NANOS 2025 - Dr. Susan Mollan and more!

The NANOS 2025 annual meeting in Tucson Arizona was as informative, exciting, fun, and impactful as ever. 

In this episode, I bring you a unique taste of the meeting through a conversation with a wonderful neuro-ophthalmologist and through reflections of meeting attendees from Tucson during the event.

In the first part, I speak with Dr. Susan Mollan who is a world-renowned Neuro-ophthalmologist practicing in Birmingham, England. Her group is at the forefront of IIH research and we spoke about her background and interests in Neuro-ophthalmology, the latest in IIH and GLP-1 agonists, her reflections on the NANOS meeting, and more.

In the second part of the episode we hear from a diverse group of meeting attendees about their favorite highlights and experiences from NANOS, a new and fun event debuting at this year’s meeting, and an impactful symposium we’ll hear more about in future podcast episodes.

The IIH Intervention Leadership Group

NANOS 2025 Resources

Transcript

SPEAKER_13 0:01

This is out of the mind spot. I'm a neuroophthalmologist for the edition. The views and opinions I express in this podcast are purely mine alone. The Nano's 2025 annual meeting in Tucson, Arizona has come and gone, but it left a lasting impression, as informative, inspiring, and impactful as ever. From cutting-edge science and hands-on skills transfer courses to vibrant discussions about the future of our field, this year's meeting brought together the heartbeat of neuroophthalmology in a special setting. As usual, it was more than just a conference. It was a reunion, a chance to reconnect with friends, colleagues, and trainees, some of whom were experiencing their first taste of neuroophthalmology. It was a chance to learn, to laugh, and to grow together at the most important meeting in our specialty. In this episode, I bring you a unique flavor of the Nano's experience through two special segments, most of which was recorded during the meeting. First, I sit down with Dr. Susan Susie Mullen, a world-renowned neuroophthalmologist based in Birmingham, England, whose team is leading the charge in idiopathic intracranial hypertension research. We talk about her path into neuroophthalmology, the latest on GLP-1 receptor agonists in IIH, her reflections on the meeting, and much more.

SPEAKER_16 1:38

Yeah, so I grew up in Northern Ireland, but I also went to boarding school in England. I did my university in Scotland, and while I was at university, I started flying the University Air Squadron.

SPEAKER_13 1:51

Next in the episode, we'll hear directly from the voices of Nanos, a diverse group of attendees sharing their favorite meeting highlights, their excitement about a fun new event that made its debut at the meeting this year, and a powerful symposium that left a mark on almost everyone who attended it. Whether you made it to Tucson or are catching up from your corner of the globe, the Super Bowl of Nerdum did not disappoint. And I'm excited to bring you this unique look at Nennos 2025. This is Out of the Blind Spot, the podcast where we discuss all things neuroophthalmology, the specialty of medicine that connects the brain to the eye and to the world for all to see. I'm here at the 2025 Nanos Annual Meeting in Tucson, Arizona, and I'm excited to be joined by Dr. Susan Mullen. Many of us in Nanos know who you are, Dr. Mullen, but welcome to the podcast. And please tell us your title and where you practice. And then we'd like to know about your background, how you became a neuroophthalmologist, and then we'll talk about some of your interest in neuroophthalmology.

SPEAKER_16 3:04

Yeah, it's wonderful to be here. So my name is Susie Molin. I'm an honorary professor at the University of Birmingham. I'm a consultant neuroophthalmologist at University Hospitals Birmingham. And I've been a neuro ophthalmologist for about 10 years now as a consultant practicing in Birmingham. And my background is I'm an ophthalmology-trained neuroophthalmologist. But prior to starting neuroophthalmology, I was in the Royal Air Force as a medical officer. So I've done some family medicine within that too, and I think that kind of suits the systemic disease piece in neuroophthalmology.

SPEAKER_13 3:37

Wonderful, wonderful. Tell us a bit about where you grew up, you know, your training, and what was it that made you transition from flying medicine to neuroophthalmology?

SPEAKER_16 3:48

Yeah, so I grew up in Northern Ireland, but I also went to boarding school in England. I did my university in Scotland, and while I was at university, I started flying at the University Air Squadron, and that really began my connection with the Royal Air Force, joining as a medical cadet and then transitioning to a Royal Air Force medical officer, being stationed at a number of different bases, sort of all over the United Kingdom. And really, it was from about fourth year in university I saw a lecture on ophthalmology, and I thought, that's me, I've got it, this is my home. And as I started my training in ophthalmology, which was both in Birmingham and also in Oxford, I really realised I loved the surgery part of it, but there was something about the whole patient and really sort of being that detective. So when I moved to Birmingham, I had three wonderful mentors through my training: Michael Burden, Andrew Jackson, Tim Matthews, who were all Nanos members, and they really supported me, not sort of directing me towards neuroophthalmology, but by example, I could see how rewarding their careers were, and I just naturally morphed into neuroophthalmology, coming to Nanos as an ophthalmology resident, and then later becoming a fellow.

SPEAKER_13 5:05

Oh wonderful. So can you tell us a bit about your early Nanos experience? What that was like for you?

SPEAKER_16 5:11

It was really exciting. So, for example, I've met some of my best friends at a rodeo. You know, the sort of not only the science part of it but also the training part of it. It's that sort of community and network that we have. And for example, this must be my tenth Nanos that I've been to or more. I'm still meeting new people, and I know that you know, over the course of the next year I'll be contacting some of those people for collaborations, or even if they're just visiting Europe or in country, you know that somebody can ring you up or email you and say, Hey, I'm gonna be in England at this time. What are you up to? And so we really do make an effort to continue those connections.

SPEAKER_13 5:53

Yeah, that's the beauty of power of NANDAVES. Tell us about your particular interest in neuroophthalmology. I personally know you as the IIH expert and the work you've done with IIH and GLP1s. Talk about how you became interested in those subjects and where we are in our understanding of IIH and the work your group is doing.

SPEAKER_16 6:14

Yeah, I think it's it is really funny. Yeah, certainly I'm definitely seen in Birmingham as the IIH lady, but I think obviously I'm a comprehensive neuroophthalmologist, so my specialty clinic is IIH, but I do do a huge other neuroophthalmology, general neuroophthalmology clinics. I'm probably a little bit biased towards afferent work, but I used to do strabismus, so I did a fair bit of efferent. Oh, wonderful. So my IIH interest was really based on the fact in Birmingham it's an area of social deprivation, so we get lots of patients coming through. And also regionally we don't have other neuroophthalmologists, so they naturally gravitate towards our unit in Birmingham, which is very vibrant. And it just seems sensible to set up a specialty clinic where also the women could meet in the waiting room and talk to each other and network, and we had very good relationships early on with IIHUK, which is a charity, and they've been very supportive of our patient group, and it was just understanding the burden of the disease, but also the fact that you know 10% of these women have significant sight loss, and we just don't understand those mechanisms. I was very lucky early on, so I started, and within a couple of months of me starting my consultant post, Dr. Alexandra Sinclair joined, and we started this joint clinic, and she was on the academic side, and I was more on the clinical side, and because of her energy and excitement for the disease, we were able to get really quite good opportunities and funding.

SPEAKER_13 7:47

Dr. Alexandra Sinclair is a professor of neurology within the Department of Metabolism and System Science at the University of Birmingham, and is head of the translational brain science research group. She is an international figure in translational research in idiopathic intraprinal hypertension, headache, and traumatic brain injury, and as mentioned, has been an invaluable member of the neurothomology team at the University of Birmingham.

SPEAKER_16 8:16

We started with a very early trial called the IIH drug trial, and then the one that I was more involved with was the IIH weight trial, which was bariatric surgery versus community weight watchers. And these trials take such a long time to set up. You see the paper at the end of the day, but there's like a decade of work before it. And over the time, we recognized sitting in a university endocrine metabolic systems department, that actually we needed to think more about how we could modify the disease with new drugs, knowing that it's such a challenge for our patients to take azetazolamide and encourage them to take it. And so, looking across the board at what was happening, it seemed sensible to move to something like GLP1 receptor agonists because of the synergy in anatomy and physiology between the renal proximal tubule and the choroid plexus. And so a lot of the basic science work was done in Alexandra's lab, and obviously the clinical side of it was making sure that I was growing the population that was engaged with research so we'd be able to recruit to these studies and obviously coming in quite heavily on the ophthalmic outcomes as well. So the GLP1 story is exciting in IIH because we know of its great benefits with weight management and type 2 diabetes, but actually, what we wanted to show there was that axenoti, which is a very specific GLP1 receptor agonist, had direct effect to reduce secretion at the choroid plexus. Because although there's debate about what drives IIH from a sort of CSF point of view, I think we firmly believe in Birmingham this is much more of a hyper-secretion disease rather than other major components to it. So we reckoned if we could turn off CSF secretion, such like acetazolamide and topyramate, frusamide, spironolactone do, with a drug that's you know very tolerable with good side effect profile, that that would be really good for our patients. So the IIH pressure trial, we used telemetric ICP devices in a small group of women, and the reason to use those was they're super accurate, and also we didn't need to do lumbar punctures. And so being able to show very early on that axenoide reduces CSF pressure within two and a half hours meant that not only was this going to be applicable to IIH patients but for all those really difficult to treat, traumatic patients, hyperkethalis patients. So it's been very exciting to work in that sort of environment which uniquely combines clinical expertise along with academic expertise. I'm really delighted to see so many registries for idiopathic endocranial hypertension publishing now, the Vienna Group, and obviously the Australian group, the Neuroophthalmology Database Group, and I think we know so much more in the last 10 years. And it's obviously not only our work on the IIH treatment trial, we're still seeing great papers coming from all that data, including the visual field data. And I think yesterday we were hearing all about the metabolomics.

SPEAKER_13 11:47

In IIH, the metabolomic analysis of CSF, serum, and urine have identified distinct metabolic imbalances compared to healthy controls, suggesting that metabolic dysregulation may play a role in the pathogenesis of IIH and it's associated with visual dysfunction.

SPEAKER_16 12:07

Trying to understand mechanistic pathways.

SPEAKER_13 12:10

Yeah. So Xenodide was the medication that you used in your study. Is that directly transferable to the medications that are coming out? WAIGOVI, semaglutide, trzepatide. Have you done work seeing the same ICP lowering with those medications, or because they're the same class, you we think it's just transferable?

SPEAKER_16 12:32

See, that is a really, really good question. So in the IH pressure trial, we didn't actively get the women to lose weight. And so when you take a GLP1 receptor agonist, you have to use it in combination with lifestyle changes for weight loss. And what we wanted to show in that short phase two trial that this was a direct ICP effect. So our women didn't lose weight, and you're quite right. I'm not sure we can translate a xenotide, which we were using as a twice-daily injection, which was short-acting, to those other medicines in the same class. There has been some work done, and I think there will be more work coming out on semglutide, lyriglutide, and also the GIPs as well to see whether they have an effect on ICP. But they're much more long-acting. Okay. You know, so to get steady state, as you know, for type 2 diabetes or indeed weight loss, it takes weeks to get your steady state. So it would need a different approach in a clinical trial if we find the basic science evidence that they reduced ICP in the same way.

SPEAKER_13 13:39

Okay, okay. In follow up with this question about GLP1s and ICP, we're hearing more about the other ophthalmic side effects of GLP1 agonists, and you put a nice statement about that late last year. Can you talk more about any concerns you might have about the GLP1 agonists given their association with ischemic optic neuropathy? And if there's any correlation or any concern you have in patients with IIH taking those medications as well?

SPEAKER_16 14:07

So interestingly, I mean, I I only have my practice to speak for. I've not had a patient with IIH also have an ischemic optic neuropathy that's on a GLP1 receptor agonist or even a combination therapy. That's probably because my access to a very large group of patients on GLP1 is limited by the funding within the NHS, I would say. So it takes quite a lot for me to be able to get my patients with IIH into that pathway. But what I would say is I've definitely seen non-arteritic anterior ischemic optic neuropathy in patients on concurrent treatment with GLP1 receptor agonist. I am very interested in it because with the Hathaway study, which was a seminal paper coming out of from the Boston group.

SPEAKER_13 14:58

The seminal study Dr. Maulin is referring to is the retrospective review published in the August 2024 edition of Gemma Ophalmology, investigating whether semaglutide, the widely used TLP1 receptor agonist, is linked to non-arteritic anterior ischemic optagonography or NAION, or rare but serious efficient threatening condition. The study suggests that semaglutide users may face a four to sevenfold increased risk of developing NAION. While the study was observational and did not determine a causal relationship between semi-glutide and NAION, it has brought this association to the forefront and highlighted the need for further research to determine the extent of any causal link between GLPON agonists and the development of ischemic optic neuropathy.

SPEAKER_16 15:52

I think we were all starting to feel like I'm seeing a few more of these patients coming through. And obviously there's been some very large data studies, some across the world, some in the States. We've now had another case series out in JAMA ophthalmology, which was a NANOS net study of gathering of cases. And some studies say yes, this is an association, and other studies say no, there's not an association. And I think that's just down to the fact that, you know, to really understand this, we have to prospectively study it. And that takes quite an undertaking because of the numbers. So if we look back at the randomized controlled trials that were done in the GLP1 receptor agonists, there were very few patients that had an adverse event of a non-arteritic anterior schemacoptic neuropathy. And that's out of thousands and thousands of patients being in these trials. So the number is small. Causality is very difficult to assign, as we all know, of the criteria. And I personally feel, and this is my own personal feeling, that it may be a metabolic change. So some of the data that's missing from these big studies is understanding what's happening with the HBA1C at the time somebody has an ischemic optic neuropathy. And the way we all practice, we're not capturing that real-world data as to what's happening in a person on one of those pretty much life-saving medicines in many cases. And it's a real challenge for us as a community to respond to that. I also feel in my practice, and also looking through some of the posters that have been here at NANOS, that the ischemic optic neuropathy in patients on concurrent treatment with GLP1 seems to be quite severe. It doesn't seem to be the sort of, you know, sort of full spectrum of non-arthritic in my mind. So big edema, you know, big visual loss. So I think it's gonna be, it's gonna be, I was gonna say exciting. Obviously, it's it's not exciting to have this to deal with, but I think we have to respond to it for our patients and make sure we can work out the mechanisms, and I think it's gonna help us actually with the pathophysiology of non-arteritic. I hope that's what it's gonna do.

SPEAKER_13 18:08

That's a really good point. That's a really good point. And you're right, maybe we're biased to more of the more severe cases because the patient population that we're dealing with with the medications. Speaking about the pathophysiology of a disease process, you're working on the pathophysiology of IIH, and in addition to the GLP1 work that you're doing, is there any other work that you're doing looking at the pathophysiology, maybe treatment and management and outcomes of this disease?

SPEAKER_16 18:29

Yeah, so we've also had a bit of a shift in the GLP1, so we've got next generation, and so when you plan things, you're always way behind the head of time is coming out. So I think it's about trying to be clever about hey, what drugs work in what parts of the body and how could we translate that either to the eye or to the choroid plexus? So that that's definitely a direction for going because we know that treatments are an unmet need. I think the other thing that does excite me is really headache in IIH because it's a burden that the patients have, you know, significant problems. The papilledema often settles and it can settle without doing very much, you know, in some patients. And what these patients are left with is horrible headaches. And I think we need to be more responsible as clinicians at making sure they get to a good headache neurologist for active treatment. But those headache pathways I think are interesting and think could give insights across the board into secondary headaches, such as traumatic headaches and traumatic migraine-like headaches, as well as you know, previously raised pressure headaches. Yeah.

SPEAKER_13 19:39

Oh, you're right, you're right. We're gonna switch gears a little bit. Yeah. Talk about your experience with Nanos.

SPEAKER_17 19:46

Yeah.

SPEAKER_13 19:46

And also UNOS, so the European Orthan Society, because you remember both. Yes. How would your experience with Nanos been like? And maybe compare and contrast that to UNOS and talk a bit about what UNOS is and what UNOS is.

SPEAKER_16 19:58

Yeah, so I think it's really interesting. I've had much more experience of NANOS because it's an annual meeting. I think the organization with NANOS is very inclusive in terms of getting international people involved on committees, understanding the different parts and how to support members. UNOS is a it's a really fun meeting. It happens every other year in terms of the scientific meeting, and then on the alternate year it has a trainee meeting. So actually, if I think back, my first UNOS meeting was actually a trainee meeting. My mentors suggested I go on it and it was a weekend of lots of didactic lectures but also networking with other people of my age around Europe who were interested in neuro ophthalmology. And so the emphasis is there is more on teaching. Obviously, as the sort of community has required more neuroophthalmologists and the disease prevalences have really grown, we have a huge shortage of neuroophthalmologists all over the world. And I think both organizations are now benefiting from that in terms of growth. And I think the the risk is with any of these things, is we remember back to when we joined and how small they were, and now things get bigger, and we just have to try and foster the community that we have. And I think Nanos is doing a great job of that. I think UNOS is that it's sort of more infancy stages of just sort of starting to grow out. I would say that you know, in terms of both meetings, I enjoy going to both meetings, and I get different things from the meetings, yeah.

SPEAKER_13 21:37

So we're here in Tucson, Arizona. You may hear the planes flying overhead, we're outside talking, it's a really nice conversation. What has been your experience here so far at this meeting, and what have the highlights been for you at this annual meeting?

SPEAKER_16 21:52

So I think again, I think the highlight is just seeing people, you know. Like during the year, we might bump into each other at various Meetings across the world, but it's actually having a bit of time to meet people, talk to people, find out how they're doing in their practice is really usually the general chit-chat, but it's also you know going to the poster session, picking up what's changing in our specialty. And as we talked about a little bit, you know, the ischemic optic neuropathy story, what's new, the new medicines, particularly for my senior gravist, talking about thyroid eye, you know, these areas of growth in say neurology and ophthalmology that are relevant to neuroophthalmology. And so on the ophthalmology side, it's definitely the changes in the newer imaging modalities and how I could get that into my practice. I think you know, everybody loves the walsh. We love a case thing, so you know, when we kick off with the walsh, it's always like a reset button, and I always take away from the walsh one or two things that I'm like, huh, I've got to test that. Either I've forgotten to test it or it's fallen into my back of my mind, or just like how am I going to be able to arrange that test where I work? And I think that's fun. And some of my members from Birmingham aren't here this year, and we've we've got a WhatsApp group, so we've been sending back a few slide pictures and keeping them involved and up to date, and when the team get back, we always do like a sort of update from Nanos, a little bit of a like journal update. So it's also not only for me, but making sure that you know my colleagues at home also get to experience a little bit of Nanos.

SPEAKER_13 23:28

Wonderful. As we wrap up our conversation, any final thoughts on the difference between your practice in the UK versus the US and what people want to know about the research you're doing and the work you're doing over there in Birmingham?

SPEAKER_16 23:40

Yeah, I think I mean there is big differences in practice, different practices all across the world. We all see a different spectrum of patients depending on what is around us. I think fundamentally we all have the same problems, and the problems are about engaging people to come into the specialty, making sure that you know, I think there's a reimbursement in the states. Even at home, we have this issue because we're competing against high-throughput cataract services and medical retinoclinics doing injections, are making the other specialties aware of what a contribution we make to the hospital environment. And I think it's a there's many other things in terms of making sure that we've got a good pipeline for people coming into the specialty to really enjoy it and not be daunted by it.

SPEAKER_13 24:29

No, you're right, you're right. Well, Susie, thank you so much for joining me. This was a wonderful conversation. I do hope to have you back on the podcast again in the future to hear more about the work you're doing and the advancements you're making in the forefront of IIH research. Enjoy the rest of your meeting. Thank you. It was really a pleasure to speak with Dr. Mollin, and I sincerely appreciated the opportunity to hear her unique perspectives and her thoughts about the NANOS meeting. Keeping with the spirit, I thought it would be interesting to take you further into the NANOS 2025 experience. Up next, we'll hear directly from a diverse group of meeting attendees sharing their personal highlights and reflections from Tucson, including two young trainees experiencing their first NANOS meeting.

SPEAKER_00 25:19

Hi, I'm Sarat Vikanta. I'm a pediatric neuroophthalmologist practicing at the University of Utah in Salt Lake City. Um I absolutely love this meeting. It's every year it's so wonderful to see my colleagues and learn from them and learn different pearls regarding how they practice. For example, I learned a lot about uh how Dr. Adishina does his Botox injections compared to how I do them. Um it's so wonderful to connect with new and um just fresh candidates who are interested in neuroophthalmology and and meet with different like medical students and residents and fellows and get them introduced to our wonderful community. And plus two sounds amazing.

SPEAKER_02 26:05

Hi, I'm Kim Winges, and I'm from Portland, Oregon, and I do have time neurooph and comprehensive. Um this meeting was absolutely fantastic. I think extra good this year. There's something about what they organized and how they got everything together in the topics that we all just really wanted to know. My personal highlights were a chemo denervation session where we actually got to practically practice Botox in both migraine and hemifacial spasm and blufferospasm. The second is always, always, always seeing my great friends and my mentors and my mentees all together in one place. It's like a big family, and that's obviously a highlight every year.

SPEAKER_04 26:43

My name is Nifisayo. I'm a neurologist, uh, of course, neuroophthalmologist. I practice in Yale University, and this is my 12th or 13th uh meeting, and my two highlights from this particular meeting are firstly always the Walsh, but more specifically, I got a few more insights about underlying mechanisms behind common phenotypes. For example, there was a particular case presenting as cognitive impairment and optic neuropathy, uh, which could be the result of vitamin B12 deficiency, but in this particular case it was due to a new, newly discovered antibody, anti-CD320. And it really is fascinating to me to get a deeper knowledge about the underlying mechanisms behind common phenotypes. And there were, of course, many other fascinating cases. And um, second really, my second highlight for the meeting was catching up with old friends and colleagues, and that's partly recreational but also professional, sharing ideas about how to improve practice and sharing ideas about how to uh take care of ourselves and take care of patients. And um, I've got so many insights over the years about some uh peculiar patient cases, and just running into colleagues and running cases by them has always been uh very fascinating and helpful, and uh also helpful to build mutual respect. And uh, I really love the meeting and look forward to many more meetings in the future.

SPEAKER_07 28:23

Hi, my name is Billy Garcher, and I'm a third-year medical student at the University of Houston College of Medicine. I'm interested in pursuing a career in ophthalmology and learning more about neuro ophthalmology. This year, I had the opportunity to attend and present my research at my first NANOS meeting, and it far exceeded my expectations. One of the highlights was attending the Frank B. Wall sessions. As a medical student, still honing my clinical reasoning, watching expert neuroophthalmologists work through complex cases in real life, felt like witnessing Sherlock Holmes unravel a mystery. Following their approach to diagnosis and treatment, navigating the uncertainties at each step was both informative and entertaining, and showcased the brilliance in the field. Another highlight was the overall atmosphere of the conference. Everyone was genuinely excited to be there, engage our trainees, and broaden our perspectives of careers in neuroophthalmology. The sense of community really stood out. It was clear that this is a collaborative field filled with brilliant, kind, and curious people who are committed to advancing care together and improving their sub-specialty. Overall, Nanos was a welcoming and intellectually rich experience, and deepened my appreciation for how neuroophthalmology blends critical thinking, problem solving, and patience-centered care. I left the meeting feeling inspired and confident that I myself could build a meaningful career in this subspecialty. And I'm grateful to the mentors who made it possible for me to attend. And I'm looking forward to attending and reconnecting with everyone at future Nanos meetings.

SPEAKER_09 29:46

Hi, my name is Garrett Christom. I'm a current PGY1, about to be PGY2, ophthalmology resident at the University of Houston. This past March, I attended my first Nanos meeting where I had the opportunity and pleasure of presenting a research poster. Two big highlights I would take away from this meeting is first the WALS presentations, which are essentially uh strange, non-typical presenting, um ophthalmic cases that I think are super educational, cool, and just a neat aspect of Nanos. Second are the connections I made there. Um I was meeting people as young as high school students all the way to tenured attendings. I just, you know, that's that's always such a fun part for me at these meetings is uh exchanging contact information and making those connections, which ultimately segues me into my overall impression of the meeting. If I were to describe this meeting, I would describe it as an excellent learner's environment. You know, it's not too big where you're getting overwhelmed and just embodied with material or um the people. No, here you you quickly realize uh how small but strong the ophthalmology community is, specifically neuroophthalmology. And it's it's truly just so fun being able to speak with others and and learn about neuroophthalmology and and learn about future colleagues and and those you know, going through what you're going through right now, specifically me in residency, you know, and and what others' residencies are like and what they're working on, and those in fellowship and so on. And so I just think that's a that's a great component of Nanos, is is truly the community. It's you know, this Nanos is more so a community than it is a conference. Um a community that's that's created or cultivated an excellent learning environment, and and that's how I would uh describe Nanos. And I truly had such a blast, and I'm I'm looking forward to hopefully coming back again in 2026. And briefly I just want to give a quick shout-out and and thank you to Dr. Dejna for presenting me with you know this research opportunity and you know the opportunity to attend Nanos. So again, thank you.

SPEAKER_13 32:02

It's great to get the perspective of young trainees and seasoned meeting attendings alike. The Walsh is always a hit at Nanos, as is reconnecting with friends and colleagues and sharing ideas, which is a theme we will hear more about. The next two attendees also shared their appreciation for a new event that debuted at NANOS 2025, the Neuro Ophthalmology Bowl.

SPEAKER_08 32:28

My name is Kevin Lai. I'm a neuroophthalmologist in Indiana, Kentucky, and Ohio. And the two things that I have enjoyed the most about NANOS 2025 are getting to meet new people, as I do. Every year I get a chance to um rub shoulders with the giants of neuroophthalmology, but also encourage um the encourage uh trainees who have maybe never once encountered neuroophthalmology until now. And I've been really encouraged to see the excitement of the new generation of trainees who are wanting to go into our field, and um also encouraged just by the passion that so many um of the neuroophthalmologists who have trained me and um my peers have also just continued to uh devote their resources to advance the science of neuroophthalmology. The second thing is um just the overall scientific program, all of the fun things that we do, ranging from the WALS session to the neuroophthalmology bowl, to even just the small um small things that that we talk about in between the sessions. And I think that that exchange of scientific knowledge is more valuable than anything that you can just pick up by reading something on the internet.

SPEAKER_06 33:59

Hi, my name is Ellen Mitchell. I am a pediatric neuroophthalmologist and I practice in the Atlanta metro area. I would have to say that my two favorite things about the meeting, um, two of my most enjoyable things about the meeting or favorite memories would have to be just reconnecting with friends and colleagues from around the country and around the world, people who I don't necessarily see or talk to on a regular basis. I think the reconnections and also making new connections, I think, was a was a great aspect of this meeting this year. And my other favorite thing or favorite memory would have to be um Nano's Bowl. That was pretty awesome, pretty amazing. Um that was it was a lot of fun and it was a fun way of learning and sort of refreshing your memory of things. I love the way that um Shishank and Colin did that event. It's I think it's something that we should have every year. So that's that's all I have to say.

SPEAKER_13 35:01

To learn more about the Neuroophthalmology Bowl, I took the opportunity to speak with Dr. Sashank Prasad and Colin McClelland, the developers and referees of the event.

SPEAKER_05 35:11

Hi, I'm Sashank Prasad, I'm a neuroophthalmologist at the University of Pennsylvania.

SPEAKER_03 35:16

Hi, I'm Colin McClelland, I'm a neuroophthalmologist at the University of Minnesota.

SPEAKER_05 35:20

Yeah, and we were so excited to develop Neuroophthalmology Bowl this year. Um we proposed the idea last year to our Nano's leadership, and we're thrilled that they were excited to, you know, let us make it happen. And the origin story is that actually I've been working on this for years, to be honest. Since the beginning of the pandemic, around that time everyone was so, you know, education was tough. Uh there was like not much community among learners and teachers and things like that. You remember at the very beginning. And uh I started developing this neurology bowl, uh, as nerdy as it is, as a way to kind of get people together to, you know, remember what we do in medicine, which is learn one case at a time and kind of dig into some, you know, and find opportunities to learn things we don't know yet. And I just I meant I developed a monthly neurology bowl um for the American Academy of Neurology back then in 2020. And a few hundred people would log on and watch this thing. It was done virtually, and I still keep edits, so all these years later, we still do a um a version of that, and and so I've built a library of these cases, and for that it's a lot of neurology, but in it is a good amount of neuroophthalmology, and so I wondered if it would work out at the meeting. And so I partnered up with Colin, who I thought is also an amazing educator and has got a library of cases and kind of complement. I'm a neurology trained neuroophthalmologist, obviously, and Colin's ophthalmology trained, so I thought maybe there'd be a cool synergy there, and it was fun working on it together with Colin.

SPEAKER_03 36:44

Yeah, I really enjoyed it. Um, you know, it I think it was something novel for um the neuroophthalmology world, and so Shank and I really tried to choose cases, curate carefully, so that he would present cases that were more neurology-based and perhaps more challenging for the ophthalmology-trained neurohthalmologists, and I would choose cases that were ophthalmology-based and more challenging for the neurology-trained neuroophthalmologist. And I think also the the perspective here is we were trying to present information didactically in small um portions. I I think the younger generation of learners really appreciates learning in a high-yield format, um, you know, one to five minutes of teaching rather than prolonged lectures where uh perhaps you know their attention span doesn't hold up.

SPEAKER_13 37:32

Can you speak to the format, the competition format, and how you think that went uh at this year's NANUS meeting?

SPEAKER_05 37:38

Yeah, um, that's something we've sort of worked on over the years to tie in the Cahoot and find ways to have teams working in a way that emphasized collaboration. I think there's a lot of ways you could do this wrong and have it super competitive and stressful and someone's losing, all this kind of stuff. So we thought it was really fun to just have teams working together, which really represents what medicine's like, right? Like we all uh have got to collaborate in order to be able to be as you know effective and take great care of patients together. We all know what we know and then rely on colleagues to help us with the stuff we don't. And uh and so we just built this thing where the teams are working together and make it fun and lighthearted in that way, and then found a way to use Kahoot to tie in the audience so they're actively engaged and you know, playing with this leaderboard thing, but in a way that's meant to just be fun and active and collaborative. So that's the format that's uh I mean it probably needs it's probably room for improvement as well. Like we're like we're excited to get feedback about how it went, and there's parts of it that could be made even better.

SPEAKER_13 38:31

So yeah, talk about that. What do you think this looks like moving forward? Do we do it every year? Do we do like a pre-nano tournament and then have the champions come and duke it out at the meeting? I mean, what do you think about that?

SPEAKER_03 38:43

Well, yeah, that's hard to say. I think uh Sashank and I would be open to doing it again, but at the same time, there might be value in having you know different people come in with their curated collections of cases and presenting things in a in a different format. Um, and so you know, it might be something that would be very um valuable to continue in the future.

SPEAKER_05 39:05

We're really excited about all the energy and positive feedback that it got. I'll be honest, I was a little nervous because uh I'm like proposing this thing and now it's on the main stage, and it was just hard to know if the cases shouldn't be too easy, but they couldn't be obscure and like Walsh kind of cases that are like really hard to know. So finding that sweet spot of what the cases should look like, but I'm really energized by it and I to think that there'd be a future for it and we could like work together to figure out how to, you know, who all could be involved and what what that format should be. I think it's exciting.

SPEAKER_03 39:35

And I must say, I was really impressed with the performance of the young faculty members. Uh you know, I think the the future of neuroophthalmology is bright if you look at how good these young attendees are.

SPEAKER_13 39:46

No, I think you guys hit a home run. I smash it. I've gotten positive feedback from everybody I've talked to. Oh, that's awesome. You know, I think you guys nailed it, you know, the referee uniforms, the trophies. I think it was perfect.

SPEAKER_05 39:57

Um and I do feel a little corny with that. No, it was great.

SPEAKER_13 40:00

I think it was I think it was appropriate. I think it was it made it fun, it made it lighthearted. I think it wasn't too I don't think questions were too hard. Some of them were hard for me because I'm not a neurologist, but I digress. But that was our goal. No, it was great. It was great.

SPEAKER_05 40:12

Um I remember when I had a glitch on the slide and I threw the yellow flag on myself.

SPEAKER_13 40:18

Delay of games. Yeah, but you woke up the kinks, and I think like I'd love to see it, you know, moving forward, and I really appreciate you guys putting the hard work to do that and support education for Nanos and just make it in a in a fun way.

SPEAKER_05 40:32

And the meeting's amazing with so many more trainees now than I remember in years past. There's so many medical students and residents coming, and so if this is a way to remind them that, you know, and actually the teaching style often starts with a video of the patient's own history, because I think a lot of times, you know, that takes some effort to remember to capture that history from you know from the patient with their consent and everything, and you know, but usually they're really willing. And then the story starts with hell or you know, that's where the that's where clinical medicine starts. Every day in clinic we got to start with that history and then move to the exam and the scans and all that kind of stuff. And so I hope that by show teaching it that way, the students get to, you know, um really feel the power of starting with the history, then to the key exam findings and the other data is that get to the answer.

SPEAKER_03 41:15

I think the Neurobowl is definitely a powerful pipeline tool. You know, there is not a doubt that we have the most interesting cases in all of ophthalmology. And I I can't speak for neurology, but I think we're amongst the most interesting cases.

SPEAKER_13 41:28

Yeah, yeah.

SPEAKER_03 41:29

Uh and so to highlight those cases and the diversity of pathology that we see in neuroophthalmology uh in this session, I think is a powerful recruitment tool.

SPEAKER_12 41:37

Definitely, definitely. Well, Shank, Colin, thank you so much. And keep doing the good work. Thanks, Ray.

SPEAKER_05 41:42

Uh we appreciate it.

SPEAKER_13 41:44

We continue with a few more reflections from Nanos attendees. They continue to highlight the important themes of friendship and camaraderie intrinsic to Nanos, while also sharing their experiences from a powerful symposium that made a lasting impact on many meeting attendees.

SPEAKER_11 42:01

Hi, my name is Alana Tisdale. I'm a neuroophthalmologist that's based in the Boston area at a hospital called Leahy Clinic. This is probably my fourth time at Nanos. And one of my favorite parts about being here is running into all of my favorite colleagues from all over the country and having the chance to catch up with people who I have not had the chance to see for a long time. So, whether that's friends and mentors from fellowship or residency or previous jobs, it's really nice to have everyone in one place. And so that's one thing I love about NANOS every year. Another thing that I really enjoyed this year was a session that I went to that was about vision loss from the patient perspective and how to maintain compassion and empathy as a provider. Um, it was really moving that they had the father of a patient who unfortunately passed away at age seven and had also gone blind. Um, and so it was just very interesting to hear from the family member of a patient who was suffering. Since a lot of us deal with patients who have vision loss. And of course, for us, it becomes very common for us to talk to these patients, and sometimes it becomes very um, it seems normalized for us because we meet so many people like this. But it was definitely very powerful to hear things from the patient and family perspective and just to realize that um for people in that position, it might be the worst thing that's ever happened in their lives. And so it's important for us as providers to pause and really try to put ourselves in their shoes. But yeah, this NANOS meeting was uh awesome, and I'm glad that I came.

SPEAKER_01 43:38

Hi, I'm Dr. Devin Mackey. I practice neuroophthalmology at Indiana University, and uh it's been a pleasure to be here at the 2025 NANOS annual meeting. Uh some of the things that stood out most to me uh one was we we had a session about uh the importance of of compassion and of really trying to um you know meet our patients where they are in terms of uh some. With vision loss. A lot of times we focus on the ways to treat a disease and how to help someone from the medicine perspective, which is important. There's also another dimension of someone's suffering and what we can do to help alleviate that and really help them through their journey. So that was inspiring. And then of course the wall sessions are always amazing. So we we get together and talk through some of the most uh challenging cases that we that we see in our specialty and the the way they're presented, the the new um, you know, the way um science and technology have really allowed us to make um increasingly more complex uh diagnoses and assessments of patients is uh really inspiring, and I learn a ton from that each year. So those are some of the things that stood out to me this year.

SPEAKER_10 44:50

I'm Mark Robinson, I'm a neuroophthalmologist at the University of South Carolina and Prisma Health in Columbia, South Carolina, and I really enjoyed the Nanox meeting this year. Um two highlights. One was the vision loss session um that was really moving. I think it reminded us uh why we go into neuroophthalmology and take good care of our patients and the compassion. Um just the diff the different points that the speakers made um were um really touching and made it will make a difference in my practice. And the other is just seeing my friends and colleagues here uh at the meeting. Um I always have a lot of insights um and enjoy hearing the things they've learned and their struggles really helps me in my practice as I'm as I'm heading back uh tomorrow to clinic. So I'm really thankful to Nanos and um for everything that they do to put on such a wonderful meeting.

SPEAKER_13 45:43

In our final reflection, we hear from Dr. Heather Moss, president-elect of Nanos and the lead planner of the 2025 meeting.

SPEAKER_14 45:52

Planning the 2025 Nanos meeting was a labor of love. Love, because NANOS is my favorite meeting every year, and so it was incredibly exciting to get to lead the planning of it and plan the meeting that I wanted to attend. But also labor because it was absolutely shocking the sheer number of decisions that needed to be made. Thankfully, Nanos is an amazing executive office team who led the way, and the Scientific Programming Committee provided great perspective with which we shaped what I think turned out to be a wonderful program. Now, as for the biggest highlights, it's hard to get it down to only two, and I couldn't get it down to only two, so I have three. So the first one is kind of an obvious general one that seems trite, but I think is very true, which is seeing everyone come together for such a wonderful week of socializing, learning, and relaxing, connecting with old friends, making new friends is a highlight every year of the NANOS meeting. In terms of the programming, the therapy when there is no cure symposium, where we talked about the science and practice of supporting our patients with vision loss, and also supporting ourselves when we have patients who are having uh distress about their vision loss, was absolutely amazing. I can't remember a prior Nano symposium where people were tearful because they were so moved. And number three, the trick cowboy performer at the banquet. Who doesn't love a flaming lasso? And now it's on to planning 2026. Hope to see you in Boston.

SPEAKER_13 47:25

As you can see, the NANOS 2025 meeting did not disappoint, and once again reminds us why it remains the premier gathering for advancing neuroophthalmic knowledge and for celebrating the deep sense of community that makes our field so special. Whether you're a seasoned attendee or thinking about joining us for the first time, I hope this episode gave you a glimpse into the excitement, learning, and connection that make Nanos such a unique and meaningful experience. I had a blast and invite you to experience what so many of us have found in Nanos, a home in neuroophthalmology. I want to thank Dr. Susie Mullen and all the meeting attendees for sharing their experiences and reflections from the Nanos 2025 meeting. In the next episode, I'll bring you just a bit more from Nanos 2025, speaking with the developers and co-moderators of the Palliative Care Symposium, the powerful session that resonated deeply with so many of this year's attendees. Together, we'll explore the profound question many physicians eventually face. What do you do when you've done all you can to heal but can do no more?

SPEAKER_15 48:35

And I realized that there were times that one's spiritual self needed to be cared for, and that's really not part of the conversation typically with your doctors or with the health system that you're trying to navigate through. And let's be clear, we're not talking about religion, we're talking about the inner self, and that expression can be different for different people.

SPEAKER_13 49:00

That's our episode for today. Please stay tuned for the next episode. Until then, thanks for listening. Take care of yourself and see you next time when we come to you again out of the blind spot.