Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And we have a panel for you today with two Northwestern Medicine ophthalmologists here to share highlights and insights from the 2026 ARVO Annual Conference. They're here to give their perspectives on their presentations at the conference, key breakthroughs and notable presentations that drew their attention, insights, innovations and takeaways in ophthalmology research.

Joining me is Dr. Paul Bryar. He's the Vice Chair of Clinical Operations in the Department of Ophthalmology at Northwestern Medicine. And Dr. Dustin French, he's a Professor of Ophthalmology and Medical Social Sciences. Doctors, thank you so much for joining us today.

Dr. Bryar, I'd like to start with you. Just how was the event overall? Give us a little background on it. How was the organization, the participants? Just give us your opinion here.

Paul Bryar, MD: Sure, yeah. You know, ARVO is the biggest nationwide ophthalmic research conference and pretty much the biggest eye research conference in the world. You know, so over 10,000 attendees each year, you know, over 70 countries. And so, it's really where we go to present our research, but also to learn, you know, what is advancing in our field. And it's in all sorts of different areas of eye care from basic science research, you know, bench research, lab, to clinical research, what's being done in the operating rooms, you know, what new treatments, gene therapies, and also what other population health studies are being done.

So, it was really a great conference to go to. I look forward to it each year because, you know, there's just so much to learn and so much to collaborate when you get there with people. So, that's what I enjoy about it.

Melanie Cole, MS: Well, we are excited to learn what you found so interesting. So Dr. Bryar, sticking with you, what topics did you present on? Give us a little bit of a summary.

Paul Bryar, MD: Yeah. So, a number of different topics. You know, we had about eight different presentations. A lot of them focused on population health in terms of, you know, diabetic eye disease, you know, diabetic retinopathy, glaucoma, but specifically looking at healthcare disparities.

You know, how do different populations, do they have more severe disease? Is it caught earlier? Is it caught later? And what we try to focus on is look at those disparities in various populations with the intent of once we identify a population that's at higher risk, we can target that population for increased screening, increased awareness, and increased treatment, you know?

And the way that I work with Dustin, the way we do this is looking at, you know, big data, you know. So, we are fortunate at Northwestern to be participating in a large nationwide database of electronic health records from, you know, about 40 different academic medical centers. So, we pool our data. So instead of just looking at our own institution, we can look nationwide and look at things, specifically, you know, diabetic retinopathy, you know? Where are the opportunities, you know, for us to detect this disease? Because as we know diabetic retinopathy is one of the leading causes of blindness in the United States in working age adults. But 90% of that vision loss is preventable if we can get to those patients soon enough. So, that's where we focus our research on is, you know, looking at different populations, different areas, you know, urban versus rural different ethnicities, different income levels, education levels, things like that. So, that's where we spent a lot of our time doing our presentations. Another area that we did it in is here at Northwestern, you know, looking at just our own patients.

You know, we started a diabetic eye disease screening program where we're screening patients in the primary care clinics, you know, internal medicine, endocrinology clinics, patients with diabetes that did not get their recommended annual eye exam.

So, we can do retinal photography of these patients. And it's very, very accurate way of detecting retinopathy in somebody who otherwise would never have had that detected. So, our focus with this specific project was how do we increase that screening? You know, nationwide, only about 60% of people with diabetes get their annual eye exam. And at Northwestern, we're similar to that nationwide average, we want to increase that, you know, to 80%, 90% as close to a hundred as we can get. So, we place cameras in the various clinics that we talked about, and just looking at what are the ways of even getting those patients to say yes to get a picture. And what we found was the most effective way was something we didn't anticipate, which was not telling the doctors to take pictures of their patients' retinas, was telling the patients, send them a message before their primary care clinic visit saying, "You know what? You're overdue. We notice you haven't had your eyes examined. There's a test available. It takes two minutes. You can let your primary care know you want this test," and they get the picture done. And we found that sending them a message, you know, through myChart was the most effective way of increasing that, way more effective than us, you know, re-educating the primary care clinic saying, "Hey, you know, here's a list of patients coming in today. They're overdue. Order this test." But reaching out directly to patients we found was the best way of doing that. So, those are some of the things that we presented on at the meeting. And then, I guess Northwestern, we were going over all of our presentations, and there was over close to 70% different presentations just at that meeting with Northwestern-associated basic scientists and clinicians, you know.

So, it was very nice collaborating with all the people that I work with and seeing their work come to fruition and talking to them about things. So, that's what I enjoyed about the meeting. That's what I did in terms of presentations.

Melanie Cole, MS: Certainly so interesting, Dr. Bryar. Thank you. Now, Dr. French, tell us about the topics that you presented on. Give us a little brief summary.

Dustin French, MD: Thank you. Sure. So, Dr. Bryar and I work collaboratively. We're fortunate to be funded by the National Eye Institute on two projects. And these both use a lot of the big data that Dr. Bryar described of the consortium of 40-plus academic medical centers across the United States. It allows us to look at questions across diverse populations, and then ask questions on things like diabetic eye disease, glaucoma treatments, and specifically focusing in on the social determinants of health, like where people live, their access to medical care, their insurance, and then trying not just to diagnose, but to better serve the patient.

So really, a lot of the AI things that Dr. Bryar referred to, it's not just about getting the diagnosis. It's about better predicting and custom tailoring the treatment to specific patient needs. And I think that's what we're striving for here at Northwestern.

Melanie Cole, MS: And I mean, you get the same questions as Dr. Bryar. So, why don't you summarize some of the notable presentations that you found most interesting for physicians that could not attend. What did you find that was so exciting, Dr. French?

Dustin French, MD: Yeah. You know, we are watching the fourth industrial revolution kind of happen here. You know, we saw the mechanization of, you know, from economic history of what happened with the textile mills, and then the Henry Ford assembly line, and then fast-forward to artificial intelligence and big data science and how that is interacting our everyday lives.

So, some people may have an Alexa at their home where they talk to a machine basically, and it gives them their favorite music. It can order them food and all sorts of things. But the world is getting smaller with bigger data in a way we can't imagine. So, the imaging studies that are being done that Dr. Bryar referred to can no longer live in just isolation. They can be joined with information from the electronic medical record to look at predictive capabilities of the sick eye, sick body hypothesis.

By way of example, what Dr. Bryar sees in the eye may predict whether a person is going to have a cardiovascular event. So, we're now moving toward the field of oculonomics quickly. And then, factoring in social aspects of our patient population that Northwestern serves. It's a very diverse patient population across the Chicagoland area, and it's not a one-size-fits-all.

Melanie Cole, MS: Well, you're so right. And when you think of research 20 years ago in the silos that it was taking place in, and now the sharing ability because of things like this and AI is really amazing and must be so exciting for you to see that.

Melanie Cole, MS: Dr. Bryar, how were some of the presentations that you attended from other physicians? What were some of the more notable ones? And what really stood out for you for physicians that were unable to attend? What do you want them to know what was really exciting?

Paul Bryar, MD: Well, a couple of things I found very exciting. You know, number one being, I mean, you can't watch the news without hearing something about AI or, you know, large language, you know, learning models, right? But I found it was very interesting how we are using it now in everyday practice, you know. So, having AI help us interpret massive amounts of data, for example.

You know, what we were learning about is how different AI models can associate very large pools of what we wouldn't think as eye data. It would be just cardiac events, you know, for example, blood sugars, and things like that. And saying, "Well, here's how when we have these certain things finding in the eye that we can predict the risk of these other things happening over here totally unrelated." You know, what is the risk of somebody having a stroke in the next five years? How can we tell that just by looking at a picture of their eye, you know, of their retina, doing an OCT of their retina? How can we do that? So, kind of having AI make those connections for us in ways that we just physically can't, one person or a group of people. It would take years to go through that amount of data. So, I found that was one interesting, you know, way of doing that, you know, of going to presentations and learning how it's actually here today, right, and then how people are thinking. You know, I think we're just scratching the surface with that, how we're eventually going to use it. But I think that it's interesting to see that evolve just year to year.

Melanie Cole, MS: It certainly is exciting. And the prospect of using AI in ophthalmology is exciting and really in your field right now. Was there any research breakthroughs that you found interesting or really fascinating?

Paul Bryar, MD: There are a lot of things. You could pick and choose any field, whether it's the front of the eye stuff in terms of, you know, we looked at eye injuries, corneal chemical injuries, you know, or genetic new findings of genetic associations in pediatric ophthalmology patients, you know, related to cataract.

And then, you know, looking at new associations with our retina colleagues in terms of macular degeneration, what drugs are the best used to treat what is one of the most, you know, challenging diseases that we treat. So, I think there were just a whole bunch of little breakthroughs that we saw, that's how I view these things. It's not one breakthrough that, you know, basically stood out about all the others.

Melanie Cole, MS: Dr. Bryar, you mentioned AI. You told us about using myChart to contact patients and get them their screening. When we think of patient care specifically, were there any presentations that stood out to you that you feel that you could use in your own practice or pass on to other clinicians for their practices as far as direct patient care?

Paul Bryar, MD: Yeah, I mean, I would say that, you know, I found that if we use our current electronic health records in two different ways that will help us. You know, one is getting patient's information to them with direct messaging or getting patients alerts that, "Hey, you might be at risk," or, "You're overdue for this, and we can help," right? I think we are getting better, but we can still continue to improve at using all this information that is in the electronic record to turn it into actionable items for both patients and providers, you know? So, I think that's something that I think we can start doing today, right?

The other thing is looking at in ophthalmology, as we all know, we spend a lot of time imaging, taking pictures of retinas, doing OCTs, ultrasounds of the vasculature in the eye. And I think we're at the point where we can start using that information to predict risks of non-ophthalmic diseases, you know? And I think it's going to be in the very near future where that will become part of our standard of care.

Melanie Cole, MS: Dr. French, was there any research that you really found so interesting and you were so glad to hear about?

Dustin French, MD: Yeah. So, you know, the consortium that we're both part of really has an energy to take the de-identification of certain records to be able to then be able to better predict, you know, patients that are more likely to have vision loss.

So, we don't want to wait for that vision loss. We want to know who's most at risk so that we can get ahead of the curve early. So, those are the things that we get excited about being in an eye department is how can we save people's vision, and they can have a better life for themselves and their loved ones.

Melanie Cole, MS: Dr. French, you mentioned a few times the social determinants. And certainly, that has to do with access to care. Were there any presentations when we think of patient care and those social determinants and the access for diverse communities? Was there anything that really stood out to you?

Dustin French, MD: Yeah. So, absolutely. And that's actually what our research is about. You know, here at Northwestern, we're blessed with a very diverse patient population, and the medical centers that expand not just here in Cook County, that they go all the way out to DuPage County and up to McHenry County up north. So, we're able to tap in and look at very different patient populations and look at those access to cares of things like rural health, minority care, and making sure that we do everyone right and they get the best care that's possible.

So, our research is specifically honing in on the determinants of health as it relates to diabetic eye disease, as it relates to glaucoma, and also cataract surgery, making sure that the patients get the right surgery that fits him or her best for their vision needs.

Melanie Cole, MS: Well, I would love for you to come back on so we can hear in detail about that research, because that is just so interesting as we think of access to care and those diverse communities. I want to give you each a chance for a final thought here. So Dr. Bryar, what are you looking most forward to learning or hearing more about as a followup to this year's event?

Paul Bryar, MD: Yeah. So, the thing I'm looking most forward to is how we can continue to make better connections between huge pools of data, making connections to find associations that we would have never thought of. You know, does this type of, you know, optic nerve appearance, can that help us predict the risk of things like Parkinson's or Alzheimer's, right? Where it's physically not possible for us to do that one patient at a time to make those connections, you know?

So, that's what I'm looking forward to in the very near future, and at the next ARVO, which, you know, is, you know, how we can make those connections, and use the tools that we have. You know, I think AI's not going to replace all this, but it's going to expand what we can do and accelerate these discoveries. That's what I'm looking forward to.

Dustin French, MD: Yeah.

Melanie Cole, MS: Certainly, that's really exciting. Go on, Dr. French.

Dustin French, MD: No. And I would just add that, you know, Dr. Bryar and I, we were actually involved in creating a web-based calculator for the risk of severe diabetic, eye disease. And so, one of our presenters who's a mentee of ours presented on this topic. And so, really, we're not the only ones thinking about this, but it's going to be exciting to see how a lot of these prediction tools will be integrated into the electronic health record, into clinical workflow. Those are things that haven't been quite done yet because the data is out there, but turning big data into information requires effort.

It's kind of like, you know,, the recipe of the kitchen, right? You know, you don't have a magic cake pop out of whatever the sprinkles are and what you want on it. You have to create it. But then, there's the piece of actually getting it into the right people's hands so that it can be used, and we need to understand that too. So, it'll be exciting to see how that takes place and unfolds.

Melanie Cole, MS: Prediction tools, actionable items, all of these are really exciting. Dr. French, last word to you. What are you looking forward to? I mean, you just gave us a little bit of a summary, but expand on what you're most excited about as a followup to this year's event and what you would like other providers that could not attend to know.

Dustin French, MD: We're excited with how imaging studies in particular will be actually be available to us. These have been challenging to use in research because, they're protected health information and the possibility of actually using some of the de-identified imaging studies to better predict some of the things that Dr. Bryar described. Like, you know, looking at an image of an eye and then going from microvascular to macrovascular factors of sick eye, sick body, and predicting stroke, heart attack. These are things that we can be less invasive. We can take a simple image of the eye and then better treat patients and give them a trajectory for the care they need before something bad happens.

Melanie Cole, MS: Wow, what an exciting conference that was. Thank you both for joining us and telling us about it. That was really an excellent discussion. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/ophthalmology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.

Paul Bryar, MD: Thank you.

Dustin French, MD: Thank you.