About

Robert A Avery, DO, is an Associate Professor of Ophthalmology at the Children's Hospital of Philadelphia. His research investigates methods for assessing the visual pathway of children with optic pathway gliomas and optic neuropathy. He is the principal investigator of an NIH/NEI sponsored grant using hand-held optical coherence tomography to monitor tumor progression in children with optic pathway gliomas. Additionally, he serves as a principal investigator for a multi-center international study of optic pathway gliomas secondary to Neurofibromatosis type 1, funded by the Children’s Tumor Foundation and Gilbert Family Neurofibromatosis Institute. Clinically, Dr. Avery cares for children and adults with neuro-ophthalmic conditions at the Children’s Hospital of Philadelphia and the Perelman Center for Advanced Medicine. His clinical expertise includes managing children with vision problems secondary to Neurofibromatosis type 1, such as optic pathway gliomas and orbital plexiform neurofibromas, as well as ocular myasthenia gravis, elevated intracranial pressure, tumors of the visual pathway, unexplained vision loss, optic neuropathy, ocular motility, and pupil abnormalities.

Research topics

• Computer Science
• Medicine
• Pathology
• Biology
• Internal medicine

Selected publications

• A Spectrum of Severity of a Unifying Retinal Phenotype in TUBB4B-Associated Inherited Retinal Degeneration

  Retinal Cases & Brief Reports · 2026-01-22

  article

  PURPOSE: To increase our understanding of TUBB4B-associated autosomal dominant retinal degenerations through in-depth retinal phenotyping. METHODS: Two patients with pathogenic heterozygous variants in TUBB4B underwent a comprehensive ophthalmic exam, multimodal imaging with spectral domain optical coherence tomography (SD-OCT), ultra-widefield fundus imaging and short-wavelength (SW) and near infrared (NIR) fundus autofluorescence (FAF). Kinetic and chromatic dark- and light-adapted perimetry co-localized to the SD-OCT scans was performed in the older patient. RESULTS: A 4 year old, high hyperope (+7D) boy sensorineural hearing loss (SNHL) since one year of age presented with surface elevation of the optic nerves concerning for papilledema. Visual acuities were 20/50 and 20/60 for the right and left eye, respectively. Evaluation revealed optic disc drusen, low-grade foveal hypoplasia and a retina-wide photoreceptor degeneration, most severe in the pericentral retinal sparing of the foveal center. A 43 year-old ∼6D myope woman with a 10-year-history of subtle visual field loss presented with normal visual acuities and generalized constriction of her kinetic fields. There as a retina-wide degeneration with a severe pericentral component encircled a normally laminated central island of normal rod- and cone photoreceptor function by chromatic perimetry. She reported no hearing loss. Genetic testing revealed heterozygous pathogenic variants in TUBB4B (c.1171C>T in the child, c.1168C>T variant in the adult patient). CONCLUSIONS: We find in TUBB4B-associated retinal degeneration a predilection of disease to the pericentral retina with relative central sparing. The findings support a spectrum of severity within a recurring retinal phenotype that reconciles apparent phenotypic variability reported for this condition.

  PublisherDOI

• Remote Physiologic Monitoring and Principal Care Management for Chronic Retinal Diseases: Results from over 80,000 Encounters

  medRxiv · 2026-03-02

  articleOpen access

  Abstract Purpose Timely detection of disease activity in chronic retinal diseases improves visual outcomes but is limited by the lack of validated systems for continuous monitoring and care management. We evaluated the real-world performance of an integrated remote physiologic monitoring and principal care management program (RemoniHealth®) using a self-administered multimodal retinal function test (Macustat®) for home monitoring. Methods This single-arm real-world intervention study was conducted across 33 retina practices. A total of 2,216 adults with chronic retinal diseases performed weekly home retinal function testing with integrated care management support. Primary endpoints included the annualized rate of disease progression detection, time to intervention after first flag, true positive rate, and patient adherence. Descriptive statistics and data analyses were analyzed using chi-square tests and Clopper–Pearson confidence intervals. Results Participants contributed 82,644 encounters and 16,805 patient-months of monitoring. The program generated 241 alerts, including 101 Macustat flags and 135 care management prompts. Among 73 adjudicated flags, 56 were true positives and 17 false positives (PPV 76.7%). The annualized detection rate was 4 per 100 patient-years. Of confirmed events, 93% led to intravitreal injection or other major management change. Mean adherence was 72.1%, and patients with ≥80% adherence had higher odds of true positivity. Discussion This RPM–PCM model achieved high engagement and meaningful detection of asymptomatic progression between visits, supporting the value of home monitoring for timely intervention. Translational Relevance These findings support scalable integration of home vision testing and care management into routine retinal practice to enable earlier intervention and improved continuity of care.

  PublisherOA PDFDOI

• Clinical safety and efficacy of bevacizumab in combination with mitogen-activated protein kinase kinase inhibitor therapy for glioma: a retrospective analysis

  Neuro-Oncology Pediatrics · 2026-01-01

  articleOpen access

  Abstract Background Mitogen-activated protein kinase kinase (MEK) and vascular endothelial growth factor (VEGF) inhibitors are both used to treat progressive, pediatric low-grade glioma (LGG), and VEGF inhibitors have been used to salvage vision in optic pathway glioma (OPG). The combination of these 2 drugs may be an effective bridge to salvage vision in progressive OPG; however, a paucity of data exists on synergistic toxicities. Methods We performed a retrospective multi-institutional cohort study to examine toxicity and visual acuity (VA) outcomes among patients treated with overlapping bevacizumab and MEK inhibitor therapy. Patients were included if they had a probable or biopsy-confirmed glioma of any location treated with overlapping treatment between 2010 and 2022. Toxicities potentially related to combination therapy were abstracted by chart review and graded by CTCAE, version 5. Results Seventeen patients received treatment with a combination of bevacizumab and MEK inhibitor for a median duration of 3.5 months (range 1-21). No unexpected toxicities were identified: 3 patients experienced a grade 3 toxicity (acneiform rash, proteinuria, and asymptomatic creatine kinase elevation); no grade 4 toxicities were identified. Of the 8 patients with OPG and evaluable VA, 3 (38%) either showed vision improvement or stabilization of a documented VA decline. No patients demonstrated worsened VA. Conclusions MEK inhibitor therapy with adjuvant bevacizumab appears to be safe in patients with progressive, treatment-refractory sporadic and NF1-associated glioma. A larger, prospective study would help establish the safety and efficacy of this combination as an alternate treatment approach to optimize visual outcomes for OPG.

  PublisherDOI

• Tempered Optimism: Advances in the Precision Medicine Era for Pediatric Low-Grade Glioma

  Neuro-Oncology · 2026-05-16

  article

  The clinical trial landscape of molecularly targeted treatments for pediatric low-grade glioma (pLGG) has created an exciting and hopeful era for both patients and clinicians alike. Despite numerous clinical trials investigating the use of targeted agents for pLGG, only two oral precision-based regimens for pLGG have received federal agency approval. However, enthusiasm surrounding recently completed early phase clinical trials has resulted in increased off-label prescribing practices beyond the federally-approved indications, despite a lack of phase 3 clinical trial data and an incomplete understanding of the long-term radiographic, functional outcomes, and toxicity for both approved and experimental therapies. These gaps in knowledge are critically important to consider when selecting therapies for patients with pLGG, as the prevention and reduction of late effects in pLGG survivors is crucial to prevent long-term morbidity. In this editorial by the clinical working group of the International pLGG Coalition, we discuss the landscape of molecularly targeted therapies for pLGG, outline the unanswered questions for the use of novel therapies in the management of pLGG, review the risks and benefits of early off-label use of targeted agents, and discuss the importance of patience and evidence-based clinical practice in the rapidly evolving era of precision medicine.

  PublisherDOI

• Pediatric Optic Pathway Gliomas: Diagnosis, Management, and Outcomes

  International Ophthalmology Clinics · 2026-03-23

  articleOpen accessSenior author

  Optic pathway gliomas (OPGs) are the most common brain tumor that pediatric ophthalmologists and neuro-ophthalmologists care for. These low-grade gliomas are found along the anterior portion of the visual pathway and demonstrate unique features in their growth, impact on visual function and response to treatment. The standardized approach to the ophthalmologic evaluation and testing positions the ophthalmologist to play a vital role in the care of these unique tumors. This review will cover the epidemiology, clinical evaluation, treatment and outcomes of OPGs.

  PublisherDOI

• Including visual outcomes in optic pathway glioma clinical trials

  Neuro-Oncology · 2025-11-26 · 1 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Vision Loss

  Elsevier eBooks · 2025-06-02

  book-chapter1st authorCorresponding
  PublisherDOI

• Contributors

  Elsevier eBooks · 2025-06-02

  book-chapter
  PublisherDOI

• CMV Incidence, Risk Factors and Breakthrough Infections in a Multicenter Lung Transplant Cohort

  The Journal of Heart and Lung Transplantation · 2025-04-01

  article
  PublisherDOI

• KALM: Knowledge-Driven Active Learning for Medical Image Segmentation Using Localized Similarity

  2025-04-14 · 2 citations

  article

  Limited labeled data could compromise the robustness of segmentation models trained on medical images. In medical imaging, manual segmentation is time-consuming and financially costly since expert human labor (radiologist etc.) is required. Active learning (AL) is a promising approach to reduce the amount of labeled data required to train a model by iteratively selecting only the most beneficial instances to be labeled from the pool of unlabeled data. Towards this, we propose a novel AL query paradigm designed for the segmentation of 3D medical images. We use a selector which incorporates the knowledge related to a segmentation model performance measured by the Dice similarity coefficient on a validation dataset. The selector identifies failed validation cases and searches for potentially unsuccessful cases in the unlabeled pool by maximizing a localized image similarity metric. The method is evaluated on two datasets of medical images from multiple sites and modalities: 479 pediatric brain magnetic resonance images for the segmentation of the anterior visual pathway and 131 contrast-enhanced computed tomography scans for liver and tumor segmentation. Our results demonstrate that the proposed AL strategy achieves similar or better segmentation performance than established but computationally more complex uncertainty sampling methods, while showcasing its potential to efficiently select optimal unlabeled data.

  PublisherDOI

Recent grants

• Visual outcome measures in children with optic Pathway gliomas

  NIH · $1.1M · 2015–2017

• Biomarkers of Vision Loss in Children with Optic Pathway Gliomas

  NIH · $3.3M · 2019–2025

Frequent coauthors

• Scott R. Plotkin

  Massachusetts General Hospital

  662 shared

• Rosalie E. Ferner

  658 shared

• Brigitte C. Widemann

  National Cancer Institute

  639 shared

• Kent A. Robertson

  Indiana University – Purdue University Indianapolis

  636 shared

• Michael J. Ferguson

  Glasgow Royal Infirmary

  576 shared

• D. Gareth Evans

  The Christie NHS Foundation Trust

  524 shared

• Pamela Knight

  Children's Tumor Foundation

  510 shared

• Victor Mautner

  Cardiff University

  506 shared