Rishita Pujari

All Publications

• Quantification of Mitochondrial Stress in Nonarteritic Anterior Ischemic Optic Neuropathy Using Flavoprotein Fluorescence Imaging. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Pujari, R. R., Ren, Y., Zhang, J., Alkhabaz, A., Wu, H., Rich, C. A., Liao, Y. J. 2026

  Abstract

  Nonarteritic anterior ischemic optic neuropathy (NAION) or optic nerve stroke is the most common acute optic neuropathy in patients older than 50 years and results in severe vision loss. Endogenous flavoprotein fluorescence (FPF) imaging is a novel imaging modality to quantify axonal mitochondrial stress in the living central nervous system. We investigated the evolution of optic disc and macular FPF, and other ophthalmic measurements in the first 6 months after NAION onset.We retrospectively analyzed 10 patients (15 eyes) with acute NAION and performed serial assessments of visual function, optic disc FPF, macular FPF, and spectral-domain optical coherence tomography for 6 months. Longitudinal trends in optic disc FPF and peripapillary retinal nerve fiber layer (pRNFL) were modeled using generalized additive models with random effects to account for repeated measures. Linear mixed-effects models were used to assess changes from baseline to the 2-4 and 5-7-month follow-up periods.In the acute phase (<45 days), pRNFL thickness was elevated, consistent with optic disc edema, while optic disc FPF values were within the normal range. Over time, optic disc FPF increased, and pRNFL thickness decreased, with relative stabilization after approximately 3 months, whereas visual acuity remained stable. Linear mixed-effects analysis of eyes with baseline imaging ≤45 days and follow-up at 2-4 months (5 eyes) and/or 5-7 months (6 eyes) demonstrated a significant increase in optic disc FPF (Δ = 5.77 dB, P < 0.001) and a significant decrease in pRNFL thickness by 2-4 months (Δ = -153.02 µm, P < 0.001), with no significant changes from the 2-4-month to the 5-7-month period.Optic disc FPF is normal in acute NAION because of masking by optic disc edema. As optic disc edema resolves, optic disc FPF score increases, reaching a plateau at around 3 months after onset, consistent with increased axonal metabolic stress.

  View details for DOI 10.1097/WNO.0000000000002478

  View details for PubMedID 42456767

• Using multimodal imaging to improve the diagnostic accuracy and confidence in distinguishing non-arteritic anterior ischemic optic neuropathy from optic disc drusen. Frontiers in neurology Kim, M. Y., Alkhabaz, A., Yu, M., Pujari, R., Liao, Y. J. 2026; 17: 1653402

  Abstract

  Optic nerve head elevation (ONHE) is a common diagnostic challenge in the general eye clinic. When caused by optic disc edema (ODE), ONHE may signal a neuro-ophthalmic emergency requiring urgent and invasive evaluation, whereas pseudoedema typically does not. This study evaluated whether multimodal oph¬thalmic imaging improves diagnostic accuracy and confidence in distinguishing nonarteritic anterior ischemic optic neuropathy (NAION), used as a model of true ODE, from optic disc drusen (ODD), a common cause of pseudoedema.We prospectively collected multimodal ophthalmic images using fundus color, near-infrared reflectance (NIR), fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (OCT) optic nerve head and retinal nerve fiber layer (RNFL) analysis from 98 subjects (149 eyes: 60 NAION, 59 ODD, 30 controls). After a two-hour training session with a neuro-ophthalmologist, two masked medical trainees (a senior medical student and a recent medical gradu¬ate) independently reviewed single-, dual-, or multimodal image sets using a 0-5 confidence-weighted scale to assess for NAION, ODD, and control. Diagnostic accuracy was calculated using a weighted scoring system that penalized uncer¬tainty and misclassification. Confidence levels were categorized as high (defi¬nite), medium (likely), or low (maybe).Among single imaging modalities, NAION diagnostic accuracy was highest with RNFL (83.2%) and color fundus imaging (80.9%), and lowest with FAF (65.4%). Combining color + RNFL improved accu¬racy to 88.1%. For ODD, FAF alone yielded the highest accuracy of 82.3%. The diagnostic accuracy of control images was consistently high across all single modalities (84.2 to 93.8%). Multimodal imaging produced the highest accuracy overall (NAION 93.4%, ODD 90.5%, controls 99.5%). The highest improvement using multimodal imaging was in NAION diagnostic confidence, which improved from 3 to 37% with single modality to 28 to 82% with multimodal imaging. We used mixed ANOVA and chi-square tests to evaluate diagnostic accuracy and grader confidence across modalities.Brief training combined with multimodal imaging significantly improved diagnostic accuracy and confidence in differentiating NAION, ODD, and healthy controls. These findings support the potential clinical value of multimodal imaging in urgent-care settings where rapid and reliable evaluation of ONHE is essential.

  View details for DOI 10.3389/fneur.2026.1653402

  View details for PubMedID 41743055

  View details for PubMedCentralID PMC12929115

• Optic disc flavoprotein fluorescence imaging as a novel method to quantify disease burden in optic disc drusen. American journal of ophthalmology Pujari, R. R., Yu, M., Zhang, J., Almeda, L., Pugazhendhi, S., Zhu, P., Rich, C., Moss, H. E., Beres, S., Liao, Y. J. 2025

  Abstract

  To investigate the ability of flavoprotein fluorescence (FPF) imaging to quantify disease burden in optic disc drusen (ODD).Cross-sectional study.157 ODD eyes (94 participants, ages 7 - 89 years) and 69 control eyes (53 participants, ages 10 - 78 years).Comprehensive examination, visual function testing, and multimodal ophthalmic imaging. Statistical analysis was performed using parametric and nonparametric tests, ANOVA, and Spearman correlation.LogMAR, static perimetry mean deviation, optic disc and macular FPF, enhanced-depth imaging optical coherence tomography (EDI-OCT), OCT peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (mGCC) thickness.Optic disc FPF signal corresponded with superficial and buried drusen visualized on 97 EDI-OCT B-scans. Compared with controls, ODD eyes have significantly elevated disc FPF (p < 0.0001) but no difference in macular FPF scores. Examination of age-related changes revealed stable disc FPF in controls over the first 7 decades of life. In contrast, ODD eyes exhibited elevated disc FPF within the first 2 decades of age, which increased over time and remained relatively plateaued after age 40. Sectoral analysis showed significantly elevated disc FPF in all quadrants in ODD compared with controls (p < 0.001). ODD eyes with visual field loss (mean deviation (MD < -2 dB) had significantly higher disc FPF and lower pRNFL and mGCC thicknesses compared with ODD eyes without visual field loss (MD ≥ -2 dB) (p < 0.001 for all). We found a nonlinear relationship between disc FPF and MD (RMSE = 4.4271, R² = 0.4504) and a negative correlation between disc FPF and pRNFL (r = -0.78) and mGCC thicknesses (r = -0.62). Disc FPF, pRNFL, and mGCC had high statistical power in segregating ODD eyes with and without visual field loss.Disc FPF is an objective imaging technique to quantify disease burden in ODD, reflecting a combination of drusen autofluorescence signal and metabolic stress from axonopathy. Disc FPF is correlated with structural and functional changes and has high predictive power of visual field loss in ODD, supporting its use as an outcome measure in prospective natural history and treatment studies in ODD.

  View details for DOI 10.1016/j.ajo.2025.11.018

  View details for PubMedID 41260483

• Age-related macular degeneration associated with optic disc drusen FRONTIERS IN OPHTHALMOLOGY Alkhabaz, A., Kim, M., Pujari, R., Zhang, J., Ren, Y., Leung, L., Liao, Y. 2025; 5: 1620616

  Abstract

  The aim of this study was to investigate the risk of age-related macular degeneration (AMD) in association with optic disc drusen (ODD).This was an observational, cross-sectional study.Participants were consecutive patients with and without ODD from the neuro-ophthalmology clinic. Ten patients with concomitant ODD-AMD were sub-analyzed.The two cohorts were identified from a prospectively recruited dataset between July 2022 and June 2024. Patients received formal diagnoses of ODD and AMD after ophthalmic and imaging assessment. A logistic regression model was utilized in calculating AMD risk to account for demographic differences.A total of 94 patients with ODD (median age: 44 [Q1: 20, Q3: 69], 64% women) and 100 patients without ODD (median age: 60 [Q1: 44, Q3: 69], 48% women) were identified. AMD was observed in 9.6% and 3% of the ODD and non-ODD cohorts, respectively. The risk of AMD was higher in the ODD group (OR = 3.93, 95% CI: 0.89-21.85, p = 0.084). Although the association was not statistically significant, a logistic regression model attributed that to the age difference between the two cohorts. Of the 10 patients with ODD-AMD, 70% had a family history of AMD. These patients were all Caucasians and had a median age of 75 years (range: 56-91); 70% were women. Only 30% were smokers. On optic disc imaging, 70% of eyes demonstrated moderate-to-severe ODD.Patients with ODD might be at a higher risk of AMD compared to patients without ODD, and AMD screening might be warranted. A family history of AMD is often present, indicating shared genetic risk factors.

  View details for DOI 10.3389/fopht.2025.1620616

  View details for Web of Science ID 001529635000001

  View details for PubMedID 40677744

  View details for PubMedCentralID PMC12267001

• Using Multimodal Imaging to Improve the Diagnostic Accuracy of Optic Disc Edema Kim, M., Alkhabaz, A., Yu, M., Pujari, R., Zhang, J., Zhu, P., Liao, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001560033700013

• Classification of Superficial and Buried Optic Disc Drusen using EDI-OCT B-Scans Yu, M., Pujari, R., Zhang, J., Zhu, P., Liao, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558935600010

• Plasma lipids as novel biomarker of non-arteritic anterior ischemic optic neuropathy Alkhabaz, A., Kaushal, K., Ren, Y., Modgil, S., Pujari, R., Zhang, J., Zhu, P., Fu, M., Dai, Y., Liao, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001560033700010

• Microvascular changes in acute nonarteritic anterior ischemic optic neuropathy with or Zhang, J., Pujari, R., Alkhabaz, A., Zhu, P., Yaping, S., Liao, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558421400018

• Reading and Eye-Tracking Metrics as Visual Function Indicators for Patients with Optic Neuropathies Ren, Y., Pujari, R., Peters, P., Zhang, J., Zhu, P., Liao, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558634800043

• Optic disc edema masks optic disc flavoprotein fluorescence signal in optic nerve stroke Pujari, R., Ren, Y., Zhang, J., Zhu, P., Pugazhendhi, S., Rich, C., Liao, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001561732600014

• Optic disc drusen-associated neovascularization: A systematic review. Survey of ophthalmology Alkhabaz, A., Pujari, R., Ren, Y., Smith, S. J., Liao, Y. J. 2025

  Abstract

  We have integrated current evidence of visual outcomes in optic disc drusen-associated choroidal neovascularization (ODD-CNV). We systematically reviewed all published ODD-CNV cases from 1974 to 2024 using three databases (PubMed, EMBASE, and Web of Science). Only studies reporting baseline visual acuity, follow-up visual acuity, and an intervention were included. Methodological quality was assessed using a standardized tool for case reports. Seventy-four eyes (65 patients) were identified from 48 eligible articles. The median age of the subjects was 13 years (range: 3-75), and 63.5% were females. CNVs were mainly peripapillary, with 45.7% of them progressing into the macula. On average, the eyes had a follow-up period of 21.5 months. Overall, treatment (of any type) showed better outcomes (0.53 LogMAR improvement, >3 lines on Snellen chart) compared to observation only (0.09 LogMAR improvement). Anti-VEGF injections and laser photocoagulation, the most frequently used interventions, showed 0.62 and 0.19 LogMAR improvement, respectively; however, the difference was not statistically significant (p = 0.05398). Among 24 pediatric eyes, anti-VEGF showed 0.71 LogMAR improvement with minimal side effects and recurrence in one eye only. When stratified by age, pediatric patients experienced a greater LogMAR improvement compared to adults, even when adjusting for anti-VEGF treatment (p = 0.0279). Our findings highlight the importance of intervention in ODD-CNV patients, particularly in the younger population, as they are more responsive to treatment. Anti-VEGF demonstrates great efficacy and safety profile in the pediatric population.

  View details for DOI 10.1016/j.survophthal.2025.05.010

  View details for PubMedID 40441443

• Structure and Function Comparison of Autosomal Dominant and Sporadic Optic Disc Drusen Zhang, J., Pujari, R., Zhu, P., Pugazhendhi, S., Yu, M., Liao, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316205043

• Endogenous flavoprotein fluorescence imaging revealed increased optic disc metabolic stress in optic neuropathies Liao, Y., Pujari, R., Zhu, P., Rich, C., Yu, M., Pugazhendhi, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227701116

• Outcomes of endoscopic retrograde cholangio-pancreatography in patients with liver transplant. Clinical and experimental hepatology Yang, T., Patel, A., Pujari, R., Okine, V. P., Chirumamilla, L. G., Jnaneswaran, G., Raj, A., Kwajok, K. L., Goswami, R., Maiyani, P., Desai, M., Shah, H., Grossman, M. 2022; 8 (3): 226-232

  Abstract

  Biliary complications are the leading causes of morbidity and mortality after liver transplant (LT). However, national data on endoscopic retrograde cholangiopancreatography (ERCP) usage and outcomes in LT patients are lacking. Our study aims to identify the trends, outcomes, and predictors of ERCP and related complications in this patient subgroup.We derived our study cohort from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) between 2007 and 2017. LT patients were identified using ICD-9/10CM diagnosis codes and patients who underwent ERCP were identified by ICD-9/10-CM procedure codes. We utilized the Cochrane-Armitage trend test and multivariate logistic regression to analyze temporal trends, outcomes, and predictors.A total of 372,814 hospitalizations occurred in LT patients between 2007 and 2017. ERCP was performed in 2.05% (n = 7632) of all hospitalizations. There was a rise in ERCP procedures from 1.96% (n = 477) in 2007 to 2.05% (n = 845) in 2017. Among LT patients who underwent ERCP, the in-hospital mortality rate was 1% (n = 73) and 8% (n = 607) were discharged to facilities. Mean length of hospital stay was 7 ±0.3 days. Septicemia was the most common periprocedural complication (18.3%, n = 1399) followed by post-ERCP pancreatitis (8.8%, n = 674).There has been an increase in ERCP procedures over the past decade among LT patients. Our study highlights the periprocedural complications and outcomes of ERCP in LT patients from a nationally representative dataset.

  View details for DOI 10.5114/ceh.2022.119246

  View details for PubMedID 36685268

  View details for PubMedCentralID PMC9850314

• Therapeutic Options for COVID-19: A Review. Cureus Pujari, R., Thommana, M. V., Ruiz Mercedes, B., Serwat, A. 2020; 12 (9): e10480

  Abstract

  An acute respiratory disease caused by a novel coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV], the coronavirus disease 2019 (COVID-19) was first detected in Wuhan, China. Since then, the virus has spread rapidly worldwide leading to a global public health crisis. Due to its devastating effect on public health, it is crucial to identify a viable therapeutic option to mitigate the damage the disease causes. In spite of various governments implementing aggressive global lock-down and quarantine protocols, the number of cases continues to follow an upward trend. At present, the therapeutic strategies are supportive or preventative, focusing on reducing transmission. Given the gravity of the situation, we aim to explore the drugs that have been tried so far and their efficacy when applied in clinical trials. Since newer interventions would take months to years to develop, by looking at the pool of existing therapeutic options, including remdesivir (RDV), plasma exchange or cytapheresis, hydroxychloroquine, baricitinib, and lopinavir (LPV), we have tried to detail the principles behind their use to treat COVID-19, current application, and adverse effects. Many coronaviruses have a highly mutable single-stranded RNA genome and hence discovering new drugs against the virus is going to be challenging owing to the possible viral genetic recombination. Extensive research is still needed to safely advocate the efficacy of the currently available therapeutic options.

  View details for DOI 10.7759/cureus.10480

  View details for PubMedID 32953365

  View details for PubMedCentralID PMC7496561