SCORE2 Report 10: Month 24 Outcomes After Treatment Initiation With Anti-VEGF for Macular Edema (2024)

Key Points

Question From month 12 to 24 in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) trial, when treatment was at investigator discretion, what were outcomes among participants initially randomized to aflibercept or bevacizumab for treatment of macular edema due to central retinal or hemiretinal vein occlusion?

Findings Among 236 participants in this secondary analysis of the SCORE2 randomized clinical trial, visual acuity letter score and optical coherence tomography–measured central subfield thickness improvement from baseline to month 12 subsequently worsened from month 12 to 24 in both groups, with no differences between treatment groups.

Meaning Management of macular edema due to retinal vein occlusion likely warrants close monitoring for at least 2 years, although follow-up of only two-thirds of participants at month 24 limits confidence in these results.

Importance Two-year outcomes are reported comparing eyes originally assigned to aflibercept or bevacizumab to assess the need for continued anti–vascular endothelial growth factor (VEGF) therapy for macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) from participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) trial.

Objective To investigate outcomes 1 year after cessation of the SCORE2 treatment schedule.

Design, Setting, and Participants In this secondary analysis of the SCORE2 randomized clinical trial, follow-up included 117 participants originally randomized to aflibercept and 119 participants originally randomized to bevacizumab between September 17, 2014, and November 18, 2015. Data for the analyses were frozen on September 13, 2018.

Interventions SCORE2 participants completed the treatment protocol at month 12, were subsequently treated at investigator discretion, and underwent assessment at month 24.

Main Outcomes and Measures Visual acuity letter score (VALS) and central subfield thickness (CST) on spectral-domain optical coherence tomography.

Results Among 362 participants randomized to aflibercept or bevacizumab, 65.2% (236 of 362) completed a protocol visit at month 24 (mean [SD] age, 68.5 (12.0) years; 53.8% male). The mean (SD) VALS improved from baseline to 12 months by 21.6 (14.5) in the aflibercept group compared with 21.9 (16.6) in the bevacizumab group (difference, −0.3; 99% CI, −5.6 to 4.9), then worsened from those values by a mean (SD) VALS of 7.6 (17.5) in the aflibercept group and 7.5 (14.5) in the bevacizumab group (difference, −0.1; 99% CI, −5.6 to 5.3) at month 24. The mean (SD) CST improved from baseline to 12 months by 394 (231) μm in the aflibercept group compared with 420 (274) μm in the bevacizumab group (difference, 26 μm; 99% CI, −62 to 114 μm), then worsened from those values by a mean (SD) of 58 (192) μm in the aflibercept group compared with 48 (186) μm in the bevacizumab group (difference, 10 μm; 99% CI, −58 to 78 μm) at month 24.

Conclusions and Relevance No differences in VALS or CST outcomes at month 24 were identified when participants originally assigned to aflibercept were compared with those assigned to bevacizumab. Caution in interpretation is needed because of loss to follow-up. In both groups, VALS and CST improved through month 12 and then worsened somewhat during the second year, when treatment was at investigator discretion. This analysis suggests that CRVO and HRVO warrant close monitoring and treatment as needed over at least 2 years to optimize outcomes in eyes treated with anti-VEGF therapy.

Trial Registration ClinicalTrials.gov identifier: NCT01969708

Macular edema (central retinal swelling) is the leading cause of visual impairment in patients with retinal vein occlusion.^1-3 The Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) randomized clinical trial showed that bevacizumab, an anti–vascular endothelial growth factor (anti-VEGF) treatment commonly used off-label, is noninferior to aflibercept, a more expensive anti-VEGF treatment approved by the US Food and Drug Administration, with respect to visual acuity (VA) at 6 months in eyes with macular edema associated with central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO).⁴ The present investigation evaluated longer-term outcomes among the SCORE2 participants 24 months after initiation of treatment, which is 12 months after cessation of the SCORE2 protocol–defined treatment schedule.

The study adhered to the tenets of the Declaration of Helsinki⁵ and is registered at ClinicalTrials.gov (NCT01969708). Institutional review board (IRB) approval of the protocol was obtained from a site-specific or centralized IRB (Advarra, Columbia, Maryland), and written informed consent was obtained from all participants.

The SCORE2 methods have been described in detail.⁶ Between September 17, 2014, and November 18, 2015, a total of 362 patients (305 patients with CRVO and 57 patients with HRVO) were randomly assigned to receive intravitreous injection of aflibercept (2.0 mg) or bevacizumab (1.25 mg) at randomization and every 4 weeks through month 5. The primary outcome was change from baseline in best-corrected, electronic Early Treatment Diabetic Retinopathy Study visual acuity letter score (VALS) at month 6 (with a noninferiority margin of 5).^4,6 After assessment of the primary outcome at month 6, participants originally assigned to treatment with aflibercept who met the protocol-defined criteria for a good response were rerandomized to either continuing aflibercept therapy every 4 weeks (n = 79) vs changing to a treat-and-extend regimen (n = 80); 15 participants with a protocol-defined poor or marginal response at 6 months were to receive a dexamethasone implant. Participants originally assigned to treatment with bevacizumab who met the protocol-defined criteria for a good response were rerandomized to either continuing bevacizumab therapy every 4 weeks (n = 67) vs changing to a treat-and-extend regimen (n = 67); 39 participants with a protocol-defined poor or marginal response at 6 months were to receive treatment with aflibercept. The SCORE2 participants’ last visit as part of the SCORE2 protocol–defined treatment schedule was at month 12. This secondary analysis of the SCORE2 randomized clinical trial at 64 centers in the United States focuses on the follow-up of 117 participants initially randomized to treatment with aflibercept at month 0 and 119 participants initially randomized to bevacizumab at month 0 who completed the month 24 visit (defined as month 24 completers). A graphical description of the SCORE2 participant flow through month 24 is shown in Figure 1.

After month 12, there was no protocol-defined treatment schedule. Rather, physicians could treat as they deemed necessary using any commercially available drug (including nonstudy drug or no drug) based on their typical practice and on any schedule. Only intravitreous injections given in the study eye for treatment of macular edema secondary to CRVO or HRVO during this period were documented. Study data included injections given at nonstudy offices provided they were documented in the medical record. At month 0, 6, 12, and 24, data were collected on best-corrected, electronic Early Treatment Diabetic Retinopathy Study VALS and central subfield thickness (CST) assessed by spectral-domain optical coherence tomography (SD-OCT) and eye examinations. The SD-OCT images were sent to the Fundus Photograph Reading Center at the University of Wisconsin–Madison for grading. At month 24, there was a medical record review of new ocular conditions, procedures, and other new conditions occurring since month 12. Data for these analyses were frozen on September 13, 2018.

The primary outcomes were VALS and CST. Comparisons were exploratory and descriptive, all calculated using statistical software (SAS, version 9.4; SAS Institute Inc). Because no hypothesis testing was being done, no P values from statistical tests comparing treatment outcomes are provided, and 99% CIs are presented rather than the traditional 95% CIs to give an idea of variability and help account for multiple testing. Confidence intervals for injection rates were calculated by bootstrapping the SCORE2 participants’ injection histories separately within treatment groups. Because not all participants completed a visit at month 24, we performed propensity score matching⁷ (PSM) with statistical tests and P values to investigate whether the results we report for VALS and CST are representative of the entire SCORE2 population. A brief exegesis of PSM as applied to the SCORE2 data is provided in the eAppendix in the Supplement.

Among 236 participants randomized to treatment with aflibercept or bevacizumab (mean [SD] age, 68.5 [12.0] years; 53.8% [127 of 236] male), the original randomly assigned groups exhibited similar retention, with 117 of 180 participants (65.0%) randomized to aflibercept at month 0 and 119 of 182 participants (65.4%) randomized to bevacizumab at month 0 having a visit at month 24. Reasons for the 126 participants who did not complete a month 24 visit were as follows: were not willing to return or were not interested in returning (n = 35), were unable to contact (n = 25), were deceased (n = 19), had health issues (n = 14), withdrew consent (n = 11), had transportation or mobility issues (n = 10), were at 2 sites that did not participate in long-term follow-up (n = 5), moved out of the area (n = 4), and gave no reason (n = 3). Month 24 completers were similar to month 24 noncompleters with respect to month 0 VALS, CST, and treatment assignment, but they received on average 1 more anti-VEGF treatment between month 0 and up to month 12 (mean [SD], 10.8 [1.4] vs 9.7 [2.9] treatments), had an average of 3 more months between diagnosis of macular edema and randomization (mean [SD], 7.7 [15.5] vs 4.4 [10.1] months), and had 8.7% fewer black participants (28 of 236 [11.9%] vs 26 of 126 [20.6%]) than the month 24 noncompleters (Table 1).

Between months 12 and 24, the bevacizumab group received 1 more treatment per participant than the aflibercept group (mean [SD], 4.5 [3.5] vs 3.6 [3.2] treatments) (Table 2). The annualized rates of injection were substantially lower during months 12 to 24 than in earlier periods. To illustrate, injections during months 12 to 24 decreased by 817 injections, or 7.7 injections per participant-year, from months 0 to 12 in aflibercept completers and by 813 injections, or 7.6 injections per participant per year, from months 0 to 12 in bevacizumab completers (rate difference, 0.1; 99% CI, −1.1 to 1.3). From months 0 to month 24, there were 1657 injections (7.4 per participant per year) in aflibercept completers and 1877 injections (8.2 per participant per year) in bevacizumab completers (rate difference, 0.8; 99% CI, 0.2-1.5).

Most participants received either no treatment for their macular edema (24.4% [29 of 119] of originally assigned bevacizumab participants and 28.2% [33 of 117] of originally assigned aflibercept participants) or only 1 type of drug (51.3% [61 of 119] of bevacizumab participants and 60.7% [71 of 117] of aflibercept participants). Figure 2 shows the percentage of treatment types at the 3 main follow-up periods (months 0-5, months 6-11, and months 12-24) for each of the 2 originally randomized groups. In both groups, the percentage receiving the originally randomized treatments declined with time, and a substantial percentage of participants received no treatment during months 12 to 24. Among the 155 of 236 completers (65.7%) treated only with anti-VEGF therapy between months 12 and 24, the mean (SD) number of injections was 5.1 (2.7) for those originally assigned to aflibercept and 5.9 (2.8) for those originally assigned to bevacizumab. Among the 121 of 236 completers (51.3%) treated only with aflibercept or only with bevacizumab during months 12 to 24, the mean (SD) number of injections was 4.7 (2.5) for those originally assigned to aflibercept and 5.5 (2.8) for those originally assigned to bevacizumab. Of the month 24 completers, 65 of the 117 participants (55.6%) originally assigned to aflibercept were treated exclusively with aflibercept between months 0 and 24, and 48 of the 119 participants (40.3%) originally assigned to bevacizumab were treated exclusively with bevacizumab between months 0 and 24. Continuing the original treatment assignment was slightly more common than switching to the other drug or discontinuing drug therapy (Table 2). In the aflibercept group, 42 continued, 24 switched, and 33 discontinued. In the bevacizumab group, 33 continued, 22 switched, and 29 discontinued.

Among the SCORE2 participants randomized to the aflibercept or bevacizumab groups, 65.2% (236 of 362) completed a month 24 visit in both groups. Among month 24 completers, the mean (SD) VALS improved from baseline to 12 months by 21.6 (14.5) (99% CI, 18.1-25.1) in the aflibercept group compared with 21.9 (16.6) (99% CI, 17.9-25.9) in the bevacizumab group (difference, −0.3; 99% CI, −5.6 to 4.9), then worsened from those values with a mean (SD) VALS of −7.6 (17.5) (99% CI, −11.8 to −3.3) in the aflibercept group compared with −7.5 (14.5) (99% CI, −10.9 to −4.0) in the bevacizumab group (difference, −0.1; 99% CI, −5.6 to 5.3) at month 24 (Table 3).

The mean CST improved from baseline to 12 months, with values (SDs) of −394 (231) μm (99% CI, −452 to −337 μm) in the aflibercept completers compared with −420 (274) μm (99% CI, −487 to −352 μm) in the bevacizumab completers (difference, 26 μm; 99% CI, −62 to 114 μm). Mean CST then worsened from those values by a mean (SD) of 58 (192) μm (99% CI, 8-108 μm) in the aflibercept completers compared with 48 (186) μm (99% CI, 1-95 μm) in the bevacizumab completers (difference, 10 μm; 99% CI, −58 to 78 μm) at month 24 (Table 3).

Fifty-five percent (130 of 236) of the SCORE2 month 24 completers achieved a VALS of 70 letters (approximate Snellen VA equivalent 20/40) or better at 24 months, with little difference between the 2 original treatment groups (56.4% [66 of 117] of the aflibercept group and 53.8% [64 of 119] of the bevacizumab group). Apart from a lower CST in the aflibercept group than in the bevacizumab group at month 6 (227 vs 290), the 2 original treatment groups were similar. The SCORE2 participants who completed the month 24 visit had a longer duration between diagnosis of macular edema and randomization (7.7 vs 4.4 months, P = .02) and a smaller proportion with black race (11.9% vs 20.6%, P = .05) than those who did not complete the visit.

About 35% (126 of 362) of participants did not complete a month 24 visit. This outcome raises the question of whether the missing participants differ from, and thus are not representative of, the entire SCORE2 cohort. To investigate this possibility, we applied PSM to this SCORE2 cohort by regressing a month 24 completer/month 24 noncompleter indicator on 18 covariates measured at month 0 in all 362 SCORE2 participants (236 for month 24 completers and 126 for month 24 noncompleters). Month 12 was the last completed visit for 78.6% (99 of 126) of the noncompleters, with the remainder having a last completed visit before month 12. The matched month 24 completers and month 24 noncompleters were compared with respect to VALS and CST using the paired t test. The mean (SD) noncompleter VALS at the last visit was 65.4 (21.6) (approximate Snellen VA equivalent of the mean, 20/50), an increase of 14.7 from baseline, compared with 72.3 (16.3) (approximate Snellen VA equivalent of the mean, 20/40) for the corresponding visit of the completers, an increase of 22.1 from baseline (eTable 1 in the Supplement). Matched month 24 completers have a VALS approximately 6 higher than month 24 noncompleters, but they do not differ significantly with respect to CST. Eighteen of the 126 month 24 noncompleters died before 24 months. Repeating the PSM after removing these 18 participants did not alter the results appreciably. When propensity score analysis was carried out separately within the 2 treatment groups, month 24 noncompleter VALS was lower than the matched month 24 completer VALS in both treatment groups, but the month 24 completer minus month 24 noncompleter difference was significant only in the aflibercept group (difference for the aflibercept group, 8.53; P = .009; difference for the bevacizumab group, 2.66; P = .47).

Rates of ocular safety events did not differ appreciably in month 24 completers between months 0 and 12 and between months 12 and 24 (eTable 2 in the Supplement) except that, within the aflibercept group, there were more cases of open-angle glaucoma and more cataract extractions between months 12 and 24. For cataract extractions, in the aflibercept group, there were 12 events between months 12 and 24 compared with 3 events between months 0 and 12. In the bevacizumab group, there were 7 events between months 12 and 24 and 0 events between months 0 and 12. Five completers experienced Antiplatelet Trialists Collaboration (APTC) events during months 0 to 12, and 6 completers experienced APTC events during months 12 to 24. No participants with APTC events died. Because month 24 completers cannot have died before month 24, death statistics are presented for the entire SCORE2 cohort, with more deaths between months 12 and 24 than between months 0 and 12 (14 vs 5). There were no differences between the aflibercept and bevacizumab groups in deaths between months 0 and 24 (11 of 180 deaths [6.1%] in the aflibercept group and 8 of 182 deaths [4.4%] in the bevacizumab group).

Among participants with macular edema associated with CRVO or HRVO, the SCORE2 trial demonstrated that intravitreous bevacizumab is noninferior to intravitreous aflibercept with respect to VA after 6 months of monthly injections.⁴ Although treatment with bevacizumab was associated with a significantly lower proportion of eyes that achieved complete resolution of macular edema at 6 months, this finding did not translate into poorer VA outcomes at 6 months.⁴ The original treatment assignment was not associated with significant differences in VALS or CST at month 24, which is 12 months after participants exited the SCORE2 treatment protocol, although eyes originally treated with bevacizumab received a mean of 1 more injection between months 12 and 24 compared with eyes originally treated with aflibercept. Therefore, the poorer anatomic outcomes associated with bevacizumab compared with aflibercept during the first 6 months of the study did not translate into poorer VA or anatomic outcomes at month 24.

Most of the improvement in VALS and CST observed in the SCORE2 trial occurred during the first 6 months of the study, when treatment was administered monthly. This initial improvement decreased during months 12 to 24, when participants went off the treatment protocol. This finding is consistent with the results from the GALILEO study,⁸ in which patients with macular edema associated with CRVO were treated with monthly aflibercept until week 24 and then switched to as-needed dosing; after week 52, the monitoring interval was changed from monthly to every 8 weeks. At week 76, there was a decrease in the visual and anatomic improvements initially observed at week 24. Similarly, in the COPERNICUS study,⁹ with the same dosing schedule as in the GALILEO study, the visual and anatomic improvements observed at week 24 were diminished at 2 years. Furthermore, in the HORIZON trial,¹⁰ an open-label extension trial of the 12-month BRAVO and CRUISE trials that investigated ranibizumab treatment for treatment of macular edema secondary to branch retinal vein occlusion and CRVO, respectively, reduced follow-up and fewer ranibizumab injections in the second year of treatment were associated with a decline in the visual and anatomic improvements achieved during the first year of treatment in participants with CRVO. Moreover, in the RETAIN study¹¹ (an open-label, single-arm extension study of the HORIZON trial that included the 7 highest-enrolling HORIZON study sites), among the 32 participants with CRVO and a mean follow-up of 51.4 months from the CRUISE trial baseline, only 14 (43.8%) had resolution of macular edema; the remaining 18 of 32 participants (56.3%) still required 6 injections of ranibizumab on average during their last year of follow-up. Finally, authors of a prospective case series¹² of 40 eyes with CRVO-associated macular edema treated with anti-VEGF agents with a mean of 78 months’ follow-up also noted the need for continued treatment, with a reported annual treatment rate of 4.4 injections (the mean number of injections per year decreased from 8.6 in year 1 to 3.1 in year 6). In their cohort, the mean VALS improved by 12 letters by month 6 and was maintained at this level through month 36, after which time the mean VALS decreased with less treatment. These clinical trial and case series results, taken together with the 2-year outcomes of the SCORE2 trial, suggest that close monitoring and treatment as indicated are needed to optimize the long-term visual and anatomic outcomes of patients treated initially with anti-VEGF therapy for macular edema due to CRVO or HRVO.

The propensity scores herein suggest that the month 24 VALS outcomes among the entire SCORE2 cohort would, if we knew them, have been lower than the outcomes we report for month 24 completers. This upward bias caused by the missing data is supported by the significantly lower VALS in month 24 noncompleters than in matched month 24 completers as of the last month 24 noncompleter visit (eTable 1 in the Supplement). The fact that, when propensity score analysis was carried out within treatment groups, noncompleter VALS differed significantly from completer VALS only in the aflibercept group suggests that missing data were upwardly biasing month 24 completer VALS outcomes in the aflibercept group but not the bevacizumab group. If so, the missing data, if we knew them, would even more strongly support long-term bevacizumab noninferiority to aflibercept with respect to VALS. In contrast to VALS, propensity score analysis of the CST outcomes does not suggest a bias because of missing data.

Our study has some limitations. Because participants went off the treatment protocol after month 12, month 24 results did not compare aflibercept monotherapy with bevacizumab monotherapy. Furthermore, only 65.0% (117 of 180) of the original SCORE2 participants were retained at month 24. Propensity score analysis suggests that, among the entire SCORE2 cohort, the month 24 VALS outcomes may have been lower than the month 24 completer outcomes we report herein. In addition, definitive conclusions regarding causation during months 12 and 24 between less treatment and lessening improvement of outcome measures compared with baseline values cannot be made because treatment decisions between months 12 and 24 were not based on a structured treatment protocol with protocol-defined treatment criteria. Finally, we do not present outcomes separately for eyes with CRVO and eyes with HRVO because the low number of recruited patients with HRVO did not permit meaningful analyses in this group. However, outcomes after the initial 6 months of anti-VEGF therapy were similar in eyes with HRVO and eyes with CRVO in the SCORE2 trial.⁴

In summary, this SCORE2 secondary analysis provides longer-term (2-year) information on the outcomes of anti-VEGF therapy for macular edema due to CRVO or HRVO at 12 months after cessation of the SCORE2 treatment protocol. Although participants improved substantially in VALS and CST through month 12, this improvement over baseline was lessened during the second year when fewer treatments were received. Nevertheless, month 24 outcomes were significantly better than at randomization into the SCORE2 trial. Poorer anatomic outcomes associated with bevacizumab compared with aflibercept during the first 6 months of the study did not translate into poorer VA or anatomic outcomes at month 24. No significant VALS or CST differences were observed at month 24 between the originally randomized groups, although caution is warranted in interpreting these results because of the considerable level of participant loss and investigator-chosen treatment plan and treatment frequency between months 12 and 24. It is not known whether the VA outcomes would have been better at month 24 had a structured treatment protocol been instituted between months 12 and 24. This analysis suggests that CRVO and HRVO warrant close monitoring and treatment as indicated over at least a 2-year period as needed to optimize outcomes in eyes treated with anti-VEGF therapy. Long-term outcomes out to 5 years after randomization are being investigated by the SCORE2 Investigator Group.

Accepted for Publication: July 23, 2019.

Corresponding Author: Paul C. VanVeldhuisen, PhD, The Emmes Company, LLC, 401 N Washington St, Ste 700, Rockville, MD 20850 (score2@emmes.com).

Published Online: October 10, 2019. doi:10.1001/jamaophthalmol.2019.3947

Author Contributions: Dr VanVeldhuisen, the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) trial data coordinating center principal investigator, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Scott, VanVeldhuisen, Blodi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Scott, VanVeldhuisen.

Critical revision of the manuscript for important intellectual content: Oden, VanVeldhuisen, Ip, Blodi, Chan.

Statistical analysis: Oden, VanVeldhuisen.

Obtained funding: Scott, VanVeldhuisen, Blodi.

Administrative, technical, or material support: VanVeldhuisen, Ip, Blodi, Chan.

Supervision: VanVeldhuisen.

Conflict of Interest Disclosures: Drs Scott, Oden, VanVeldhuisen, and Chan reported receiving grants from the National Eye Institute (NEI). Dr Scott reported serving as a consultant to Allergan. Dr Ip reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and receiving personal fees from Aerie, Allergan, Boehringer Ingelheim, Genentech, Quark, Omeros, ThromboGenics, REGENEXBIO, Clearside, BioTime, and Novartis. Dr Chan reported receiving grants and/or other support from Allergan, Roche-Genentech, Regeneron, and Regenerative Patch Technologies. No other disclosures were reported.

Funding/Support: This study was supported by grants U10EY023529, U10EY023533, and U10EY023521 from the NEI. Support was also provided in part by Regeneron and Allergan through donation of study drug. This work was supported in part by an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology and Visual Sciences at the University of Wisconsin–Madison and to the Jules Stein Eye Institute and the Doheny Eye Institute UCLA, Department of Ophthalmology at the University of California, Los Angeles.

Role of the Funder/Sponsor: The NIH participated in oversight of the conduct of the study and review of the manuscript but not directly in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or in the preparation of the manuscript. The role of Regeneron and Allergan was only through donation of study drug. Research to Prevent Blindness had no role in the conduct of the study. No funding source had a role in the decision to submit the manuscript for publication.

Group Information: The SCORE2 Investigator Group members include the following: SCORE2 Executive Committee: Ingrid U. Scott (Study Chair), Penn State College of Medicine; Michael S. Ip (Study Co-Chair), Doheny Eye Institute UCLA; Barbara A. Blodi (Principal Investigator), Fundus Photograph Reading Center; Sangeeta Bhargava (Director, Clinical Trials), NEI, NIH; Paul C. VanVeldhuisen (Data Coordinating Center [DCC] Principal Investigator), The Emmes Company, LLC; Neal L. Oden (DCC Statistician), The Emmes Company, LLC; Maria J. Figueroa (DCC Project Director), The Emmes Company, LLC. SCORE2 Data and Safety Monitoring Committee: David C. Musch (Chair), University of Michigan; Sangeeta Bhargava, NEI, NIH; Dennis P. Han, Medical College of Wisconsin; Srinivas R. Sadda, Doheny Eye Institute UCLA; George A. Williams, Beaumont Eye Institute; Stephen Wisniewski, University of Pittsburgh. Penn State University: Ingrid U. Scott (Study Chair), Janelle Gaston (Research Project Manager). SCORE2 DCC: Paul C. VanVeldhuisen (Principal Investigator), Maria Figueroa (Project Director), Lena Bradley, Jodi De Stefano, Eileen Guan, Anne Hoehn, Alexa Irazabal, Sue Isman, Jacquie King, Radhika Kondapaka, Hamsa Kumar, Matt Lahut, Robert Lindblad, Robin Lovett, Neal L. Oden, Michael Patschak, Ro Shauna Rothwell, Rosemary Smith, Janet Van Dyke, Valerie Watson, Lauren Yesko. SCORE2 Fundus Photograph Reading Center (FPRC): Barbara A. Blodi (Principal Investigator), Amitha Domalpally (Research Director), Susan Reed (Research Program Manager), Pam Vargo (Lead Imaging Specialist). Institute for Personalized Medicine: Cynthia Reed (Patient Enrollment Specialist). Sites are listed in alphabetical order. Personnel are listed by their primary role as principal investigator (PI), subinvestigator (SI), clinic coordinator (CC), visual acuity technician (V), photographer (P), pharmacist (PH), and other (O). Black Hills Regional Eye Institute: Prema Abraham (PI), Beth Bement-Stump (V), Leah Callahan (CC), Mindi Dockter (V), Kristi Livermont (CC), Robert Nixon (SI), Dan Parks (P), Nathan Steinle (SI), Alison Thompson (CC), Dylan Yu (SI). Casey Eye Institute–Oregon Health & Science University: Steven Bailey (SI), Jordan Barth (P), J. Peter Campbell (SI), Christina Flaxel (SI), Christopher Howell (P), Jocelyn Hui (P), Thomas Hwang (SI), Shirley Ira (V), Andreas Lauer (PI), Phoebe Lin (SI), Ann Lundquist (CC), Susan Nolte (V), Scott Pickell (P), Dawn Ryan (P), Mitchell Schain (CC), Peter Steinkamp (P), Chiedozie Ukachukwu (P), Sara Blefgen (PH), Brad Fujisaki (PH), Jeanne Liming (PH), Frank Mistretta (PH), Jennifer Petrolati (PH). Center for Retina and Macular Disease: Adam Berger (SI), Erika Darby (P), Vera Dilts (V), Richard Hamilton (SI), Laura Holm (V), Tammy McCarty (CC), Esmeralda Medina (CC), David Misch (SI), Suk Jin Moon (SI), Kari Owen (P), John Randolph (SI), Jason Strickland (P), Dawn Sutherland (CC), Michael Tolentino (PI), Nicole Varner (V). Charlotte Eye Ear Nose & Throat: Andrew Antoszyk (PI), Uma Balasubramaniam (P), Swann Bojaj (P), David Browning (SI), Loraine Clark (P), Sarah Ennis (V), Christina Fleming (CC), Autumn Finch (P), Sherry Fredenberg (V), Angie Gentile (CC), Lisa Jackson (P), Donna McClain (P), Michael McOwen (P), Angela Price (CC), Omar Punjabi (SI), Beverly Rowland (P), Lynn Watson (P). Cumberland Valley Retina Consultants: Ellis Bloom (P), Thomas Catapano (P), Mariia Chornobai (CC), Nicole Hollimon (P), Allen Hu (SI), Donna King (V), Christa McChancy (P), Wendy McCullough (V), Kristen Miller (CC), George Sanborn (SI), Ejiatu Sesay (P), Veronica Shetler (V), Paula Smith (CC), Becca Varner (P), Leslee Wallech (V), Shayla Ward (CC), David Warrow (SI), Cherie Wenger (P), Alison Wentz (CC), Kimberly Wood (P), John Wroblewski (PI). Dean McGee Eye Institute: Shannon Almeida (CC), Vanessa Bergman (V), Joann Booth (P), Reagan Bradford (SI), Alisha Brewer (CC), Russ Burris (P), Mandi Butt (P), Vanessa Drummond (CC), Stephen Fransen (SI), Sonny Icks (V), Ronald Kingsley (PI), Robert Leonard (SI), Heather Miller (V), Vinay Shah (SI), Vicki Wolzen (P). Delaware Valley Retina Associates: Krista Bayer (P), Lorraine Eggert (V), Susan Geraghty (P), Morgan Harper (V), Darmakusuma Ie (PI), Lauren Knezek (P), Jeffrey Lipkowitz (SI), Beverly Sannazzaro (CC), Kekul Shah (SI). East Bay Retina Consultants Inc: Renjini Balakrishnan (CC), Fazilla Bano (V), Daniel Brinton (SI), Denise Bustamante (V), Elyssa Casugay (CC), Roby Casupanan (V), Patty Chung (V), Heather Enyart (P), Caroline Frambach (V), Khaliah Jackson (V), Afsoon Jamali (P), Mae Kwan (V), Scott Lee (SI), Eugene Lit (PI), Joshua Machacon (V), Patty Madrigal (V), Scotty Renslow (CC), Helen Ricks (V), Soraya Rofa*gha (SI), Heidi Winje (CC). Elman Retina Group PA: Jennifer Belz (CC), Theresa Cain (P), Teresa Coffey (V), Ashley Davis (V), Michael Elman (PI), Henry Leder (SI), Ashley Metzger (P), Peggy Orr (V), Dallas Sandler (V), Jennifer Simmons (V), Perel Simpson (V), Pamela Singletary (V), Peter Sotirakos (P), JoAnn Starr (CC), Amy Thompson (V). Emory University Eye Center: Judy Brower (V), Blaine Cribbs (SI), Linda Curtis (CC), Jannah Dobbs (P), Deborah Gibbs (CC), Andrew Hendrick (PI), G. Baker Hubbard (SI), Debbie Jordan (P), Donna Leef (V), Darien Middleton (O), Ghazala O’Keefe (SI), Timothy Olson (SI), Samillya Pearson (P), Matthew Raeber (P), Joshua Robinson (SI), Susan Rogers (PH), Jiong Yan (SI). Florida Retina Consultants: Jackie Andrews (V), Steve Carlton (P), Katrina Dawson (CC), Damanda fa*gan (CC), Scott Friedman (PI), Tammi Marsh (CC), Allen McKinney (V), Nader Moinfar (SI), Karen Seyez (V), Paige Walters (V), Ceara Wendel (CC), Kimberly Williamson (CC). Georgia Retina: Jini Jones (P), Leslie Jones (V), Scott Lampert (SI), Leslie Marcus (CC), Krishna Mukkamala (SI), Lindsey Neal (P), Lauren Nunn (CC), Maria Rogers (V), Atul Sharma (SI), Robert Stoltz (PI), Morgan West (P). Henry Ford Health System: Megan Allis (P), Celia Benvenutti (CC), David Burley (P), Uday Desai (SI), Paul Edwards (PI), Hua Gao (SI), John Grybas (P), Melanie Gutkowski (V), Julianne Hall (CC), Thomas Hessburg (SI), Nitin Kumar (SI), Nicole Massu (P), Melina Mazurek (V), Mary Monk (CC), Janet Murphy (V), Jessica Nelson (P), Dinah Oude-Reimerink (V), Brian Rusinek (P), Jenny Shaheen (P), Jessica Staffne (P), Bradley Stern (P), Tracey Troszak (P), Katie Ventimiglia (V). Icahn School of Medicine at Mount Sinai: Wanda Carrasquillo-Boyd (P), John Bo Soo Choi (V), Yuen Ping Chui (SI), Ronald Gentile (SI), Priya Mehta (V), Melissa Rivas (CC), Richard Rosen (PI), Katy Tai (CC), Jia Tan (V), Meliza Unson (V), Paul Whitten (P), Alex Yang (V). Illinois Eye and Ear Infirmary University of Illinois at Chicago: Catherine Carroll (P), Felix Chau (SI), Mark Janowicz (P), Tametha Johnson (V), Yannek Leiderman (SI), Jennifer Lim (PI), Marcia Niec (CC), Yesenia Ovando (V), Kevin Reyes (P), Natasa Stankovic (V), Jie (Jessica) Sun (CC), Lauren Talasnik (CC), Lawrence Ulanski (SI). Loma Linda University: Armand Assissini (P), Marvyn Cerdenio (CC), Joseph Fan (SI), Raquel Hernandez (CC), Lynn Huang (SI), William Kiernan (V), Jesse Knabb (P), Michael Rauser (PI), Gisela Santiago (CC), Mukesh Suthar (SI), Brandon Williams (P). Long Island Vitreoretinal Consultants: Michael Chitjian (P), Kristen D’Amore (CC), Vincent Deramo (SI), David Fastenberg (SI), Philip Ferrone (PI), Barry Golub (SI), Kenneth Graham (SI), Sandra Jaya (V), Jonathan Jonisch (SI), David Rhee (SI), Juan Romero (SI), Brett Rosenblatt (SI), Marianne Schlameuss (CC), Jeffrey Shakin (SI), Eric Shakin (SI), Vasanti Sookhai (V), Jamie Szczepanski (V). Mayo Clinic: Betsy Baker (CC), Sophie Bakri (PI), Andrew Barkmeier (SI), Jean Burrington (V), Gillian Currie (CC), Melissa Franzen (CC), Shannon Goddard (P), Denise Lewison (P), Jessica Morgan (V), Rebecca Nielsen (CC), Joan Overend (V), Heidi Rubin (CC), Wendy Smith (SI), Jamie Tesmer (P), Stephanie Thatcher (P), Diane Vogen (CC). Medical Center Ophthalmology Associates: Rahen Ahmed (SI), Rene Andrade (P), Darren Bell (SI), Connie Bermea (V), Carrisa Bolado (CC), Jason Burns (SI), Melissa Dominguez (V), Catherine Ellis (CC), Rosa Escobar (P), Richard Evans (SI), Shelli Goel (P), Roxanne Gomez (V), Felicia Huron (V), Felicia Huron (V), Guillermo Montoya (CC), Cynthia Myrick (CC), Nellie Quiroga (P), Judy Rittimann (CC), Vincent Segovia (P), Michael Singer (PI). Medical College of Wisconsin: Marriner Altmann (P), Vicki Barwick (V), Joe Beringer (P), Joseph Carroll (SI), Thomas Connor (SI), Eleanor Dorsey (CC), Mara Goldberg (P), Kristy Keller (P), Judy Kim (PI), Katie McKenney (CC), Stephanie Moebius (P), Krissa Packard (CC), Brittany Rego (V), Amber Roberts (V), Hannah Russell (P), Kimberly Stepien (SI), David Weinberg (SI), Vesper Williams (CC), Pat Winter (V), William Wirostko (SI). Mid Atlantic Retina: Hannah Benfield (CC), Christina Centinaro (V), Allen Chiang (SI), Lauren Devine (V), Mitchell Fineman (SI), Michele Formoso (CC), Sunir Garg (SI), Cedric George (O), Elaine Gonzales (P), Lisa Grande (V), Omesh Gupta (SI), Allen Ho (SI), Samuel Houston (SI), Jason Hsu (SI), Maryann Jay (P), Richard Kaiser (SI), Brianna Kenney (CC), Lisa Lavetsky (P), Theresa Listner (CC), Joseph Maguire (SI), Sonia Mehta (SI), Jill Noble (O), Carl Park (SI), Ehsan Rahimy (SI), David Reed (SI), Carl Regillo (PI), Noga Senderowitsch (CC), Arunan Sivalingam (SI), Marc Spirn (SI), Jamilla Sudler (V). Midwest Eye Institute: Erin Brown (CC), Thomas Ciulla (SI), Tammy Dale (V), Neil Finnen (PI), Charlotte Harris (P), Cindi Hood (P), Shyla Keesling (CC), Ingrid Kerr (CC), Raj Maturi (SI), Stephanie Morrow (P), Kristin Phillips (V), Ashley Radtke (V), Bethany Sink (CC), Tom Steele (P). National Ophthalmic Research Institute: A. Thomas Ghuman (PI), Laura Greenhoe (CC), Cheryl Kiesel (CC), Ray Kiesel (P), Eileen Knips (P), Anita Leslie (V), Kristi Maro (CC), Crystal Peters (CC), Paul Raskauskas (SI), Cheryl Ryan (CC), Jessica Lynn Saez (CC), Ashish Sharma (SI), Natalie Torres (Crawford) (CC), Danielle Turnbo (V), Joseph Walker (SI), Glenn Wing (SI). New Jersey Medical School: Tamara Berezina (P), Neelakshi Bhagat (PI), Kathryn Boschert (CC), Eileen Buroff (V), Janie Ellenberger (CC), Catherine Fay (CC), Marian Konop (P), Michael Lazar (P), Tatiana Mikheyeva (P), Monique Roy (SI), Marco Zarbin (SI). NJ Retina: Howard Fine (SI), Laura Fox Gadless (CC), Eric Friedman (SI), Robyn Green (CC), Stuart Green (SI), Bruce Keyser (SI), Amy Leviton (V), Celeste Nelson (CC), Jennifer Pilato (CC), Jonathan Prenner (SI), Daniel Roth (SI), Alex Schlosser (P), Sumit Shah (PI), H. Matthew Wheatley (SI), David Yarian (SI). Northern California Retina Vitreous Associates: Roxanne Arrivas (P), Alok Bansal (SI), Edwin Boldrey (SI), Jesus Borrillo (SI), Louis Chang (SI), Giovanna Corazzi (V), Amy Dennis (V), Sharon Depaz (CC), Andrea Gadda (V), Amy Goldstein (P), Rahul Khurana (PI), Diana Lam (CC), Celeste Obando (P), James Palmer (SI), Olga Sessions (P), Mark Wieland (SI). Orange County Retina Medical Group: Trisha Ambrocio (CC), Marinel Casiano (CC), Eugene Chang (SI), Sanford Chen (PI), Millie Liu (V), Jessica Lowery (P), John Maggiano (SI), Rajiv Rathod (SI), Timothy You (SI). Paducah Retinal Center: Carl Baker (PI), Tracey Caldwell (CC), Alecia Camp (P), Samantha Kettler (P), Lynnette Lambert (CC), Tracey Martin (V), Margaret Orr (V), Mary Jill Palmer (V), Ron Tilford (SI), Tana Williams (P). Palmetto Retina Center: Ruth Bearden (O), Lloyd Clark (PI), Pamela Darlington (O), Rene Griggs (O), David Johnson (SI), Stephanie Karuza (CC), Peggy Miller (CC), Tiffany Ogbuewu (V), John Payne (SI), Robin Spivey (P), Ashley Studebaker (P), Tiffany Swinford (V), Mallie Taylor (CC), Deborah Watts (O), John Wells (SI), Amanda Wilson (O). Palmetto Retina Center, LLC Florence: Krystal Canupp (CC), W. Lloyd Clark (SI), Ashley Floyd (V), Cassandra Garrison (CC), David Johnson (SI), Tyler Huggins (P), Crystal Parker (V), John Payne (PI), Erin Poston (P), Jessica Ross (P), Kristin Stokes (CC), John Wells (SI), Ashley Williams (P). Retina & Vitreous of Texas: Diana Abdelgani (CC), Doug Blanchard (P), Colin Blank (P), Emmanuel Chang (SI), Deborah Fredrickson (V), Joseph Khawly (PI), Desiree Lopez (P), Donald Lowd (P), Lorena Martinez (V), Pam Miller (CC), Jason Muniz (P), Erica Pineda (V), Hassan Rahman (SI), Natalie Roncancio (P), Andrea Sales (P), Arthur Willis (SI). Retina Associates: Lexie Ainley (CC), Ivan Batlle (PI), Karla Batlle (CC), Kiersten Bruce (V), Ryan Christensen (SI), Blake Cooper (SI), David Dyer (SI), Gregory Fox (SI), Amber Konrade (V), Samantha Perkins (P), Katherine Pippin (P), Ravi Singh (SI), Beatty Suiter (SI), Frank Yeager (P). Retina Associates of Cleveland Inc: Brett Amonett (CC), Cindy Boehm (P), Joseph Coney (SI), Jim Coyne (P), Tia Drugan (V), John DuBois (P), Gregg Greanoff (P), Mary Ilc (V), Aimee Kenska (P), Elizabeth McNamara (P), David Miller (SI), Michael Novak (SI), Llewelyn Rao (SI), Susan Rath (CC), Cecelia Rykena (V), Jerome Schartman (SI), Lawrence Singerman (PI), Veronica Smith (CC), Vivian Tanner (CC). Retina Associates of Kentucky: Lisa Bicknell (V), Michelle Buck (P), Vernie Daniels (CC), Diana Holcomb (CC), Ricky Isernhagen (SI), John Kitchens (SI), Andrew Moshfeghi (PI), Bryan Noel (P), Ed Slade (P), Thomas Stone (SI), Jeanne Van Arsdall (V), Brenda VanHoose (V), William Wood (PI). Retina Associates of Western New York: Mindy Burgess (V), Brian Connolly (SI), Mary Jo Doran (CC), Ernest Guillet (SI), Edward Hall (PI), Tiffany Heard (P), Anne Reynard (V), Steven Rose (SI), Joseph Territo (P), Margaret Whelehan (P), Meg Yagoda (CC). Retina Centers: Dyonne Bachmann (V), Sally Brandon (CC), Kassandra Burdick (V), Jennifer Carreon (CC), Crystal Duncan (P), Susana Flores (V), Stacey Halper (P), Henry Hudson (SI), Amy Kan (CC), Shree Kurup (SI), Claudia Mendoza (P), Brianna Morris (V), George Novalis (SI), Patricia Wilkins (CC), Ryan Wong (SI), Martin Worrall (PI). Retina Consultants of Houston PA: Belinda Almanza (V), Matthew Benz (SI), Meredith Berry (CC), David Brown (PI), JoLene Carranza (CC), Eric Chen (SI), Brenda Dives (V), Lauren Epp (CC), Richard Fish (SI), Nikki Franks (CC), Debbie Gillaspia (CC), Amy Hutson Hernandez (CC), Eric Kegley (P), Rosa Kim (SI), Nubia Landaverde (CC), James Major (SI), Elizabeth Quellar (V), Mary Reagan (CC), Beau Richter (P), Tressa Royse (V), Amy Schefler (SI), Robert Smith (O), Veronica Sneed (V), Cary Stoever (P), Sushma Vance (SI), Tien Wong (SI), Charles Wykoff (SI). Retina Consultants of Nevada: Kelly Anderson (CC), Thomas Arambula (P), Linda Cortes (CC), Jennie Fabro (V), Joe Galura (P), Nikki Garcia (V), Leide Gomes (V), Marcy Henry (P), Rodney Hollifield (SI), Roy Loo (SI), Janet Marchese (CC), Ifeyinwa Okeke (V), Matthew Pezda (SI), Javier Rendorio (P), Treseelyn Spencer (P), Allen Thach (PI), Irene Voo (SI), Jason Wickens (SI), Meher Yepremyan (SI). Retina Group of Florida: Scott Anagnoste (SI), Jaclyn Brady-Pyka (CC), Mario del Cid (PI), Mandeep Dhalla (SI), Lawrence Halperin (SI), Monica Hamlin (CC), Ann Marie Lamb (V), Angelia Mannarelli (P), Jamie Mariano (V), Linda O'Koren (V), Krista Rosenberg (SI), Barry Taney (SI), W. Scott Thompson (SI), Eduardo Uchiyama (SI), Rita Veksler (P). Retina Group of New England: Heather Casey (V), Nauman Chaudhry (PI), Justin Cocilo (P), Alison Fontecchio (V), Emma German (CC), Samantha Gunter (V). Retina Northwest: Ashley Adamo (CC), Peggy Charpentier (V), Josh Cohen (P), Michele Connaughton (P), Richard Dreyer (SI), Inessa Flato (V), Stephanie Ho (V), Stephen Hobbs (CC), Christine ho*rner (P), Marcia Kopfer (CC), Michael Lee (SI), Joseph Logan (P), Colin Ma (SI), Amanda Milliron (V), Apurva Patel (SI), Mark Peters (PI), Paul Tlucek (SI). Retina Research Institute of Texas: Leah Adams (V), Cecilia Escamilla (O), Geneva Espinoza (P), Kristen Garcia (CC), Grant Janzen (SI), Seong Lee (SI), Priscilla Moreno (V), Sunil Patel (PI), Cindy Petty (CC), Gary Rickert (P), Deisy Villarreal (CC), Eric Zavaleta (SI). Retina Vitreous Consultants: Robert Bergren (PI), Jennifer Chamberlin (CC), Paul Conrad (SI), Dawn DiPerna (P), Bernard Doft (SI), James Eadie (SI), Amanda Fec (P), Moryssa Grossman (P), Keith McBroom (P), Lori Merlotti (CC), Karl Olsen (SI), Pamela Rath (SI), Christina Schultz (V), David Steinberg (P), Lois Stepansky (V), Avni Vyas (SI), Julie Walter (V). Retina Vitreous Surgeons of Central New York PC: Jeffrey Barker (P), Brandi Bellows (V), Jamin Brown (SI), Teresa Deforge (P), Stefanie DeSantis (P), Christine Dorr (CC), Viki Gabris (CC), Cindy Grinnell (CC), Christy Hall (CC), G. Robert Hampton (PI), Peter Hay (P), Lynn Kwasniewski (V), Michelle Manley (V), Abigail Miller (P), Nicole Robarge (P), Kevin Rosenberg (SI), Rajeev Seth (SI), Laurie Sienkiewycz (CC), Lisa Spuches (V). Retinal and Ophthalmic Consultants PC: Kim Clark (P), Brett Foxman (SI), Scott Foxman (SI), Natalie Mahan (CC), Thomas Margolis (PI), Chastity Mendez (V), Felisha Morales (P), Suzie Post (P), Julie Rosenthal (SI), Qahdirah Torres (V). Retinal Consultants Medical Group: Margaret Chang (SI), Robert Equi (SI), Danny Lopez (P), Erin Nickerman (CC), Arun Patel (SI), Joel Pearlman (PI), Nanette Podesta (CC), J. Brian Reed (SI), David Telander (SI), Tony Tsai (SI), Brooke Waller (V), Robert Wendel (SI), Kimberlee Wong (V). Retinal Consultants of AZ: Sandra Arenas (V), Mark Barakat (SI), Dayna Bartoli (P), Jermain Byers (CC), Deedra Caraveo (P), Pravin Dugel (SI), David Goldenberg (SI), L. Milad Haak (SI), Ronald Hawkins (CC), Valerie Hoback (CC), Sujit Itty (SI), Karim Jamal (SI), Norma Jimenez (P), Peter Khoury (V), Derek Kunimoto (PI), Ashleigh Levison (SI), Georgina Lopez-Wood (CC), Elena Marcos (V), John Martin (P), Sachin Mehta (SI), Neal Palejwala (SI), Edward Quinlan (SI), Nohemi Ramirez (V), Ignacio Torres (P), Diania Joy Wilson (CC), Heather Yoshimura (CC). Retinal Consultants of San Antonio: Lydia Adams (CC), Jaynee Baker (CC), Elaine Castillo (V), Moises Chica (SI), Sarah Holy (SI), Lita Kirschbaum (CC), Richard Gary Lane (SI), Calvin Mein (PI), Tori Moore (V), Brenda Nakoski (P), C. Sean Wienecke (P). Sabates Eye Centers: Kelli Burge (V), Michael Cassell (PI), Yin Chen (CC), Heather Elliott (P), Gary Gallimore (P), Kristen Kietzman (CC), Nancy Kunjukunju (SI), Jeanne Niblock (V), Abraham Poulose (SI), Felix Sabates (PI), Nelson Sabates (SI), April Snider (V). Sarasota Retina Institute: Melvin Chen (PI), Evelyn Inlow (CC), Peggy Jelemensky (CC), Marc Levy (SI), Rosa Miller (V), Tara Raphael (V), Mark Sneath (P). Scheie Eye Institute: Jim Berger (P), Alexander Brucker (PI), Dominique Caggiano (CC), Judy Chen (CC), Sheri Drossner (V), Joan DuPont (CC), Armin Farazdaghi (V), Benjamin Kim (SI), Sara Morales (P), Jessica Morgan (SI), Beth Serpentine (P), Brian VanderBeek (SI). Southeast Retina Center: Thomas Bailey (V), Amina Farooq (CC), Allison Foster (CC), Ken Ivey (P), Robert Lalane (SI), Dennis Marcus (PI), Siobhan Ortiz (CC), Bryan Rivera (V), Harinderjit Singh (SI), Kim Tuey (CC), Michele Woodward (CC). Southeastern Retina Associates PC: Julie Asher (V), Patricia Coppola (V), Joseph Googe (SI), Raul Lince (P), Lisa Lovelady (CC), Tod McMillan (SI), Steve Morris (CC), Sarah Oelrich (P), Kristina Oliver (CC), R. Keith Shuler (PI), Justin Walsh (V), Jerry Whetstone (P). Southern California Desert Retina: Isela Aldana (V), Clement Chan (PI), Tonya Gieser (CC), Tiana Gonzales (CC), Kenneth Huff (P), Maziar Lalezary (SI), Steven Lin (SI), Lenise Myers (V), Kim Walther (CC). Tennessee Retina: Everton Arrindell (SI), Carl Awh (PI), Michelle Bowers (P), Amanda Briley (V), Brandon Busbee (SI), Talisha Campbell (V), Narey Cooper (CC), John Delaney (CC), Dezirae Elkins (P), Tara Farmer (P), Amanda Ferrell (CC), Casi Fleischman (P), Paul (Dustin) Freeman (P), Courtney Harris (V), Sarah Hines (CC), Kenneth Moffat (SI), Stephanie Morrow (P), Sue Rataski (CC), Franco Recchia (SI), David Reichstein (SI), Kris Rose (V), Eric Schneider (SI), Natalie Schwebel (V), Shari Scott (V), Gina Smith (CC), Peter Sonkin (SI), Cora Sonnier (CC), Kyra Stepney (V), Katlyne Thompson (V), Caleb Walker (P), R. Trent Wallace (SI), Susan Wiser (CC), Julia Wray (P). Texas Retina Associates–Arlington: Melissa Alva (CC), Bob Boleman (P), David Callanan (SI), Jodi Creighton (V), Michelle Curry (CC), Chris Dock (P), Sandy Lash (V), Wayne Solley (SI), Patrick Williams (PI). Texas Retina Associates–Dallas: Rajiv Anand (SI), Sally Arceneaux (V), Erik Arredondo-Perez (P), Daniel Carpintero (P), Deborah Chong (SI), Lori Coors (SI), Karl Csaky (SI), Karen Duignan (CC), Gary Fish (PI), Dwain Fuller (SI), Nick Hesse (P), Diana Jaramillo (CC), Tiffany Keaton (P), Michael Mackens (P), Amy Madrid (P), Gary Maines (P), Samantha Marin (P), James Nguyen (P), Brenda Sanchez (V), Kimberly Stanfel (P), Tina Stanley (P), Robert Wang (SI). The Ohio State University: William Bloom (CC), PJ Fish (P), Alan Letson (PI), Barbara Mihalik (V), Matthew Ohr (SI), Jerilyn Perry (V), Jill Salerno (CC). The Retina Group of Washington: Tanya Alexander-Snowden (CC), Sekou Alou (P), Daniel Berinstein (PI), Thomas Blondo (V), Jennifer Camia (V), Maggie Cashion (CC), Ashley Chancey (CC), Clete Clark (O), Justin Davis (P), William Deegan (SI), Vanessa Denny (V), Irene Fanous (CC), Richard Garfinkel (SI), Bryan Gallerson (V), Smitha Gopakumar (CC), Sarah Hanselman (V), Jessica Iglesias (O), Yury Iraheta (V), Thomas Johnson (SI), Molly Kalisch (V), Andrew King (V), Michael Lai (SI), Myradis Marin-Quinones (O), Alexander Melamud (SI), Howard Morris (O), Bryan Murphy (P), Robert Murphy (SI), Stacie Orencia (P), Michael Osman (SI), Jennifer Phosaksee (V), Steve Rauch (P), Gayatri Reilly (SI), Pamela Renteria (V), Michael Rivers (SI), James Russell (V), Reginald Sanders (SI), Nicole Schorer (V), Mona Shah (V), Manali Shah (CC), Maya Talatory (CC), Tiffany Tam (V), Manfred von Fricken (SI), Danielle Walker (V). The Retina Institute: Kevin Blinder (PI), Lynda Boyd (V), Dana Gabel (P), Erika Hoehn (CC), Stephanie Guevara (V), Ginny Nobel (CC), Kelly Pepple (V), Brooke Pulliam (V), Diana Reardon (V), Steve Schremp (P), Gaurav Shah (SI), Bradley Smith (SI), Maria Stuart (V), Rhonda Weeks (CC), Jarrod Wehmeier (P), Tim Wright (P). The Retina Research Center: Brian Berger (PI), Chelsey Bravenec (V), Saradha Chexal (SI), Boris Corak (V), Ivana Gunderson (V), Kimberly Hosein (CC), Chirag Jhaveri (SI), Ginger Manhart (CC), Brandon Nguyen (V), Ryan Reid (V), Yong Ren (P), Tina Seidu (CC), Chandler Stovall (P). TLC Eyecare & Laser Centers: Kristi Ballard (P), Ashley Blaisdell (P), April Clay (CC), Shellie Fuentes (CC), Stephanie Gillispie (CC), Carmelina Gordon (PI), Heather Hill (V), Hailey Litzer (P), Elaine Lok (P), Bonnie Minier (CC), Susan Partridge (V), Surendar Purohit (SI), Tiffany Westgate (P), Jennifer Wireman (CC), Celia Wohlscheid (CC). University of California–Davis: Marie Andrada (PH), Ashley Bryant (PH), Dominique Cargill (PH), Karishma Chandra (P), Sashi Deo (P), Katrina Imson (CC), Lawrence Morse (SI), Ala Moshiri (SI), Susanna Park (PI), Ellen Redenbo (P), Marisa Salvador (V), Nadir Sarwary (PH), Igor Slabosnitskiy (P), Peter Trovitch (PH), Jessica Turner (PH), Cindy Wallace (CC). University of California–San Francisco: Jacque Duncan (PI), Don Eubank (CC), Scott Fields (PH), Betty Hom (P), Mary Lew (V), Andrew Light (P), Arshia Mian (CC), John Peterson (P), Jay Stewart (SI). University of Florida: Kakarla Chalam (PI), Ashley Cowart (V), Sandeep Grover (SI), Shailesh Gupta (SI), Shamim Haji (V), Ghulam Hamdani (CC), Sherri Hart (P), Kumar Sambhav (CC), Jazzmin Smith (P). University of Kentucky: Miroslava Aprelkov (V), Peter Blackburn (SI), Claire Fraser (SI), Mike Hanson (P), Eric Higgins (SI), Mark Kleinman (SI), Deborah McDonald (P), P. Andrew Pearson (PI), Susan Phillips (O), Lyudmila Pigulko (V), Michele Reg (CC), Stephen Sitzlar (PH), Lakisha Smith (V). University of Rochester Flaum Eye Institute: Rachel Aleese (V), Mina Chung (PI), Arielle Conrad (V), Andrea Czubinski (V), David DiLoreto (SI), Tanya Forbes (CC), Gary Gagarinas (V), Rachel Hollar (P), Lisa Latchney (CC), Katherine Nedrow (CC), Taylor Pannell (P), Brittany Richardson (P). University of Wisconsin: Angie Adler (CC), Michael Altaweel (PI), Barbara Blodi (SI), Shirley Craanen (P), Kristine Dietzman (V), Justin Gottlieb (SI), Michael S. Ip (SI), Denise Krolnik (P), Jennie Perry-Raymond (CC), Sandie Reed (P), Christopher Smith (V), John Peterson (P). University of Nebraska Medical Center Truhlsen Eye Institute: Bryan Angle (PI), Lola Berg (P), Maria Blaiotta (V), Christopher Blodi (PI), Kunal Dansingani (PI), Diana Do (SI), Lisa Greer (CC), Fayez Jawed (V), Kristi Miller (CC), Donna Neely (P), Quan Nguyen (PI), Julie Sigmund (CC). University of Washington Medicine Eye Institute: Brad Clifton (P), Patricia Ernst (V), Ron Jones (P), James Kinyoun (PI), Soojin Kyle (P), Jim Leslie (P), Juli Pettingill (V), Jeffrey Purcell (PH), Sue Rath (CC), Kasra Rezaei (SI), Gurunadh Vemulakonda (SI), Bao-Chau Vo (O). Valley Retina Institute: Rohit Adyanthaya (SI), Lazaro Aguero (P), Samuel Alonso (P), Deyla Anaya (CC), Isaac Cabrera (V), Monica Cantu (V), Tabatha Deluna (V), Roberto Diaz-Rohena (SI), Santos Garza (P), Victor Gonzalez (PI), Hector Jasso (P), Karina Miranda (V), Jessica Muniz (P), Nehal Patel (SI), Jessica Rodriguez (CC), Rachel Rodriguez (V), Kethsaly Salinas (CC), Nancy Salinas (CC), Yesenia Salinas (CC), Juan Santiago (SI), Lissete Villanueva (CC). Vanderbilt Eye Institute: Tony Adkins (P), Anita Agarwal (SI), Milam Brantley (PI), Joshua Carlson (SI), Edward Cherney (SI), Anthony Daniels (SI), Gowtham Jonna (SI), Stephen Kim (SI), Janice Law (SI), Rocky Munn (P), Sandy Owings (CC), Shriji Patel (SI), Scott Ruark (CC), Richard Skellie (P), Paul Sternberg (SI), Maryann Taylor-Ward (V). Virginia Eye Institute: Lea Anderlini (V), Mark Bartlett (P), James Combs (SI), Eleanore Ebert (SI), Michael Hughes (P), Byron Ladd (PI), Kristin McKeever (V), Lynn Roderick (P), George Sanborn (SI), Karen Sullivan (CC), Melissa Vaughan (CC). Vitreoretinal Associates of Washington: A. Samuel Barloon (SI), Charles Birnbach (SI), Andrea Blustein (V), Robert Francis (SI), Renee Gagnon (CC), Pamela Goldman (P), Ray Hunt (V), Frances Kipp (V), Todd Klesert (SI), DeShawn Minnis (P), Robert Nash (SI), Tetyana Nazarchuk (CC), David Saperstein (PI), Craig Wells (SI). Vitreoretinal Surgery: Steven Bennett (SI), Tamra Bogolin (V), Carmen Chan-Tram (CC), Holly Cheshier (P), John Davies (SI), Sundeep Dev (PI), Julianne Enloe (CC), Peggy Gilbert (V), Timothy Gromov (V), Jill Johnson (SI), Tori Jones (P), Robert Mittra (SI), Neal Oestreich (CC), D. Wilkin Parke (SI), Polly Quiram (SI), Robert Ramsay (SI), Carol Rogers (V), Joy Royle (V), Trenise Steele (P), Jessica Tonsfeldt (P), David Williams (SI).