About

Laura Joan Balcer, M.D., M.S.C.E., is an Adjunct Professor of Neurology at the Department of Neurology at the University of Pennsylvania. Her primary research focus is on the identification and development of clinical visual outcome measures for multiple sclerosis (MS) trials. Her group, funded jointly by the National Eye Institute and the National MS Society, concentrates on determining which clinical tests best identify visual dysfunction in patients with MS. Her studies have examined the relationship of visual function to neurologic impairment, magnetic resonance imaging abnormalities, and health-related quality of life. Data from her investigations have led to the inclusion of low-contrast letter acuity as a secondary outcome measure in two international MS treatment trials. She has also utilized optical coherence tomography (OCT) to examine retinal nerve fiber layer and macular thickness as biological markers of neuronal and axonal loss in MS patients.

Research topics

• Medicine
• Psychiatry
• Internal medicine
• Pediatrics
• Computer Science
• Psychology
• Artificial Intelligence
• Political Science
• Intensive care medicine
• Audiology
• Physical medicine and rehabilitation
• Physical therapy
• Ophthalmology
• Optometry
• Clinical psychology
• Virology
• Emergency medicine
• Neuroscience

Selected publications

• Factors associated with subjective cognitive complaints in former American football players

  Journal of the International Neuropsychological Society · 2026-02-01

  article

  Abstract Objective: Subjective cognitive complaints (SCC) can precede cognitive decline and are associated with demographic, exposure, lifestyle, and psychological factors. Prevalences of SCC and their correlates in individuals with repetitive head impacts (RHI) are poorly understood. This study characterized SCC in former elite American football players by frequency, mood and behavioral correlates, concordance with informant reports, and associations with neuropsychological test performance, cerebrospinal fluid (CSF), and magnetic resonance imaging (MRI) markers of neurodegeneration. Method: Former American football players ( n = 180) completed measures of global and domain-specific SCC, neuropsychiatric symptom questionnaires, neuropsychological testing, lumbar puncture, and MRI. Elastic net regression evaluated the relative importance of potential SCC correlates. Intraclass correlation coefficients measured concordance between self and informant reports. Multiple linear regressions tested associations between SCC and verbal memory and executive functioning scores. CSF Aβ 1-42 , p-tau 181 , t-tau, neurofilament light (NfL), hippocampal volume, and regional cortical thickness were examined for their potential associations with SCC. Results: Rates of SCC ranged from 43 to 77% depending on the domain. Symptoms of depression, impulsivity, and anxiety were strongly associated with SCC. Self- and informant-reported SCC showed moderate inter-rater agreement. Adjusting for age, race, education, APOE ϵ4 carrier status, and depressive symptoms, SCC were associated with lower objective verbal memory and executive functioning performance. SCC were associated with lower parahippocampal cortical thickness but not with hippocampal volume or any of the measured CSF tests. Conclusions: SCC are strongly associated with neuropsychiatric factors in former American football players. SCC may also be a marker of cognitive decline and neurodegeneration.

  PublisherDOI

• Inflammation, Limbic White Matter Microstructure, and Clinical Symptoms in Retired American Football Players With Repetitive Head Impacts

  Neurology · 2026-02-25 · 1 citations

  article

  BACKGROUND AND OBJECTIVES: The link between repetitive head impact (RHI) exposure, later-life cognitive decline, and neurobehavioral dysregulation (NBD) is not well understood. Recent work has implicated inflammation and limbic dysfunction as relevant RHI correlates. Our goal was to integrate plasma and CSF inflammatory biomarkers, structural brain imaging, and clinical measures in former elite American football players to better understand reasons for RHI-related cognitive and neurobehavioral changes. METHODS: ) among inflammation, WM, and clinical outcomes in former football players. Post hoc analyses tested whether associations differed by group (football vs UE; group interactions) or were stronger in football players considered at highest risk of CTE. RESULTS: = 0.003 [0.008-0.16]). Most of the observed associations were stronger in the CTE probable subgroup. There were no direct associations between plasma or CSF markers of inflammation and cognition. DISCUSSION: In former elite football players, elevated plasma and CSF inflammatory markers were associated with poorer limbic WM microstructure, which in turn related to worse cognition. Given the limbic system's role in cognition and behavior, inflammation may be a modifiable target for RHI-related neurodegeneration. Limitations include the cross-sectional design and limited generalizability to other contact sports, lower levels of play, female athletes, or other RHI sources.

  PublisherDOI

• Imaging the later‐life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI

  Alzheimer s & Dementia · 2026-04-01

  articleOpen access

  INTRODUCTION: Repetitive head impacts (RHI) from contact sports may cause a unique pattern of white matter hyperintensities (WMH) on T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), termed RHI-associated WMH (RHI-WMH). These lesions are punctate, circular, and located at the gray-white matter boundary, an area vulnerable to trauma-related damage. METHODS: We investigated the association of RHI with these lesions in two aging cohorts: (1) former American football players versus asymptomatic unexposed men and (2) individuals with RHI from various contact sports versus non-RHI participants. RHI-WMH were assessed using visual ratings and a novel automated quantification pipeline. RESULTS: Individuals with RHI had greater RHI-WMH by both detection methods in both cohorts. RHI-WMH were associated with plasma neurofilament light and p-tau231, and flortaucipir positron emission tomography (PET) uptake. DISCUSSION: RHI-WMH may represent a new supportive biomarker for the detection of RHI-related neuropathologies later in life.

  PublisherDOI

• An Urban Transdisciplinary Concussion Center

  Neurology Clinical Practice · 2026-02-25

  article

  Public awareness of concussion has grown significantly over the past 2 decades, driven largely by media coverage of sports-related injuries. This has paralleled a rise in traumatic brain injury (TBI)–related emergency department visits, underscoring the need for specialized concussion care centers. Despite this, most existing programs focus on sports or pediatric populations, leaving critical care gaps.

  PublisherDOI

• Cognitive, biomarker, and neuroimaging indices associated with traumatic encephalopathy syndrome across two independent athlete cohorts

  Research Square · 2026-04-28

  preprintOpen access
  PublisherOA PDFDOI

• Faculty Perspectives on Appreciation Strategies in a Neurology Department

  Neurology Clinical Practice · 2025-09-04

  articleOpen access

  Background and Objectives: Burnout is a pervasive occupational hazard for neurologists-undermining their well-being, jeopardizing patient safety and satisfaction, limiting access to care, and inflating health care costs. Well-designed appreciation and recognition practices may help mitigate some of its key drivers. This pilot study evaluates faculty perspectives on appreciation strategies in an academic neurology department. We used the Moffitt Provider Appreciation Assessment (MPAA), which assesses the types of appreciation methods respondents value, regardless of whether those practices are currently implemented in their workplace. Methods: A cross-sectional survey was conducted among full-time clinical faculty in the Department of Neurology at NYU Grossman School of Medicine. The survey included demographics, the MPAA, the single-item Mini-Z burnout inventory to assess self-reported burnout levels, and an intent-to-leave question. MPAA responses were analyzed for frequencies, and the association between burnout and intent to leave was examined. Results: < 0.00001). Because the scores for self-reported burnout and intent to leave reflect current work conditions while MPAA scores capture enduring personal values, MPAA rankings cannot be compared directly with burnout or turnover metrics. Discussion: Neurology clinical faculty prioritized appreciation methods that directly address clinical work, underscoring the value of implementing tailored recognition practices that may reduce burnout. The methodology used in this pilot study can be adapted for broader application in other settings. After identifying faculty preferences, health care organizations can implement meaningful, transparent, and inclusive appreciation strategies that have the potential to strengthen physician relationships, promote well-being, and support a sustainable workforce.

  PublisherOA PDFDOI

• Autonomic dysfunction and quality of life in a cohort of neurology outpatients with post-acute sequelae of COVID-19, a two-year follow-up study

  Journal of Clinical Neuroscience · 2025-11-06

  article
  PublisherDOI

• Visual Pathway Structure and Function in Pediatric-onset Multiple Sclerosis (POMS): Are Social Determinants of Health (SDOH) Related? (P10-1.011)

  Neurology · 2025-04-07

  article

  To determine the relation of visual function tests and optical coherence tomography (OCT) measures to social determinants of health (SDOH) in pediatric-onset multiple sclerosis (POMS).

  PublisherDOI

• Combining inter-eye differences enhances detection of optic nerve involvement in multiple sclerosis

  Brain · 2025-11-25 · 1 citations

  article

  The 2024 revised McDonald criteria for multiple sclerosis recognize the optic nerve as a topography for dissemination in space. Optical coherence tomography-derived inter-eye differences in peri-papillary retinal nerve fiber layer or ganglion cell-inner plexiform layer thicknesses (≥6μm or ≥4μm, respectively) are proposed for identifying unilateral optic nerve involvement. However, the value of combining inter-eye difference measures and optimal temporal-quadrant peri-papillary retinal nerve fiber layer inter-eye differences remains unclear. We investigated the diagnostic performance of combined inter-eye differences, optimal temporal-quadrant peri-papillary retinal nerve fiber layer inter-eye differences, and examined the effects of time, prior optic neuritis frequency, sex, and race on inter-eye differences. Retinal optical coherence tomography images from all study participants underwent rigorous quality control. Receiver operating characteristic analyses and area under the receiver operating characteristic curves (AUC) were used to determine optimal inter-eye differences of individual and combined measures to distinguish eyes with, from without, prior optic neuritis in people with multiple sclerosis. Mixed-effects models were used to assess impact of time, prior optic neuritis events, sex, and race on inter-eye differences. An independent multiple sclerosis cohort from a second center was examined for external validation. Among 1854 people with multiple sclerosis, optimal inter-eye difference thresholds for identifying unilateral optic nerve involvement were 6μm for peri-papillary retinal nerve fiber layer (AUC=0.80), 4μm for ganglion cell-inner plexiform layer (AUC=0.83), and 8μm for temporal-quadrant peri-papillary retinal nerve fiber layer (AUC=0.71) thicknesses. Peri-papillary retinal nerve fiber layer inter-eye differences ≥6μm or ganglion cell-inner plexiform layer inter-eye differences ≥4μm yielded 87.6% sensitivity, 70.0% specificity, and 64.0% positive predictive value. Concurrent inter-eye differences at lower thresholds (≥5μm peri-papillary retinal nerve fiber layer, ≥3μm ganglion cell-inner plexiform layer) reduced sensitivity to 72.5%, but improved specificity (86.6%) and positive predictive value (76.7%), while maintaining accuracy and negative predictive value. Temporal-quadrant peri-papillary retinal nerve fiber layer inter-eye differences did not improve diagnostic performance. Over a median of 5.1 years, ganglion cell-inner plexiform layer and peri-papillary retinal nerve fiber layer inter-eye differences remained stable. Prior optic neuritis counts and sex did not affect inter-eye differences. Although Black Americans had higher inter-eye differences than White Americans, optimal thresholds were comparable across races. The validation cohort comprising 254 people with multiple sclerosis confirmed these findings. In conclusion, concurrent peri-papillary retinal nerve fiber layer (≥5μm) and ganglion cell-inner plexiform layer inter-eye differences (≥3μm) improve unilateral optic nerve involvement detection versus either alone (≥6μm or ≥4μm, respectively), while temporal-quadrant peri-papillary retinal nerve fiber layer inter-eye differences offer limited benefit. Inter-eye differences remain stable longitudinally and unaffected by prior optic neuritis frequency.

  PublisherDOI

• The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis

  The Lancet Neurology · 2025-09-17 · 38 citations

  reviewOpen access
  PublisherOA PDFDOI

Recent grants

• NIH Grant K24EY018136

  NIH · $792k · 2013

• Neurologic Clinical Epidemiology Training Program

  NIH · $156k · 2008–2013

• NIH Grant R01EY019473

  NIH · $1.3M · 2012

• Neurologic Clinical Epidemiology Training Program

  NIH · $4.0M · 2008–2029

• NIH Grant R01EY014993

  NIH · $891k · 2010

Frequent coauthors

• Steven Galetta

  1060 shared

• Elliot M. Frohman

  Stanford University

  740 shared

• Teresa C. Frohman

  Stanford University

  634 shared

• Peter A. Calabresi

  National Institutes of Health

  614 shared

• Shiv Saidha

  Johns Hopkins Medicine

  361 shared

• Scott S. Zamvil

  Cornell University

  351 shared

• Robert P. Lisak

  Wayne State University

  347 shared

• Scott D. Newsome

  Neurology, Inc

  285 shared