Recap: The Association for Research in Vision and Ophthalmology takes Seattle

The Association for Research in Vision and Ophthalmology (ARVO) convened in Seattle, Washington, from 5 to 9 May, 2024. The conference brought together thousands of eye care professionals from around the globe to speak about clinical research, deliver updates on long-awaited therapeutics and exchange ideas in a spirited, supportive setting. This year, the speaker schedule included a number of awards lectures: Emily Y. Chew, MD, FARVO, delivered the Proctor Medal Lecture; Anand Swaroop, PhD, FARVO, gave the Friedenwald Award Lecture; Martine J. Jager, MD, PhD, FARVO, presented the Weisenfeld Award Lecture; and Daniel R. Saban, PhD, FARVO, provided the Cogan Award Lecture. In addition, this served as the final meeting as President for Patricia A. D’Amore, PhD, MBA, FARVO, who specialises in retinal cell biology at Schepens Eye Research Institute, Massachusetts Eye and Ear, in Boston, Massachusetts. At the end of the meeting, the position of President was assumed by SriniVas Sadda MD, FARVO, who is a retina specialist from Doheny Eye Institute in Los Angeles, California.

ARVO President Srinivas Sadda, MD, FARVO, leads a preview of the 2025 meeting. Image provided courtesy of the Association for Research in Vision and Ophthalmology (ARVO).

Speaking to Ophthalmology Times® ahead of the meeting, Dr Sadda shared goals for his upcoming term as president and addressed the biggest challenges to the industry. He reiterated the organisation’s mission, which is to promote scientific exchange between vision science researchers and clinicians with the world at large. That intentionality is what undergirds all to come in future ARVO initiatives. “We spent [time], even at the last ARVO, meeting devising our next strategic plan for the next 5 years, trying to expand our outreach to our vision science research community, including internationally,” Dr Sadda said. “I’d like to… promote vision scientists from around the world, try to be as inclusive as possible, try to energise and excite more people globally to participate in the meeting and to contribute.”

Of course, world-wide goals come with global challenges, the foremost of which is funding, Dr Sadda explained. “We’re only able to bring together a meeting of vision science researchers as long as there’s vision science research ongoing in many ways, and for that, we really are dependent on having broad support for research,” he said. “Another goal of mine during my presidency…is really to be an advocate for funding for vision science research. I think it’s critical. We all recognise how important vision is to all of us and for our patients. Those are the real challenges.

In many cases, he said, researchers are navigating an unstable financial landscape alongside the everyday challenges of their clinical work. “The worry that whether it’s due to a recession or other budgetary constraints that there’ll be a reduction in funding available to our vision scientists,” he said. “I think that is a potential challenge but I think it could be overcome with advocacy and making sure that the public as a whole is aware of the importance of supporting research in this area.”

The president-elect also reflected on the role he will fulfill as president, and placed an emphasis on the collaborative nature of ARVO’s leadership structure. “Ultimately, as president you really are a member of a much broader team with our board of trustees, our executive vice president, and the phenomenal staff that we have. One of the things that oftentimes people don’t fully appreciate is the amazing full-time staff that makes things happen at ARVO,” Dr Sadda continued. “As a president, it’s a pleasure for me to work with those individuals. It’s great to have a chance to be able to influence the direction that we’re going but ultimately understand that we’re really executing a mission that we’ve all agreed to as members of ARVO.”

Global paediatric findings

The Eye Care Network honed in on recent research findings in a series of interviews with ARVO presenters. Dr Srijana Adhikari, Head of Paediatric Ophthalmology and Strabismus at Tilganga Institute of Ophthalmology in Kathmandu, Nepal. Dr Adhikari delivered a presentation titled “Differences in Objective Physical Activity Between Children with Visual Impairment and Normal Sight.” Ahead of discussing the data, Dr Adhikari described the study design, which was uniquely structured to daily life for vision-impaired children in Nepal. “There is an integrated system of education. Blind children also study in the same schools as normal sighted children,” Dr Adhikari explained. In many cases, she noted, visually-impaired children stayed in boarding schools and hostels, while students with normal vision tend to live at home with parents. After situating both groups of patients with actimeters, investigators measured students’ activity, categorising their activity levels at different times of day.

Image provided courtesy of the Association for Research in Vision and Ophthalmology (ARVO).

Across both groups, the children primarily exhibited sedentary activity levels; the level of moderate of high activity was not consistent with World Health Organisation benchmarks. There was a notable discrepancy in that the visually-impaired students were more active in the morning hours. “So the [visually-impaired] children who stay in the hostel, they do their own morning activities. They get dressed up, they may prepare breakfast, and all these things by themselves. They are trained like that, and they have to do all those things [independently],” she explained. “But at the same time, the children who stay with their parents, most of the things are done by the parents...That may be the difference.”

In another notable finding, Dr Adhikari said that children with normal vision were much more active during school hours than visually-impaired children. This could speak to accessibility or adaptability challenges in a school setting that prevent participation, she said. Though there were existing opportunities for visually-impaired children on an institutional level, there may be ad-hoc barriers that account for the discrepancy. “The playgrounds of the schools were very good, they have assigned physical activity classes for all the children, but still, the children with visual impairment have less opportunities,” Dr Adhikari said. “Maybe there are some barriers: they don’t have games that are suitable for them, like dancing, gymnastics or swimming…They cannot freely play football, basketball, or [other games] like that.” In the future, Dr Adhikari said, this research could change how unstructured play time functions in the school setting.

The discussion of paediatric patients continued in a conversation with David A. Berntsen, OD, PhD, FAAO, the Chair of the Department of Clinical Sciences, as well as an Associate Professor and the Golden-Golden Professor of Optometry, at the College of Optometry, University of Houston, Texas. In his presentation, he discussed the Bifocal Lenses In Nearsighted Kids (BLINK) Study and results from the subsequent BLINK2 Study. Research findings from BLINK2 explored outcomes when children discontinued myopia control methods; in this case, high-add multifocal contact lenses. “All the children who completed BLINK were invited to participate in the BLINK-2 study, which was another 3 years beyond the the original BLINK study, and all the kids were, for the first 2 years of the study, put into the high-add multifocal lens that we had found slow progression in the original BLINK study,” Berntsen explained. “After 2 years of wearing that multifocal lens, we then switched all children into a single vision soft contact lens and followed them for an additional year to look and see what happened to the rate of eye growth, their axial length, and also to look at the myopia progression.”

While both axial length growth and myopia progression increased slightly, those figures were consistent with physiological development for children at those age groups, Berntsen said. There was not, he said, a “rebound” that negated treatment effect following discontinuation of the lens. “Refractive error was progression over the course of that year in the single vision lens, was just barely under a quarter diopter for the year, and then the growth of the eye the axial growth over that year was about 0.8 millimeters in the course of the year,” he said. “All of the benefits that had been accrued originally from wearing the lenses continue to stick around, and it didn’t matter how long a child had been in multifocal lenses.”

He also spoke to the changing nature of myopia management research, expressing hope that the next decade of clinical research will take a deep dive into the mechanisms of myopia control. “In the last 10 years, we’ve seen us go from almost no long-term trials for any type of intervention to long-term trials on various novel spectacle designs, on multifocal centre distance multifocal contact lens designs, other novel contact lens designs, and now, very recently, within the last year, there are multiple studies that all came out looking at low concentration atropine to see whether the dose of .01% versus .05%,” he said. “I’m hopeful that we will learn more about mechanisms because, in order to optimise treatments, we really need to understand what the signal is that the eye is paying attention to…I’m hopeful. I don’t think we’re going to be all the way there in 10 years, but I am hopeful that we will have made progress on that front, where we can have better ideas of who’s going to respond best to which treatments.”

Taking an active approach

Activity inventories for adult patients came to the forefront in a study presented by Antonio Filipe Macedo, OD, MSc, PhD, Professor of Optometry in the Department of Medicine and Optometry at Linnaeus University, Växjö, Sweden. In that research, Prof Macedo assessed vision-related activity difficulties in patients with neovascular age-related macular degeneration (nAMD). “This presentation is part of a bigger project that we are conducting here in Sweden, looking at the burden of neovascular AMD,” he said. “This new instrument, or this version of the instrument, is to test if our instrument can give us better outcomes in terms of how the reported problems correlate with the clinical scenarios.”

That “instrument,” the activity inventory, is a comprehensive set of fifty common activities, ranging from near to distance vision and accounting for leisure or recreation activities, hygiene, cooking, and daily tasks like navigating public transportation. Prof Macedo noted that patients could opt out of recording their challenges on questionnaire items that were not important to them. “For example, we may ask about playing board games, but the person might not be interested in board games. So vision is not affected or, even if vision is affected, this is not going to affect the way the person plays chess, for example,” he said.

Image provided courtesy of the Association for Research in Vision and Ophthalmology (ARVO).

Detailing the findings of the inventory, Dr Macedo said he and his colleagues were interested to see how many patients were struggling with near vision activities. This was because their near vision had not been corrected, or the correction was not optimal. “There was quite a significant proportion of patients reporting near difficulties, and I think [that] is mostly because the patients that are on the treatment for neovascular AMD get much attention to their distance vision, as well monitor every injection or every checkpoint,” he explained. Those patients who reported near vision challenges also experienced heightened stress related to the near-vision challenges, so Prof Macedo suggested regular low-vision screenings as part of the standard of care for those nAMD patients.

Professor Shahina Pardhan, BSC, PhD, MBCO, H DHealth Brad, detailed misconceptions around vision loss and the accompanying effect on auditory processing. Prof Pardhan is the Director of the Vision and Eye Research Institute, School of Medicine, at Anglia Ruskin University in Cambridge, United Kingdom. Her presentation, “Comparison between early onset and late onset vision impairment and age-matched sight controls for auditory distance estimation,” focused on patients with complete, partial and no vision loss, and with varying onsets of visual impairment.

“People with vision loss tend to use their auditory performance; they use sounds to navigate safely around the world. They’re so much reliant on sound because they’ve lost their vision,” Prof Pardhan explained. “And what we found was quite interesting, actually.” The research findings indicated that people with vision loss tended to estimate sounds to be farther away, compared to the actual distance and compared with the performance of participants with no vision loss. “But more importantly, what we did find was those who had vision losses before the age of 10 years, actually estimated these sounds even further away than those who’d lost their vision later on, suggesting that there is something in the brain that hasn’t calibrated properly. And they’re not actually able to estimate where those sound sources are coming from accurately enough,” she said.

“This has really quite important ramifications,” Prof Pardhan emphasised. “If you think about people with vision loss wanting to travel around, and navigate safely in their environments, they actually might think that what they’re hearing is further away than they think, so there’s quite a lot of safety ramifications on that.”

For example, a person with early-onset vision loss could have a less-accurate auditory perception of the distance of vehicles in a busy crosswalk, leading to serious safety concerns.

David Hutton and Martin Harp, both of Ophthalmology Times, conduct an interview on the conference floor. Image courtesy of Silas Inman.

Much of this research challenges preexisting understandings of vision and hearing.

“When I first started, I just assumed that if you’ve lost your vision, your hearing is going to get better,” Prof Pardhan explained. “What we wanted to know was how much has it gotten better? Therefore we were quite surprised that, in a task where we actually had that discrimination, people who were completely blind were much better. But people who had still some remnants of vision, which is what I call partial vision loss, then they didn’t do any better than normal [patients with no vision loss]. So for that particular discrimination task, vision had to be lost completely before hearing got better,” she said.

Prof Pardhan went on to explain, “Your hearing performance, when you’ve lost vision, is very much task-dependent…People who’ve lost their vision will hear better, because there is what we call sensory substitution in the brain. But only for some tasks, not for everybody, and not for every task. There are some tasks [where] hearing gets better. And for some tasks, hearing does get worse.” In the future, she added, these findings can be used to shape methods of “calibrating” the brain to better estimate distances based on auditory cues. Those training programmes, she said, could bridge the gap between the brain’s sensory substitution and environmental aides for patients with visual loss. After all, she said, “There’s no point doing any research if it’s not going to help patients.”