About

Alexander J. Brucker, MD, is the Founder's Professor in Retinal and Vitreous Diseases in Ophthalmology at the University of Pennsylvania. He serves as the Chief of the Retina and Vitreous Service of the Department of Ophthalmology at the University of Pennsylvania and is the Director of the Retina Fellowship Program at the Scheie Eye Institute. Dr. Brucker's clinical practice involves caring for patients at both the Scheie Eye Institute and Penn Medicine at Radnor. His research focuses on three main areas: age-related macular degeneration, diabetic retinopathy, and other retinal, vitreous, and retinovascular diseases. He is currently the Principal Investigator in multiple clinical trials related to age-related macular degeneration, diabetes, macular telangiectasia, and other retinal vascular disorders. Dr. Brucker has contributed significantly to the understanding and treatment of retinal diseases through his clinical and research activities.

Research topics

• Medicine
• Ophthalmology
• Internal medicine
• Surgery
• Pediatrics
• Biology
• Pathology
• Computational biology
• Genetics

Selected publications

• Préface

  Elsevier eBooks · 2025-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

• 0569 iPSC-derived fibroblasts and keratinocytes from individuals with recessive dystrophic epidermolysis bullosa reveal deficits in early-stage autophagy and lipid accumulation

  Journal of Investigative Dermatology · 2025-07-21

  articleOpen access
  PublisherOA PDFDOI

• VITREOUS PROTEOME IN COMBINED RHEGMATOGENOUS RETINAL AND CHOROIDAL DETACHMENT

  Retina · 2025-06-27

  article

  PURPOSE: To review the literature on vitreous analysis in eyes with concurrent rhegmatogenous retinal and choroidal detachment (RRD-CD). METHODS: A comprehensive literature search was performed from January 2000 through December 2023 for "rhegmatogenous retinal detachment", "choroidal detachment", AND "vitreous." All English language primary literature was reviewed, and seven studies were found to meet inclusion criteria. Vitreous molecules were categorized by upregulated and downregulated states in RRD-CD eyes compared to controls. The cytokines, chemokines, growth-factors, metabolites, transporter molecules, and other plasma proteins/lipids in the vitreous samples were evaluated in a systematic format to identify pathophysiologic processes involved. RESULTS: Mass spectrometry and immunoassays were most commonly employed for evaluation. Notable dysregulation of the complement cascade (C3a and C5a), immunologic response (sICAM-1, IL-1B, and cellular metabolites), and major inflammatory mediators (MIF and IL-6) was identified and may serve as salient targets. Intravitreal and systemic agents have had mixed success in treating RRD-CD. Utilization of existing modalities and targeting novel factors have not been fully evaluated in RRD-CD. CONCLUSIONS: Identification of alterations in levels of vitreous proteins in RRD-CD cases compared to controls highlights disease pathophysiology. Clinical targets exist and additional studies are warranted to improve management of this condition.

  PublisherDOI

• MULTICENTER STUDY OF FACTORS ASSOCIATED WITH VISUAL AND ANATOMIC OUTCOMES OF SUPRACHOROIDAL HEMORRHAGE

  Retina · 2025-09-09

  article

  PURPOSE: To report outcomes of suprachoroidal hemorrhage (SCH). METHODS: Retrospective nonrandomized study of eyes with SCH from two sites (January 1, 2013-December 31, 2022). The primary outcome was the 6-month change in visual acuity (VA). Multivariable analysis was performed, as well as a comparison of matched eyes with and without systemic steroids. RESULTS: Overall, 143 eyes of 143 patients (mean age 70.8 years, 52.4% male) were included, with 72 perioperative, 24 traumatic, and 47 spontaneous SCH cases. The mean (SD) presenting VA was 2.07 (0.92) logMAR. 87 (60.8%) were managed nonsurgically, 24 (16.8%) underwent drainage, and 32 (22.4%) underwent drainage and vitrectomy; 36 (25.2%) received systemic steroids. At 6 months, the mean (SD) change in VA from presentation was -0.41 (0.84) logMAR. 102 eyes (71.3%) achieved anatomic success (complete retinal attachment). Concurrent retinal detachment was associated with worse VA change and anatomic success in multivariable analysis ( P < 0.05). In the matching analysis, eyes receiving systemic steroids were more likely to achieve ≥ 3-line gain in VA than matched eyes without systemic steroids (77.8% vs. 55.3%, P = 0.047). CONCLUSION: The visual prognosis of eyes with SCH remains guarded. Systemic steroids may be associated with a modest benefit for visual outcomes. Concurrent retinal detachment portends worse outcomes.

  PublisherDOI

• A REVIEW OF FLUORESCEIN ANGIOGRAPHY, INDOCYANINE GREEN ANGIOGRAPHY, AND OTHER FLUOROPHORES IN OPHTHALMOLOGY

  Retina · 2025-11-11

  article

  PURPOSE: To review fluorophores used in ophthalmology and summarize properties relevant to imaging, diagnosis, and safety. METHODS: Discussion of excitation, emission, and other essential properties of specific fluorophores. RESULTS: Sodium fluorescein, a fluorophore, is used for angiography and remains the cornerstone for retinal vascular imaging. Indocyanine green is also a fluorophore that absorbs light at longer wavelengths, enabling improved choroidal visualization and aiding in the diagnosis of various vascular, inflammatory, and neoplastic diseases. It is also used to stain the internal limiting membrane during vitreoretinal surgery. Other fluorophores, such as rose bengal, are used topically and can be used in the treatment of corneal fungal infections. Riboflavin has uses in the cornea, and curcurmin has potential uses because of its binding affinity to amyloid. CONCLUSION: In addition to fluorescein and indocyanine green, there are expanding uses for additional fluorophores, with further investigation needed for new imaging and treatment techniques.

  PublisherDOI

• Self-Supervised Learning for Improved Optical Coherence Tomography Detection of Macular Telangiectasia Type 2

  JAMA Ophthalmology · 2024-02-08 · 11 citations

  letterOpen access

  Importance: Deep learning image analysis often depends on large, labeled datasets, which are difficult to obtain for rare diseases. Objective: To develop a self-supervised approach for automated classification of macular telangiectasia type 2 (MacTel) on optical coherence tomography (OCT) with limited labeled data. Design, Setting, and Participants: This was a retrospective comparative study. OCT images from May 2014 to May 2019 were collected by the Lowy Medical Research Institute, La Jolla, California, and the University of Washington, Seattle, from January 2016 to October 2022. Clinical diagnoses of patients with and without MacTel were confirmed by retina specialists. Data were analyzed from January to September 2023. Exposures: Two convolutional neural networks were pretrained using the Bootstrap Your Own Latent algorithm on unlabeled training data and fine-tuned with labeled training data to predict MacTel (self-supervised method). ResNet18 and ResNet50 models were also trained using all labeled data (supervised method). Main Outcomes and Measures: The ground truth yes vs no MacTel diagnosis is determined by retinal specialists based on spectral-domain OCT. The models' predictions were compared against human graders using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under precision recall curve (AUPRC), and area under the receiver operating characteristic curve (AUROC). Uniform manifold approximation and projection was performed for dimension reduction and GradCAM visualizations for supervised and self-supervised methods. Results: A total of 2636 OCT scans from 780 patients with MacTel and 131 patients without MacTel were included from the MacTel Project (mean [SD] age, 60.8 [11.7] years; 63.8% female), and another 2564 from 1769 patients without MacTel from the University of Washington (mean [SD] age, 61.2 [18.1] years; 53.4% female). The self-supervised approach fine-tuned on 100% of the labeled training data with ResNet50 as the feature extractor performed the best, achieving an AUPRC of 0.971 (95% CI, 0.969-0.972), an AUROC of 0.970 (95% CI, 0.970-0.973), accuracy of 0.898%, sensitivity of 0.898, specificity of 0.949, PPV of 0.935, and NPV of 0.919. With only 419 OCT volumes (185 MacTel patients in 10% of labeled training dataset), the ResNet18 self-supervised model achieved comparable performance, with an AUPRC of 0.958 (95% CI, 0.957-0.960), an AUROC of 0.966 (95% CI, 0.964-0.967), and accuracy, sensitivity, specificity, PPV, and NPV of 90.2%, 0.884, 0.916, 0.896, and 0.906, respectively. The self-supervised models showed better agreement with the more experienced human expert graders. Conclusions and Relevance: The findings suggest that self-supervised learning may improve the accuracy of automated MacTel vs non-MacTel binary classification on OCT with limited labeled training data, and these approaches may be applicable to other rare diseases, although further research is warranted.

  PublisherOA PDFDOI

• Genome-wide association analyses identify distinct genetic architectures for age-related macular degeneration across ancestries

  Nature Genetics · 2024-12-01 · 35 citations

  articleOpen access
  PublisherOA PDFDOI

• SUPRACHOROIDAL SPACE INJECTION TECHNIQUE

  Retina · 2024-03-06 · 10 citations

  article

  PURPOSE: To develop professional guidelines for best practices for suprachoroidal space (SCS) injection, an innovative technique for retinal therapeutic delivery, based on current published evidence and clinical experience. METHODS: A panel of expert ophthalmologists reviewed current published evidence and clinical experience during a live working group meeting to define points of consensus and key clinical considerations to inform the development of guidelines for in-office SCS injection. RESULTS: Core consensus guidelines for in-office SCS injection were reached and reported by the expert panel. Current clinical evidence and physician experience supported SCS injection as a safe and effective method for delivering retinal and choroidal therapeutics. The panel established consensus on the rationale for SCS injection, including potential benefits relative to other intraocular delivery methods and current best practices in patient preparation, pre- and peri-injection management, SCS-specific injection techniques, and postinjection management and follow-up. CONCLUSION: These expert panel guidelines may support and promote standardization of SCS injection technique, with the goal of optimizing patient safety and outcomes. Some aspects of the procedure may reasonably be modified based on the clinical setting and physician judgment, as well as additional study.

  PublisherDOI

• Ultra-Widefield and Early Treatment Diabetic Retinopathy Study 7-Field Grading of Diabetic Retinopathy

  JAMA Ophthalmology · 2024-08-15 · 4 citations

  letterOpen access

  Importance: High concordance in diabetic retinopathy (DR) outcomes between 7-field (7F) and ultra-widefield (UWF) images would allow for combining longitudinal assessments based on the 2 modalities both in clinical studies and clinical care. Objective: To compare 7F and UWF imaging with regard to DR severity and the associations of DR severity with risk factors, such as hemoglobin A1c, age, diabetes duration, and sex. Design, Setting, and Participants: This cross-sectional study describes the outcomes of the randomized clinical Diabetes Control and Complications Trial (DCCT) and its subsequent observational study, the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Of the 1441 participants with type 1 diabetes in the DCCT, 1375 were enrolled in the EDIC study. Of the 1171 participants who were active between March 2019 and December 2021, 200° UWF color imaging and 7F fundus photographs were obtained for 785 participants once at the same visit. Central graders assessed 7F-UWF with a 7F template masking the retinal periphery and the full UWF image (UWF-global). Data were analyzed from January 2022 to March 2023. Exposures: Hemoglobin A1c was assessed quarterly during the DCCT and annually during the EDIC study using high-performance liquid chromatography. Main Outcomes and Measures: Retinopathy was determined independently for all imaging as mild, moderate, or severe nonproliferative DR (SNPDR) using the Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale for the 7F images and the global ETDRS grading scale for the UWF images. Panretinal and focal photocoagulation were self-reported or based on scarring location and pattern observed during grading. Proliferative DR (PDR) was defined by observed neovascularization or evidence of panretinal photocoagulation. Results: Among the 785 participants included in this study, 420 (53%) were male and 365 (47%) were female. The mean (SD) age was 61 (7) years. DR grading between UWF-7F and 7F imaging was correlated for all outcomes, including for severe outcomes, such as SNPDR (κ, 0.73; concordance, 96%), PDR (κ, 0.74; concordance, 97%), scatter photocoagulation (κ, 0.97; concordance, 99%), and focal photocoagulation (κ, 0.71; concordance, 98%). Most DR severity scores were within 1 step (1410 of 1529 [92%]), and 3% (51 of 1529) were more than 2 steps apart (κ, 0.45; 95% CI, 0.42-0.49; weighted κ, 0.63; 95% CI, 0.60-0.67) on the ETDRS severity scale. DR severity assessed within the UWF-global area was higher compared to 7F (median [IQR] UWF-global score, 3 [2-3] vs median 7F level score, 2.0 [1-3]; P < .001), although the 2 modalities were correlated (1225 of 1508 [81%] 1-step agreement; weighted κ, 0.41). Conclusions and Relevance: Standard ETDRS 7F and UWF evaluations of DR were comparable for ETDRS severity levels as previously reported by Diabetic Retinopathy Clinical Research Retina Network reports. In addition, these evaluations of DR were comparable for DCCT/EDIT study outcomes and major study conclusions, suggesting that use of UWF imaging is not likely to introduce relevant measurement biases in future longitudinal studies. Trial Registration: ClinicalTrials.gov Identifiers: NCT00360815.

  PublisherOA PDFDOI

• ROBIN: a randomised, double-masked, placebo-controlled Phase IIa study of the AOC3 inhibitor BI 1467335 in diabetic retinopathy

  Eye · 2024-05-28 · 5 citations

  articleOpen access

  OBJECTIVE: To evaluate the safety and efficacy of BI 1467335 in patients with non-proliferative diabetic retinopathy (NPDR). METHODS: ROBIN is a Phase IIa, double-masked, randomised, placebo-controlled study (NCT03238963). Patients with NPDR and without centre-involved diabetic macular oedema were included; all had a best corrected visual acuity letter score of ≥70 Early Treatment Diabetic Retinopathy Study letters in the study eye at screening. Patients received oral BI 1467335 10 mg or placebo once daily for 12 weeks. Post-treatment follow-up was 12 weeks. The primary endpoint was the proportion of patients over the 24 weeks with ocular adverse events (AEs). Secondary endpoints were the proportion of patients with ≥2-step improvement from baseline in DRSS severity level at Week 12 and the proportion of patients with non-ocular AEs at 24 weeks. RESULTS: Seventy-nine patients entered the study (BI 1467335, n = 40; placebo, n = 39). The proportion of patients with ocular AEs over 24 weeks was greater in the BI 1467335 versus the placebo group (35.0% vs 23.1%, respectively). Treatment-related AEs were reported for similar numbers of patients in the placebo and BI 1467335 group (7.7% vs 7.5%, respectively). At Week 12, 5.7% (n = 2) of patients in the BI 1467335 group had a 2-step improvement in DRSS severity level from baseline, compared with 0% in the placebo group. CONCLUSIONS: BI 1467335 was well tolerated by patients with NPDR. There was a high variability in DRSS levels for individual patients over time, with no clear efficacy signal.

  PublisherOA PDFDOI

Frequent coauthors

• Anton M. Kolomeyer

  75 shared

• Irwin M. Siegel

  64 shared

• Juan E. Grunwald

  57 shared

• Tomas S. Alemán

  University of Pennsylvania

  52 shared

• Emily Y. Chew

  National Eye Institute

  48 shared

• Gui‐Shuang Ying

  University of Pennsylvania

  47 shared

• Benjamin J. Kim

  University of Pennsylvania

  41 shared

• Brian L. VanderBeek

  40 shared

Education

• B.S.

  University of Maryland

  1967

• M.D.

  New York Medical College

  1972

• M.D.

  University of Lausanne, Switzerland

  1972