highest average percent errors on ON-OFF perimetric testing were present in the superonasal visual field, which coincides with the thinnest total retinal thickness in the corresponding region of the retina (interotemporal). Better understanding of the structural and correspond to thinner retinal thickness in the corresponding retinal quadrant. The highest average percent errors on ON-OFF perimetric testing were present in the superonasal visual field, which coincides with the thinnest total retinal thickness in the corresponding region of the retina (interotemporal). Better understanding of the structural and corresponding functioning relationship between ON-OFF perimetric testing and retinal thickness may enhance our understanding of myopic refractive development.

Introduction: The use of alternative medicine has increased in recent years due to its minimal side effects and holistic approach to healthcare. Ginkgo biloba extract (GBE) is a natural antioxidant derived from leaves of the Maidenhair tree and is known to improve blood vessel health. However, its effect on the retinal circulation is not fully understood. The purpose of this study is to examine the effect of GBE oral supplements on the retinal circulation. Methods: Blood pressure (Omron HEM-705CP), intraocular pressure (Canon T2 non-contact Tonometer), and blood flow velocities in the ophthalmic artery, central retinal artery, and short posterior ciliary arteries (Color Doppler imaging, Sequoia) were obtained from participants aged 22 to 36 with good ocular and systemic health. Measurements were performed between 12-5pm to control for circadian rhythm effects at 3 study visits: 1 week before baseline at pre-supplement visit (T-1), at baseline (T0) and after 4 weeks of 240mg/day GBE supplementation at post-supplement visit (T4). Ocular perfusion pressure (OPP) was calculated as OPP = 2/3 * (Mean Arterial Pressure – IOP). Results: Thirteen participants were recruited (5m, 8f; 25.54 ± 3.64 years). No significant changes in systemic blood pressure, OPP or retinal circulation were observed between pre-supplement visit (T-1) and baseline (T0) prior to GBE supplementation. However, the ophthalmic and short posterior ciliary arteries peak systolic velocities increased from baseline (T0) to post-treatment (T4) (ophthalmic artery baseline ave ± SD: 18.97 ± 6.67cm/s; post-treatment:24.33 ± 6.90cm/s; short posterior ciliary artery baseline: 10.56 ± 1.87cm/s; post-treatment: 11.58 ± 1.97cm/s; both p < 0.05). The increases in ophthalmic and short posterior ciliary arteries peak systolic velocities did not correlate with changes in systolic BP, diastolic BP, or OPP. Discussion: Our preliminary data suggests that 240mg/day of Ginkgo biloba extract (GBE) may increase blood flow in two major retinal ocular arteries. Such increase appears independent from changes in systemic blood pressure or OPP.

To describe gonadal dysfunction and evaluate polycystic ovary syndrome (PCOS) and its association with metabolic syndrome (MeS) among girls in a morbidly obese adolescent population.

This study reports performance of A1C against the oral glucose tolerance test (OGTT) in predicting prediabetes among overweight and obese African-American and Caribbean children. A retrospective chart review was completed for 230 children. Receiver operating characteristic curves were generated to find the predictive performances of different tests against the OGTT. A1C alone is a poor discriminator of prediabetes in our study population, with low sensitivity (70%) and specificity (48.8%). BMI score, A1C, and homeostatic model assessment of insulin resistance are significant predictors of prediabetes and, when taken together, provide better discrimination for prediabetes.

Anemia following bariatric surgery is a known complication. To prevent nutrient deficiencies, adolescents require multivitamin/mineral supplementation following bariatric surgery. The purpose of this study was to investigate if routine multivitamin/mineral supplementation is sufficient to prevent anemia in adolescents undergoing bariatric surgery, particularly sleeve gastrectomy (SG), a procedure that may induce nutrient malabsorption.