Clinical Focus 2025

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Clinical Research Update

Shaping the Future of Ophthalmic Care

Clinician-scientists at the John A. Moran Eye Center offer their latest studies and perspectives to inform your practice. 

Complications

Keeping an eye on GLP-1 drug patients and preventing Toxic Anterior Segment Syndrome.

    "Ophthalmic Complications Associated with the Antidiabetic Drugs Semaglutide and Tirzepatide" (JAMA Ophthalmology)
    Bradley J. Katz, MD, PhD
    “Further studies are needed to test our hypothesis that rapid correction of hyperglycemia could induce ophthalmic complications. However, this is an important issue for ophthalmologists as we monitor usage of these drugs and how to best be in communication with our patients about them.”
    Bradley J. Katz MD, PhD
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    "Toxic Anterior Segment Syndrome: A 2012-2022 Update on the Most Common Causes" (Journal of Cataract & Refractive Surgery)

    “An acute postoperative non-infectious inflammatory reaction known as toxic anterior segment syndrome (TASS) can occur after cataract surgery and other ocular surgical procedures. In this study, we analyzed data from survey questionnaires received between 2012 and 2022 from surgical centers around the world that experienced TASS in order to analyze the trends in terms of the most common causes of this complication. The results demonstrated that issues involving instrument cleaning and sterilization continue to be the most common cause associated with TASS. However, both incidences of TASS and several common practices that increase the risk of TASS cases have decreased significantly over time, as we raise the awareness about this complication.”

    — Nick Mamalis, MD and Liliana Werner, MD, PhD, co-directors, Intermountain Ocular Research Center

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    Liliana Werner, MD, PhD
    Liliana Werner, MD, PhD
    Nick Mamalis, MD
    Nick Mamalis, MD

    Retina and Uveitis

    Learning about a new treatment for macular telangiectasia type 2 (MacTel) patients, rethinking age-related macular degeneration (AMD), and comparing uveitis treatments.

      CNTF-Secreting Cells for Treatment of Macular Telangiectasia Type 2 (MacTel)
      “I was the principal investigator for a large multi-center trial for a novel treatment to slow vision loss from macular telangiectasia type 2 (MacTel). Our positive results for the Neurotech NT-501 CNTF implant were submitted to the FDA, which approved the treatment for clinical use nationwide in March. We hope to be a major site for this treatment because we have so many MacTel patients.”
      Paul S. Bernstein MD, PhD, Vice-Chair for Clinical and Basic Science Research
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      Implant Announcement
      Federal Research Advancing the Understanding of AMD

      The Impact of Non-Exudative Type 1 Macular Neovascularization on AMD Progression (R01EY033365)

      Monika Fleckenstein, MD
      “This NIH-funded research project challenges the current concept of AMD. Demonstrating that a specific neovascular subtype of AMD actually prevents disease progression in the sense of an intrinsic ‘rescue mechanism’ would not only provide essential information for currently tested treatment approaches but also provide a rationale for new therapeutic strategies in AMD to prevent vision loss. Our Impact of Non-Exudative Type 1 MNV on AMD Progression clinical trial has recruited 75 patients and is in its third year. We will present the first data during the Association for Research in Vision and Ophthalmology (ARVO) 2025 annual meeting in Salt Lake City with two posters and one presentation.”
      Monika Fleckenstein MD
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      Clinical Trial Information

      The Progression of Early Atrophic Lesions in Age-related Macular Degeneration (R01EY034965)

      Steffen Schmitz-Valckenberg, MD
      “This ongoing NIH-funded study will add to our understanding of disease progression in AMD and to select which upcoming treatment options for patients might be beneficial. The Progression of Early Atrophic Lesions clinical trial is still recruiting, with a goal of 125 patients (approximately 70 have already been recruited). We will present the first data with two posters at the ARVO annual meeting in May in Salt Lake City.”
      Steffen Schmitz-Valckenberg MD, Director, Utah Retinal Reading Center
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      Clinical Trial Information
      "Age-Related Macular Degeneration: A Review" (JAMA)

      This review in the Journal of the American Medical Association, co-authored by Moran Eye Center experts Monika Fleckenstein, MD, and Steffen Schmitz-Valckenberg, MD, director, Utah Retinal Reading Center, provides an up-to-date, evidence-based overview that outlines: 

      • Changes that occur in the eye during AMD.
      • Risk factors, including genetics and smoking.
      • Diagnosis.
      • Treatment options, from vitamins to procedures.

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      Monika Fleckenstein, MD
      Monika Fleckenstein, MD
      Steffen Schmitz-Valckenberg, MD
      Steffen Schmitz-Valckenberg, MD
      Disclosing AMD Genetic Risks to Patients

      The Moran AMD Genetic Testing Assessment Study (MAGENTA)

      “We recently completed the MAGENTA study, an NIH-sponsored randomized clinical trial that examined whether disclosure of genetic risk for eventual vision loss from AMD would spur healthy lifestyle changes. Although we were not able to achieve our primary endpoint, we were able to show that disclosing AMD risk did not induce anxiety or depression and was greatly appreciated by the subjects even if they learned that they had a high risk of AMD later in life.”
      Paul S. Bernstein MD, PhD, Vice-Chair for Clinical and Basic Science Research
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      Uveitis Treatment Developments

      "Macular Edema Ranibizumab versus Intravitreal Anti-inflammatory Therapy Trial: 24-Week Outcomes of Uveitic Macular Edema Re-treatment" (Ophthalmology)

      Albert T. Vitale, MD
      “Uveitic macular edema is the most common cause of visual loss in eyes with uveitis, even among those with well-controlled intraocular inflammation. At 24 weeks, the dexamethasone intravitreal implant was more effective than the non-steroidal alternatives, intravitreal methotrexate and ranibizumab, for the treatment of persistent or recurrent uveitic macular edema with manageable side effects.”
      Albert T. Vitale MD
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      "Stopping of Adalimumab in Juvenile Idiopathic Arthritis-associated Uveitis (ADJUST): A Multicentre, Doublemasked, Randomized Controlled Trial" (The Lancet)

      Albert T. Vitale, MD
      “Adalimumab, a tumor necrosis factor inhibitor (TNFi), is the most common biologic agent approved for the treatment of intermediate, posterior, and pan-uveitis, as well as arthritis in patients with juvenile idiopathic arthritis (JIA); however, no guidelines exist for its discontinuation in either disease. Abrupt discontinuation of adalimumab resulted in significantly higher rates of recurrent uveitis, arthritis, or both in patients with previously controlled JIA-associated uveitis. Fortunately, all patients with treatment failure successfully regained control of inflammation after restarting adalimumab by the end of this 48-week study.”
      Albert T. Vitale MD
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      Fluorescein Angiography Findings

      "Utility of Fluorescein Angiography for Early Detection of Familial Exudative Vitreoretinopathy in Neurodevelopmental Disorder With Spastic Diplegia and Visual Defects due to CTNNB1 Variants" (Journal of Pediatric Ophthalmology & Strabismus)

      Eileen S. Hwang, MD, PhD
      “My lab collaborated with a student from the University of Puerto Rico, Guillermo Requejo Figueroa, on a study that showed it is important for all patients with a rare disease, neurodevelopmental disorder with spastic diplegia and visual defects, to get fluorescein angiography testing to identify which patients need to be treated to prevent vision loss.”
      Eileen S. Hwang MD, PHD
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      Retinal Surgery Robot

      The Future of Eye Surgery

      "Head-mounted Surgical Robots are an Enabling Technology for Subretinal Injections" (Science Robotics)

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      Cataract Surgery

      Understanding the impacts of energy in phaco and the next phase of accommodating lenses.

        Phacoemulsification Refinements

        "Discrepancies in CDE and Measured Phaco Tip Energy: Comparison of Energy Produced in Longitudinal and Torsional Ultrasound Using Calorimetry" (Medical Devices: Evidence and Research)

        Jeff Pettey, MD, MBA
        “Cumulative dissipated energy (CDE) is one measure of energy delivered to an eye, however, it can vary depending on the settings on the machine. Our study showed the absolute measurement of energy delivered to the eye varied from the reported CDE, which has important implications on how we understand the damage ultrasound may have on intraocular structures.”
        Jeff Pettey MD, MBA, Vice-Chair of Clinical Affairs
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        "Comparison of Ultrasound Energy Delivered to the Anterior Segment Across Different Phacoemulsification Surgical Platforms" (Medical Devices: Evidence and Research)

        Jeff Pettey, MD, MBA
        “This second study showed a significant range of energy delivery to the eye, despite the machines with identical power settings across three machines. Surgeons should not assume the same ultrasound settings deliver the same amount of potentially harmful energy to eye tissues when their settings are identical across platforms.”
        Jeff Pettey MD, MBA, Vice-Chair of Clinical Affairs
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        Pre-Clinical Study: Accommodating Intraocular Lenses

        “We have been evaluating in our laboratory a series of prototypes of accommodating intraocular lenses, which basically function by mimicking the mechanism of accommodation of the young human eye, with excellent quality of vision at all distances. The development of a truly accommodating intraocular lens will have a significant impact on clinical practices all over the world, considering the widespread prevalence of presbyopia, a common age-related condition that affects the ability to focus on close objects. Currently used presbyopia-correction lenses include multifocal lenses, as well as extended depth of focus lenses, which may be associated with visual disturbances related to their more complex optics.”

        —Liliana Werner, MD, PhD, and Nick Mamalis, MD, co-directors, Intermountain Ocular Research Center

        Liliana Werner, MD, PhD
        Liliana Werner, MD, PhD
        Nick Mamalis, MD
        Nick Mamalis, MD
          Previous Publications on Accommodating Lenses

          Glaucoma

          Evaluating promising new surgical devices and materials, and evolving research on intraocular pressure (IOP).

            Alan S. Crandall Center for Glaucoma Innovation

            Glaucoma Therapeutics Initiative

            Ike Ahmed, MD
            "At the Crandall Center, we’re very excited about the work we are doing evaluating potential new surgical therapeutics and devices that we hope can increase surgical precision and provide better outcomes for patients. For example, we’ve recently evaluated promising new devices and materials from ViaLase, Myra Vision, Elios Vision, and W.L. Gore & Associates."
            Iqbal Ike K. Ahmed MD, FRCSC, Director, Alan S. Crandall Center for Glaucoma Innovation
            Learn More About the Crandall Center
            ViaLase
            Myra Vision Calibreye System
            Elios Vision
            Gore
            New IOP Perspectives

            "The Relationship Between Intraocular Pressure and Glaucoma: An Evolving Concept"

            "IOP and Glaucoma Damage: The Essential Role of Optic Nerve Head and Retinal Mechanosensors"

            “Each of these publications appears in Progress in Retinal and Eye Research, which is one of the main journals in ophthalmology for ‘statement’ reviews. They explore the ways in which eye pressure causes glaucoma — which is something that we need to know more about.”

            —Ian F. Pitha, MD, PhD

            Ian F. Pitha, MD, PhD
            Outcomes Review: Bio-Interventional Cyclodialysis with Allograft Scleral Reinforcement

            "Surgical Outcomes, Ocular Safety and Tolerability of Bio-Interventional Cyclodialysis with Allograft Scleral Reinforcement: Clinical Experience of More than 240 Cases" (Journal of Clinical Medicine)

            Craig Chaya, MD
            "This study demonstrated that using scleral allograft material can be processed and applied to create a safe and effective supraciliary glaucoma procedure, which is another important option for patients who may not be ideal candidates for traditional incisional glaucoma surgery or micro-invasive glaucoma surgery." 
            Craig J. Chaya MD
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            Additional Research Highlights

              Cataract Surgery
              Glaucoma
              Retina
              Other Subspecialties

              Physician Referral Services

              The John A. Moran Eye Center provides care in all ophthalmic specialties and is a major referral center performing 150,000 patient visits and 8,000 surgeries annually at 11 locations. We look forward to partnering with you to provide the best possible outcomes for your patients.

              Learn More 

              Educational Resources

              Clinical Ophthalmology Resource for Education

              Moran’s online Clinical Ophthalmology Resource for Education (CORE) offers worldwide access to high-quality, peer-reviewed ophthalmic learning materials, including surgical instructional videos, lectures, and grand rounds presentations. Moran produces the site, which recorded more than 575,000 users in 224 countries in 2024, in partnership with the Spencer S. Eccles Health Sciences Library at the University of Utah.

              MoranCORE.Utah.edu

              Top 10 Most Watched Moran CORE Videos on YouTube in 2024

              Moran CORE videos
              1. The Orbital Exam
              2. The Neuro-ophthalmology Exam: Neuro
              3. The Neuro-ophthalmology Exam: Pupils; Color; Eye Movements; Prism
              4. The Ophthalmic Exam: Retina and Posterior Segment
              5. Hemifacial Spasm
              6. Learning the Ophthalmoscope
              7. Using Subjective Refraction to Calculate Glasses Prescription and Fit a Contact Lens
              8. Blepharospasm
              9. Relative Afferent Pupillary Defect - Medical Student Education
              10. Convergence Retraction Nystagmus (Parinaud's Syndrome)
              Moran CORE on YouTube

              More Educational Information

              Neuro-Ophthalmology Virtual Education Library
              Webvision: The Organization of the Retina and Visual System
              University of Utah Continuing Medical Education Information
              Read More Annual Reports From the Moran Eye Center