About

Eric Nudleman is an Associate Professor of Clinical Ophthalmology at UC San Diego School of Medicine, located at 9500 Gilman Drive, La Jolla, CA. His research activities and funding focus on the role of PDLIM1 in retinal vascular leakage and proliferation. His work involves investigating various aspects of ophthalmic diseases, including retinal vascular conditions, diabetic macular edema, retinopathy of prematurity, and age-related macular degeneration. Dr. Nudleman has contributed to the development of automated tools and deep learning algorithms for retinal image analysis, as well as studies on the clinical and imaging features of retinal diseases. His research aims to improve diagnosis, management, and understanding of ocular vascular and degenerative conditions.

Research topics

• Artificial Intelligence
• Computer Science
• Medicine
• Machine Learning
• Ophthalmology
• Pharmacology
• Mathematics
• Bioinformatics
• Internal medicine
• Biology
• Pathology

Selected publications

• Multi-grader validation of the telemedicine retinopathy of prematurity severity score

  Scientific Reports · 2026-05-12

  articleOpen access

  We aimed to statefully validate Retinopathy of Prematurity (ROP) grading by evaluating intergrader variability over age-matched simulated exams. In a prospective retinal photographic grading cohort study, both eyes of twenty patients with five images per eye per visit were graded by twelve expert graders across six weekly visits. For each eye visit, ROP experts graded the Zone, Stage, and Plus, from which the Telemedicine ROP Severity Score (tROP-SS) was calculated. Graders retained knowledge of prior assessments for a given eye and followed International Classification of ROP rules. Intergrader coefficient of variation (CoV) for Zone, Stage, Plus, and tROP-SS remained below 20% across six weeks of age-matched visits. Zone showed the most changes in CoV (p < 0.001) with a minimum at week three of 6.0% (95% CI: 3.0-8.9%). Stage (9.2-13.1%) did not significantly vary over time. CoV of Plus gradually increased (p = 0.002) from week 1 (1.2%, 95% CI: 0.3-2.0%) to week 6 (3.3%, 95% CI: 1.7-4.9%). Agreement for tROP-SS varied over time (p < 0.001) and reached a local minimum at week three (10.5%, 95% CI: 7.3-13.8%). High intergrader agreement in a stateful data set validates the use of tROP-SS as a scoring system to capture week-to-week ROP progression.

  PublisherOA PDFDOI

• Comprehensive Ocular Characteristics in Cystinosis after Hematopoietic Stem-Cell Gene Therapy Over 24 Months

  American Journal of Ophthalmology · 2026-02-09

  article
  PublisherDOI

• Re: Zhang et al.: Rates of endophthalmitis in prefilled versus nonprefilled syringes for intravitreal injections: a systematic review and meta-analysis. (Ophthalmology Retina. 2026;10:165-175)

  Ophthalmology Retina · 2026-04-01

  articleSenior author
  PublisherDOI

• Association Between Neighborhood Opportunity Levels and Requiring Retinopathy of Prematurity Treatment

  Journal of Pediatric Ophthalmology & Strabismus · 2026-03-20

  article

  Purpose: To determine the relationship between neighborhood-level socioeconomic status and requiring retinopathy of prematurity (ROP) treatment, using the Child Opportunity Index (COI). Methods: Electronic medical records for all patients who received ROP treatment from January 2010 to March 2024 at a tertiary care center were retrospectively reviewed. Controls were obtained by matching pediatric ophthalmology patients with the closest clinic visit date and no history of retinopathy of prematurity. Demographic and clinical information were collected. The patient's 5-digit ZIP code was used to determine the COI score and level. Results: This study included 245 study patients and 735 matched controls, of which 110 (44.9%) and 329 (44.8%) were female, respectively. The study group had a significantly lower mean COI score (48 ± 29) compared to controls (56 ± 31, P &lt; .001). Additionally, the study group had a higher percentage of Hispanic/Latino patients compared to the control group (51.8% vs 41.9%, respectively, P = .01). When stratified into type 1 (n = 195) and type 2 (n = 50) ROP, patients in the ROP groups continued to have lower mean COI scores (50 ± 29 and 44 ± 28, respectively) than the control group (56 ± 31; P = .01 and P = .006, respectively). The type 1 ROP group had a greater number of patients with Medi-Cal insurance compared to the control group (50.8% vs 46.4%, respectively, P = .04). Conclusions: Neighborhood socioeconomic status may play a critical role in the management of ROP. It is important to understand the synergistic relationship between social determinants of health when addressing health disparities and developing community-level interventions.

  PublisherDOI

• Universal Newborn Eye Screening in São Paulo, Brazil

  Ophthalmic surgery, lasers & imaging retina · 2026-04-22

  articleOpen access

  This brief report describes the incidence and characteristics of ocular abnormalities in healthy term newborn infants (HTNI) in 5,000 consecutive eye examinations from a database of 32,000 infants from 17 hospitals in São Paulo, Brazil. Imaging consisted of five views of the retina (optic nerve center, superior, inferior, nasal, temporal) with 130° wide-angle lens and one view of the anterior segment in each eye. These images were curated on four separate occasions for the presence or absence of ocular abnormality by a pediatric retina specialist. All images were obtained within 72 hours of birth. A total of 59,792 images were curated: Right Eye Normal (21,473 images), Left Eye Normal (21,983 images), Right Eye Abnormal (8,397 images), Left Eye Abnormal (7,939 images). An ocular abnormality appeared in 37.7% of patients; 4.88% showed a referral-warranted pathology. Based on these data, it is not unreasonable to consider instituting universal newborn eye screening in HTNI.

  PublisherDOI

• Association of metformin use with primary open-angle glaucoma using data from the National Institutes of Health <i>All of Us</i> Program

  BMJ Open Ophthalmology · 2025-09-01 · 2 citations

  articleOpen access

  BACKGROUND: Few studies have assessed the impact of metformin use on glaucoma risk. The purpose of this study was to examine the association between metformin use and the incidence of primary open-angle glaucoma (POAG) in a diverse and large nationwide cohort. METHODS: Research Program aged 40 years or older, with a diagnosis of diabetes mellitus and without a diagnosis of POAG prior to diabetes diagnosis or metformin use. Bivariate logistic regression, multivariable logistic regression and survival analysis were used to analyse the association between ever use of metformin and incidence of POAG. RESULTS: Within the cohort, 240 participants acquired a diagnosis of POAG during all available follow-up time, while 18 200 did not. In regression-based bivariate analysis, metformin use was significantly associated with a lower odds of developing POAG (OR 0.35, 95% CI 0.26 to 0.47, p<0.001). In multivariable regression analysis, metformin remained protective against POAG (OR 0.33, 95% CI 0.21 to 0.50, p<0.001), while the use of other diabetic medications was associated with an increased odds of developing POAG (OR 2.39, 95% CI 1.48 to 3.90, p<0.001). In survival analysis, the probability of developing POAG was significantly lower for the participants using metformin than for the participants not using metformin (log-rank p<0.001, Cox proportional HR 0.38, 95% CI 0.29 to 0.51). CONCLUSIONS: This study provides additional large-scale observational health data supporting the protective role of metformin in the development of POAG. However, limitations include the study's observational design and lack of data on metformin dosage and duration, glaucoma severity and ocular exam findings. Despite these limitations, our findings contribute to the growing body of evidence suggesting a potential protective effect of metformin against POAG.

  PublisherOA PDFDOI

• Review of Retinopathy of Prematurity Management in the Anti‐ <scp>VEGF</scp> Era: Evolving Global Paradigms, Persistent Challenges and Our <scp>AI</scp> ‐Assisted Future

  Clinical and Experimental Ophthalmology · 2025-09-04

  reviewOpen access

  Retinopathy of prematurity (ROP) remains a major cause of preventable blindness in premature infants worldwide, with increasing incidence due to advancements in neonatal care. Management of ROP has been revolutionised by anti-vascular endothelial growth factor (anti-VEGF) treatments. Pivotal clinical trials have demonstrated the efficacy of anti-VEGF in the management of Type 1 ROP, while investigation of safety and long-term effects is ongoing. However, infants with ROP often have persistent avascular retina (PAR) despite treatment and require lifelong monitoring for myopia, glaucoma, amblyopia, strabismus, significant refractive error, retinal tears and detachment and adult reactivation of ROP. Alternative therapeutics, including beta-blockers, polyunsaturated fatty acids and vitamin A, remain under investigation. Alongside therapeutic advancements, artificial intelligence (AI) and telemedicine programmes have the potential to expand screening accessibility, particularly in underserved regions, and improve inter-observer variability, though challenges in implementation remain. Together, advanced therapeutics and AI-enhanced screening hold promise for improving outcomes and reducing ROP-related blindness globally.

  PublisherOA PDFDOI

• Persistent avascular retina in eyes with retinopathy of prematurity: A comprehensive review

  Taiwan Journal of Ophthalmology · 2025-07-18 · 1 citations

  reviewOpen accessSenior author

  Abstract Persistent avascular retina (PAR) refers to retinal areas where vascular development permanently arrests in premature children. In the last decade, the first-line treatment for retinopathy of prematurity (ROP) has shifted from laser photocoagulation to antivascular endothelial growth factor (VEGF) therapy, leading to the increased observation of PAR in eyes treated for ROP. Emerging evidence suggests that PAR could pose a risk for late reactivation of ROP, retinal breaks, or detachment. Consequently, PAR has emerged as an important finding in eyes of regressed ROP. In this review, we summarize the recent understanding of PAR, including its pathophysiologic mechanism, prevalence, clinical pathological significance, and management. We conclude that PAR can be often observed in eyes treated with anti-VEGF therapy (type 1 ROP) and in those that regress without treatment (type 2 ROP). Current management of PAR lacks consensus; however, since PAR can potentially cause late reactivation or rhegmatogenous retinal detachment after achieving regression of ROP, treatment with laser photocoagulation should be considered, and lifelong monitoring is recommended.

  PublisherDOI

• Utilization Patterns and Costs of Ocular Amniotic Membrane Grafts in the Medicare Population

  Ophthalmology · 2025-08-26 · 2 citations

  articleOpen access

  PURPOSE: Recent investigations from the Office of the Inspector General and The New York Times have raised concerns about the costs to Medicare of skin substitutes, documenting pervasive fraudulent billing practices outside of ophthalmology. These investigations have not covered the use of tissue in eye care, despite similar reimbursement incentives for the use of sutureless ocular amniotic membrane grafts (AMGs). We examine the volume, cost, and clinical indications associated with sutureless AMGs in eye care. DESIGN: Retrospective cohort study of fee-for-service Medicare patients who received sutureless AMGs and eye care providers who bill for sutureless AMGs. PARTICIPANTS: Nationally representative 20% sample of Medicare Part B claims for sutureless AMGs between 2011 and 2020. METHODS: We use longitudinal patient-level and provider-level data to specify regression models for our primary outcomes. We estimate Cox proportional hazards survival models for time-to-event analyses and logistic regression models for binary outcomes. MAIN OUTCOME MEASURES: Clinical indications for AMG use, time from patients' first encounter with a provider to their first AMG, use of AMGs for dry eye, and costs to Medicare. RESULTS: Dry eye accounted for 44% of all sutureless AMG use in 2020, increased from 7% in 2011. Charges for ocular sutureless AMGs increased from $3.5 million in 2011 to $95.6 million in 2020; charges for AMGs used to treat dry eye increased from $250 000 to $41.4 million over this period. Some 28% of all claims for AMGS were submitted by 1% of providers. Patients are more likely to receive an AMG when seen by an optometrist (hazard ratio, 1.16; P < 0.001). The annual costs to Medicare for a patient with dry eye have increased dramatically among providers who use AMGs. CONCLUSIONS: The costs to Medicare for skin substitutes are inflated by reimbursement models that encourage their use even when there is little clinical indication. These concerns may be applicable to eye care as well, where spending on amniotic membrane grafts has increased dramatically, particularly for indications where clinical benefit may be limited. By requiring AMG manufacturers to report accurate sales prices, policymakers could reduce costs without limiting coverage of AMGs for appropriate clinical indications. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

  PublisherOA PDFDOI

• IMPACT OF FARICIMAB VERSUS AFLIBERCEPT ON EPIRETINAL MEMBRANE FORMATION OVER 2 YEARS IN PATIENTS WITH DIABETIC MACULAR EDEMA IN THE PHASE 3 YOSEMITE AND RHINE TRIALS

  Retina · 2025-07-16 · 6 citations

  articleOpen access

  BACKGROUND/PURPOSE: To assess the effects of faricimab versus aflibercept on epiretinal membrane (ERM) formation in eyes with diabetic macular edema. METHODS: Post hoc analysis of phase 3 YOSEMITE/RHINE trial data in eyes with diabetic macular edema receiving faricimab every 8 weeks (Q8W), faricimab treat-and-extend (T&E; up to Q16W depending on central subfield thickness and best-corrected visual acuity), or aflibercept Q8W for 100 weeks. RESULTS: ERMs developed in 3.8% (23/602) of eyes treated with faricimab Q8W, 5.1% (31/608) with faricimab T&E, and 7.6% (45/590) with aflibercept Q8W at 100 weeks. ERMs were less likely with faricimab Q8W versus aflibercept Q8W (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.29-0.81, P = 0.0055). The mean (SD) best-corrected visual acuity at 100 weeks in eyes with and without ERMs were 69.2 (13.6) letters [20/40 Snellen] versus 73.8 (13.1) [20/40 Snellen], respectively; the mean (SD) CSTs were 315.8 (99.2) versus 274.6 (74.1) µ m. Faricimab T&E dosing intervals were extended ≥ Q12W in 79.7% of eyes without ERMs versus 50.0% with ERMs. CONCLUSION: Risk of ERMs was 52% lower with faricimab Q8W versus aflibercept Q8W over 100 weeks in eyes with diabetic macular edema, suggesting a potential role for faricimab in reducing pre-retinal fibrotic proliferation. The results may help inform physician/patient decision-making when initiating intravitreal therapy. TRIAL REGISTRATION: NCT03622580 and NCT03622593.

  PublisherDOI

Recent grants

• Role of PDLIM1 in Retinal Vascular Leakage and Proliferation

  NIH · $713k · 2018–2021

Frequent coauthors

• William R. Freeman

  Jacobs (United States)

  50 shared

• Antonio Capone

  Oakland University

  43 shared

• Sally L. Baxter

  University of California, Davis

  31 shared

• Yoshihiro Yonekawa

  Thomas Jefferson University

  30 shared

• Michael T. Trese

  Oakland University

  30 shared

• Henry Ferreyra

  Jacobs (United States)

  29 shared

• Kevin C. Chen

  Vantage View (United States)

  28 shared

• Kimberly A. Drenser

  Associated Retinal Consultants

  27 shared

Education

• Ph.D., Ophthalmology

  University of California, San Diego

  2000

• M.D., Medicine

  University of California, San Diego

  1996

• B.A., Biology

  University of California, San Diego

  1992