From retinal mysteries to dehydrated corneas, Subspecialty Day served up curiosity and clinical brilliance.
It’s Subspecialty Day here at the American Academy of Ophthalmology Annual Meeting 2025 (AAO 2025) in Orlando, and the award lectures are in full swing. From fine-tuning diagnostic instincts to corneal preservation research, today’s talks offered eye care pros both practical insight and a few “wait, really?” moments.
Seeing patterns, not just pixels
Dr. Lee Jampol (USA) kicked off the Charles L. Schepens MD Lecture by taking attendees on a tour through his philosophy of clinical diagnostics: part detective work, part art and all about recognizing patterns in a sea of pixels.
He walked through a range of retinal and choroidal pathologies, illustrating how careful history-taking and sharp pattern recognition remain indispensable tools in modern ophthalmology.
Dr. Jampol’s discussion even touched on the ocular footprints of West Nile virus as it spread across the United States, showing that epidemiology and the clinic often intersect in unexpected ways.
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He spotlighted choroidal neovascularization (CNV), noting that, “it’s always bilateral, and it’s almost always symmetric. The lesions are centered on the fovea.” Before anti-VEGF therapies, “the lesions just kept growing and growing” while ischemia persisted, with perifoveal capillary closure visible at nine months.
Acute idiopathic maculopathy also took center stage. Dr. Jampol described the typical patient: “these are all young healthy people. They come in complaining of loss of vision in one eye. They have a remarkable recovery of vision.”
On fluorescein angiography, “you see this pouring of material into the subretinal space.” A breakthrough came when two concurrent cases were linked to hand, foot and mouth disease, emphasizing how detailed history-taking complements pattern recognition.
One example illustrated this synergy perfectly. “We said to the patients, are you sick? Do you have a sore throat? Do you have a rash? Are there any children in your household that are sick or ill?” The answers led him to a previously recognized diagnosis pattern and confirmed the hand, foot and mouth disease connection.
The lecture also explored indolent non-progressive multifocal choroidal lesions, described as a “largely ignored” entity, now recognized as indolent B-cell lymphoma. These patients maintain normal vision with no vitreous cells, rarely metastasize and demonstrate characteristic hypofluorescence on indocyanine green (ICG).
Dr. Jampol concluded with practical guidance for clinical practice: “Well, you need training and experience, and obviously, the better training and experience you have, the better you do. Don’t forget a careful history, particularly knowing what questions to ask.”
And he saved one point of emphasis for last. “Don’t stop doing physical exams. And don’t allow selective attention to distract you from new things. Be curious and use your pattern recognition.”
Dehydrated corneas take the spotlight
Dr. Christina Bavone (Italy) earned the Troutman Prize for research demonstrating that dehydrated donor corneas are just as effective as standard tissue in deep anterior lamellar keratoplasty (DALK), research that originated out of necessity during Italy’s COVID-19 lockdown.
Dr. Bavone explained that when surgery paused and eye banks faced mounting tissue waste, her team pivoted, exploring whether corneas could be dehydrated and stored for anterior lamellar procedures that don’t rely on viable endothelium.
The prospective randomized trial compared standard organ culture corneas (viable up to 28 days) against dehydrated corneas stored at room temperature using silica gel for up to 12 weeks. Keratoconus patients over 18 underwent a modified Picardo DALK technique with large grafts (9.0 to 8.75 mm) to minimize post-suture removal astigmatism, and big-bubble dissection achieved type one separation prior to randomization.
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Results showed equivalence across all parameters including best corrected visual acuity (BCVA), refractive astigmatism and endothelial cell damage. Complete epithelial regeneration occurred within seven days despite pre-surgical epithelial removal during dehydration, described as “a very important key part of the success of an anterior lamellar keratoplasty.”
Dr. Bavone recapped the key findings at the end of her lecture, noting their enduring impact on a world with perpetual donor cornea shortages. “[Dehydrated] cornea use is not inferior to standard [corneas] for direct surgery,” she concluded. “This extends the period of conservation of tissue that can help transplants to be performed as often as possible.”
From hand, foot and mouth disease to dehydrated corneas, Subspecialty Day reminded attendees that curiosity, clinical rigor and a little bit of ingenuity are always in style…even in ophthalmology.
Editor’s Note: The American Academy of Ophthalmology Annual Meeting 2025 (AAO 2025) is being held on 17-20 October 2025, in Orlando, Florida. Reporting for this story took place during the event. This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.