Houston Eye Associates

Resource adequacy (RA) and reliability has become an emergent concern across many regions in the United States grid, driven by accelerated retirements of conventional generation, load growth, and prolonged generation interconnection (GI) process resulting in the delay of conversion of queued megawatts into accredited deliverable capacity. Federal Energy Regulatory Commission (FERC) Order No. 2023 introduced many initiatives anticipated to expedite GI process timeline and enhance interconnection studies efficiency; however, implementation lead times and restricted grid transmission capacity limited near-term effects on accredited capacity. As a result, numerous regional transmission organizations and independent system operators have proposed targeted programs structured to expedite the study of generation projects that address near term reliability and reliability concerns including Southwest Power Pool’s (SPP), Midcontinent Independent System Operator’s (MISO), PJM, and California Independent System Operator’s (CAISO). This paper reviews and maps RA governance and metrics, explains GI reforms under Order No. 2023, and compares/analyzes various RA programs in terms of eligibility, deliverability, timelines, and projects participation. The analysis revealed that directed, temporarily, limited scoped mechanisms is crucial in addressing near-term reliability and RA concerns, when integrated with transparent deliverability screens, eligibility, and clear commercial milestone.

Abstract Disclosure: A. Malik: Amgen Inc. S. Bray: Amgen Inc. M. Ochoa-Maya: Amgen Inc. C. Giannopoulou: Amgen Inc. S. Kim: Amgen Inc. H. Patel: Amgen Inc. G.J. Kahaly: Amgen Inc. Introduction: Thyroid Eye Disease (TED) is a debilitating autoimmune disorder which can result in significant changes to vision and physical appearance, negatively affecting patients’ quality of life (QOL). We examined data from the Graves Ophthalmopathy Quality of Life Questionnaire (GO-QOL) in patients with active TED to assess impact on daily activities by age, sex, and history of anxiety and/or depression (Anx-Dep). Method: This post hoc analysis included GO-QOL data at baseline from 3 teprotumumab clinical trials (Phase 2 [NCT01868997], OPTIC [NCT03298867] and OPTIC-J [RCT2031210453]) of moderate-to-severe, active TED patients. GO-QOL scores (visual function [VF] and appearance [AP]) were assessed with higher scores indicating better QOL. Frequency of responses on individual questions were examined for extent of limitation (1=seriously limited, 2=a little limited, 3=not at all limited) in daily activities, appearance, and social interactions. Mean response was calculated for each question with lower scores indicating greater impairment (range 1-3). Responses were assessed by sex and age from all 3 studies, and by Anx-Dep history from Phase 2 and OPTIC; OPTIC-J did not capture Anx-Dep history. Results: Among 225 patients from all 3 studies, 163 (72%) were female, mean (SD) age was 50.7 (12.7) years. At baseline, AP and VF scores were 59.7 and 67.0, respectively. Most common limitations reported in VF were reading (68%) and watching TV (62%). The most commonly reported AP limitations were appearance (96%), self-confidence (67%), and avoidance of photos (64%). Females reported higher impairment than males in both AP scores (55.4 vs 70.9) and VF scores (66.0 vs 69.8). Females had lower mean scores and more impact/concern specifically for masking changes in appearance (1.9 vs 2.5), avoiding photos (1.8 vs 2.4), and effect on self-confidence (1.9 vs 2.3). Younger (<50 yrs) patients had lower AP scores vs older (>65 yrs) patients (56.8 vs 70.3) and lower mean scores for appearing less in photos (1.8 vs 2.4), masking changes in appearance (1.9 vs 2.4) and influence on self-confidence (2.0 vs 2.3); VF scores were 69.6 and 64.4, respectively. Among 171 patients from Ph 2 and OPTIC, 30 (17.5%) reported having Anx-Dep. Patients with Anx-Dep had lower VF scores (57.7 vs 65.8), AP scores (45.3 vs 59.5), and lower mean scores for feeling hindered (1.7 vs 2.2), effect on self-confidence (1.5 vs 2.0), and feeling socially isolated (2.2 vs 2.5) compared to those without Anx-Dep. Conclusion: Female patients, younger individuals, and those with Anx-Dep reported greater QOL impairment. These findings underscore the substantial burden of TED on patients and highlight the importance of recognizing and addressing the psychosocial impact in clinical care. Presentation: Saturday, July 12, 2025

BackgroundSyndromic surveillance, which provides real-time data, may provide timely drowning surveillance compared with hospital discharge data where the release of data may be delayed. We compared data on hospital visits for unintentional drowning identified in hospital discharge and syndromic surveillance data sets for accuracy and completeness.MethodsWe compared data for hospital visits for unintentional drowning identified in the Texas Health Care Information Collection hospital discharge and syndromic surveillance data sets for metropolitan Houston, Texas, USA from 2019 to 2021. Hospital visits included emergency department-only visits and hospital admissions. We compared time-series visualisation of hospital visits between data sets. Injury burden, demographics and intercounty distribution of drowning patients were compared using the Pearson correlation coefficient for continuous data and the Pearson χ2 goodness-of-fit test for categorical data.ResultsWe identified 860 hospital discharge visits and 929 syndromic surveillance visits (quarterly median (IQR): 64.0 (26.8–117.5); 54.5 (28.0–132.3), respectively) for unintentional drowning. Time-series visualisation showed a high correlation between syndromic surveillance and hospital discharge visits (correlation coefficient: 0.93 (95% CI: 0.77 to 0.98)). There were small differences by race, ethnicity and county for all ages and for paediatrics and large differences by sex for all ages in the number of unintentional drowning hospital visits identified within the data sets.ConclusionsRegional unintentional drowning burden and trends are highly correlated between syndromic surveillance and hospital discharge data. Small differences by race, ethnicity and county and large differences by sex in the number of unintentional drowning hospital visits were identified between data sets. Syndromic surveillance is useful for real-time surveillance of unintentional drowning.

Telomerase reverse transcriptase (TERT) modulates mitochondrial levels of reactive oxygen species (mitoROS). Deletion variants, α-, β- and αβ, are negative regulators of TERT. Increased ROS levels in diabetic CD34 + cells impair vasoreparative functions. Our recent studies showed that silencing of transforming growth factor-β1 (TGF-β1) decreased ROS levels and stimulated vasoreparative functions. This study tested the hypothesis that prevalence of TERT deletion variants is higher in diabetic CD34 + cells and that TGF-β1-silencing decreases mitoROS by downregulation of the variants. CD34 + cells derived from either male or female nondiabetic (ND) (n=38) or diabetic (DB), both type 1 and type 2, (n=43) subjects were studied. Phosphorodiamidate morpholino oligomers (PMO) were used for TGF-β1-silencing. TERT variants were characterized by qPCR and agarose gel electrophoresis. MitoSOX-flow cytometry and ELISA were used for determining mitoROS levels and telomerase activity, respectively. TGF-β1-silencing decreased mitoROS levels in DB-CD34+ cells (P<0.01 vs ND-cells, n=6). This effect was reversed by TERT inhibitor, BIBR1532 (1μM) (n=6) or mito-X-TERT, a decoy peptide that prevents mitochondrial translocation of TERT (n=5). TERT expression was higher in DB compared to ND cells (P<0.05, n=18) but telomerase activity was lower (P<0.05 vs ND, n=10). Prevalence of TERT deletion variants was higher among DB cells compared to ND (DB - 8/10 vs ND - 2/10 subjects have one or more of α, β, or αβ variants). TGF-β1-silencing downregulated the expression of TERT variants and increased full-length TERT that was accompanied by increased telomerase activity in DB-CD34+ cells (P<0.05 vs untreated, n=5). This study suggests that diabetes is associated with higher prevalence of TERT variants that would impede mitochondrial functions of TERT. TGF-β1-silencing decreases mitoROS levels at least in part by downregulation of TERT variants.

Purpose: To describe management of a patient with ligneous conjunctivitis secondary to plasminogen deficiency and review the literature on treatment with plasminogen. Design: Interventional case report. Methods: A 6-year-old Caucasian girl developed ligneous conjunctivitis recalcitrant to debridement and treatment with topical cyclosporin A and steroids. The literature was reviewed regarding treatment of ligneous conjunctivitis with plasminogen. Results: The patient was treated with plasminogen containing drops derived from her father’s fresh frozen plasma. The ligneous conjunctivitis resolved, and the patient was managed on these drops for the following 8 years, initiating treatment for flares and tapering according to clinical response. Conclusions: Plasminogen drops concentrated from fresh frozen plasma are a safe and effective option for long-term treatment of ligneous conjunctivitis.

This is the first large-scale randomized clinical trial evaluating the effectiveness and safety of overminus spectacle therapy for treatment of intermittent exotropia (IXT). To evaluate the effectiveness of overminus spectacles to improve distance IXT control. This randomized clinical trial conducted at 56 clinical sites between January 2017 and January 2019 associated with the Pediatric Eye Disease Investigator Group enrolled 386 children aged 3 to 10 years with IXT, a mean distance control score of 2 or worse, and a refractive error between 1.00 and -6.00 diopters (D). Data analysis was performed from February to December 2020. Participants were randomly assigned to overminus spectacle therapy (-2.50 D for 12 months, then -1.25 D for 3 months, followed by nonoverminus spectacles for 3 months) or to nonoverminus spectacle use. Primary and secondary outcomes were the mean distance IXT control scores of participants examined after 12 months of treatment (primary outcome) and at 18 months (3 months after treatment ended) assessed by an examiner masked to treatment group. Change in refractive error from baseline to 12 months was compared between groups. Analyses were performed using the intention-to-treat population. The mean (SD) age of 196 participants randomized to overminus therapy and 190 participants randomized to nonoverminus treatment was 6.3 (2.1) years, and 226 (59%) were female. Mean distance control at 12 months was better in participants treated with overminus spectacles than with nonoverminus spectacles (1.8 vs 2.8 points; adjusted difference, -0.8; 95% CI, -1.0 to -0.5; P < .001). At 18 months, there was little or no difference in mean distance control between overminus and nonoverminus groups (2.4 vs 2.7 points; adjusted difference, -0.2; 95% CI, -0.5 to 0.04; P = .09). Myopic shift from baseline to 12 months was greater in the overminus than the nonoverminus group (-0.42 D vs -0.04 D; adjusted difference, -0.37 D; 95% CI, -0.49 to -0.26 D; P < .001), with 33 of 189 children (17%) in the overminus group vs 2 of 169 (1%) in the nonoverminus group having a shift higher than 1.00 D. Children 3 to 10 years of age had improved distance exotropia control when assessed wearing overminus spectacles after 12 months of overminus treatment; however, this treatment was associated with increased myopic shift. The beneficial effect of overminus lens therapy on distance exotropia control was not maintained after treatment was tapered off for 3 months and children were examined 3 months later. ClinicalTrials.gov Identifier: NCT02807350.

To identify the relationship between thyroid eye disease (TED) and supraorbital neuralgia (SON) and establish a reliable approach to the diagnosis and management of TED-associated SON. This retrospective study included 1,126 patients. Demographics, active and inactive phase status and duration, and reactivation rate were noted. TED clinical activity was determined using the vision, inflammation, strabismus, and appearance assessment system, and TED severity was classified using the European Group of Graves' Orbitopathy system. Subtypes of periorbital pain were identified, and suspected SON was confirmed by supraorbital nerve block. Of the study's 1,126 patients, 935 (83%) were deemed "active" at some point during the follow up and 34 (3%) remained "active" at the study's conclusion. Of the 2,251 eyes studied, 1,193 (53%) underwent orbital decompression. Of the 1,126 patients, 946 (84%) reported a retrobulbar "pressure" or "aching," but a distinct, more debilitating pain suggestive of SON was reported in 91 (8%). All 91 patients were given a supraorbital nerve block, and all had complete pain resolution lasting from hours to weeks. Eighty-eight (97%) of the 91 patients with SON-type pain underwent orbital decompression compared to 496 (48%) of the 1,035 without SON-type pain (p < 0.00001). A difference was found in the rate of TED reactivation between those with SON-type symptoms (8%) as compared to those without (2%), p = 0.01. SON of uncertain etiology appears to be a previously underreported but significant pain associated with TED. Paradoxically, although the SON does not appear to be related to the type or severity of TED on standard rating scales, the presence of SON was found to be associated with increased likelihood of both orbital decompression and TED reactivation.

During long-duration spaceflights, nearly all astronauts exhibit some change in ocular structure within the spectrum of spaceflight-associated neuro-ocular syndrome. To quantitatively determine in a prospective study whether changes in ocular structures hypothesized to be associated with the development of spaceflight-associated neuro-ocular syndrome occur during 6-month missions on board the International Space Station (ISS). The Ocular Health ISS Study of astronauts is a longitudinal prospective cohort study that uses objective quantitative imaging modalities. The present cohort study investigated the ocular structure of 11 astronauts before, during, and after a 6-month mission on board the ISS. Changes in ocular structure (peripapillary edema, axial length, anterior chamber depth, and refraction) hypothesized to be associated with the development of spaceflight-associated neuro-ocular syndrome during 6-month missions on board the ISS were assessed. Statistical analyses were conducted from August 2018 to January 2019. Before launch, the 11 astronauts were a mean (SD) age of 45 (5) years, a mean (SD) height of 1.76 (0.05) m, and a mean (SD) weight of 75.3 (7.1) kg. Six astronauts did not have prior spaceflight experience, 3 had completed short-duration missions on board the Space Shuttle, and 2 had previous long-duration spaceflight missions on board the ISS. Their mean (SD) duration on board the ISS in the present study was 170 (19) days. Optic nerve head rim tissue and peripapillary choroidal thickness increased from preflight values during early spaceflight, with maximal change typically near the end of the mission (mean change in optic nerve head rim tissue thickness on flight day 150: 35.7 μm; 95% CI, 28.5-42.9 μm; P < .001; mean choroidal thickness change on flight day 150: 43 μm; 95% CI, 35-46 μm; P < .001). The mean postflight axial length of the eye decreased by 0.08 mm (95% CI, 0.10-0.07 mm; P < .001) compared with preflight measures, and this change persisted through the last examination (1 year after spaceflight: 0.05 mm; 95% CI, 0.07-0.03 mm; P < .001). This study found that spaceflight-associated peripapillary optic disc edema and choroid thickening were observed bilaterally and occurred in both sexes. In addition, this study documented substantial peripapillary choroid thickening during spaceflight, which has never been reported in a prospective study cohort population and which may be a contributing factor in spaceflight-associated neuro-ocular syndrome. Data collection on spaceflight missions longer than 6 months will help determine whether the duration of the mission is associated with exacerbating these observed changes in ocular structure or visual function.