The One That Got Away: Overestimation of Forgone Alternatives as a Hidden Source of Regret.

Past research has established that observing the outcomes of forgone alternatives is an important driver of regret. In this research, we predicted and empirically corroborated a seemingly opposite result: Participants in our studies were more likely to experience regret when they did not observe a forgone outcome than when it was revealed. Our prediction drew on two theoretical observations. First, feelings of regret frequently stem from comparing a chosen option with one's belief about what the forgone alternative would have been. Second, when there are many alternatives to choose from under uncertainty, the perceived attractiveness of the almost-chosen alternative tends to exceed its reality. In four preregistered studies (Ns = 800, 599, 150, and 197 adults), we found that participants predictably overestimated the forgone path, and this overestimation caused undue regret. We discuss the psychological implications of this hidden source of regret and reconcile the ostensible contradiction with past research.

Aflibercept-Related Sterile Intraocular Inflammation Outcomes.

PURPOSE: A recent increase in sterile intraocular inflammation after aflibercept (EYLEA; Regeneron Pharmaceuticals, Inc, Tarrytown, NY) injection was reported to the American Society of Retina Specialists' Research and Safety in Therapeutics Committee. This study describes their clinical characteristics and outcomes. DESIGN: Case series. PARTICIPANTS: Sixty-eight eyes of 66 patients (97% reported from May 2017 through February 2018). METHODS: Exclusion criteria were intravitreal antibiotic injection and follow-up of less than 7 days. Diagnosis was at each physician's discretion. MAIN OUTCOME MEASURES: Presenting signs and symptoms, injection characteristics, management details, and visual outcomes. RESULTS: Mean time to presentation was 2.6 days (median, 2.0 days; range, 0-15 days). Symptoms included blurry vision (93%), floaters (60%), pain (44%), severe pain (6%), and photophobia (19%). Mean visual acuities before and after injection were 20/50 and 20/178, respectively. All patients showed intraocular inflammation: 24% with only vitritis, 16% with only anterior chamber reaction, and 60% with both. Less common findings included keratic precipitates (22%), corneal edema (13%), conjunctival injection (10%), chemosis (4%), hypopyon (4%), and fibrin (3%). Two patients were affected bilaterally. Treatment included topical steroids (93%), with 1% supplemented by oral steroids. Inflammation resolved in 79% at study completion (mean, 34 days; range, 7-105 days; 51% resolved by 1 month). This group's mean final visual acuity (VA) was 20/55, and 15% lost 2 lines or more. This vision loss was associated with shorter time to presentation (P < 0.0001), magnitude of decrease in presenting VA (P = 0.0004), presence of fibrin (P = 0.02), and trended toward receiving only observation (P = 0.10). There were no other presenting factors that significantly affected visual outcome. In patients with unresolved inflammation at the final visit, mean follow-up was 29 days, and mean final VA was 20/118. Overall, 26 aflibercept lots were involved. CONCLUSIONS: This is the largest study of aflibercept-related sterile intraocular inflammation, and is the only large report to exclude eyes injected with intraocular antibiotics. Most patients presented early with decreased VA and intraocular inflammation, but without injection, hypopyon, fibrin, or severe pain. Final VA remained decreased in a significant minority of patients.

Good Choice, Bad Judgment: How Choice Under Uncertainty Generates Overoptimism.

We examine a fundamental feature of choice under uncertainty: Overestimating an alternative makes one more likely to choose it. If people are naive to this structural feature, then they will tend to have erroneously inflated expectations for the alternatives they choose. In contrast to theories of motivated reasoning, this theory suggests that individuals will overestimate chosen alternatives even before they make their choice. In four studies, we found that students and managers exhibited behavior consistent with naïveté toward this relationship between estimation error and choice, leaving them overoptimistic about their chosen alternatives. This overoptimism from choosing positive error is exacerbated when the true values of the alternatives are close together, when there is more uncertainty about the values of alternatives, and when there are many alternatives to choose from. Our results illustrate how readily overoptimism emerges as a result of statistical naïveté, even in the absence of a desire to justify one's decision after the choice.

RESOLUTION OF NONINFECTIOUS UVEITIC CYSTOID MACULAR EDEMA WITH TOPICAL DIFLUPREDNATE.

PURPOSE: To evaluate the short-term safety and efficacy of topical difluprednate (0.05%) for the treatment of noninfectious uveitic cystoid macular edema. METHODS: Twenty-seven patients (35 eyes) undergoing treatment with difluprednate 4 times daily for 3 weeks for noninfectious uveitic cystoid macular edema were reviewed for visual acuity, intraocular pressure, optical coherence tomography, and fluorescein angiography results. A mixed model analysis was fit with each measure as the outcome, visit as the primary predictor, and patient and eye as random effects. RESULTS: Mean central foveal thickness decreased by 117 µm (P < 0.001) at 30 ± 15 days, 124 µm (P < 0.001) at 60 ± 15 days, and 152 µm (P < 0.001) at 180 ± 30 days. Complete resolution of intraretinal fluid was observed in 15 of 34 (44%) eyes at 30 ± 15 days, 11 of 21 (52%) eyes at 60 ± 15 days, and 9 of 12 (75%) eyes at 180 ± 30 days. Improvement in fluorescein leakage was noted in 7 of 8 eyes (88%). Visual acuity improved by a mean of 5 letters (P = 0.001) at 30 ± 15 days, 5.5 letters (P = 0.007) at 60 ± 15 days, and 7 letters (P = 0.032) at 180 ± 30 days. Mean increase in intraocular pressure was 1.48 mmHg at 30 ± 15 days (P = 0.080), 1.92 mmHg at 60 ± 15 days (P = 0.110), and 6.18 mmHg (P = 0.001) at 180 ± 30 days. CONCLUSION: Topical difluprednate is a well-tolerated and effective treatment for noninfectious uveitic cystoid macular edema with decreased central foveal thickness, mild improvement in visual acuity, and elevation of intraocular pressure observed in a few patients.

Popularity, similarity, and the network extraversion bias.

Using the emergent friendship network of an incoming cohort of students in an M.B.A. program, we examined the role of extraversion in shaping social networks. Extraversion has two important implications for the emergence of network ties: a popularity effect, in which extraverts accumulate more friends than introverts do, and a homophily effect, in which the more similar are two people's levels of extraversion, the more likely they are to become friends. These effects result in a systematic network extraversion bias, in which people's social networks will tend to be overpopulated with extraverts and underpopulated with introverts. Moreover, the most extraverted people have the greatest network extraversion bias, and the most introverted people have the least network extraversion bias. Our finding that social networks were systematically misrepresentative of the broader social environment raises questions about whether there is a societal bias toward believing other people are more extraverted than they actually are and whether introverts are better socially calibrated than extraverts.

Integrative advances for OCT-guided ophthalmic surgery and intraoperative OCT: microscope integration, surgical instrumentation, and heads-up display surgeon feedback.

PURPOSE: To demonstrate key integrative advances in microscope-integrated intraoperative optical coherence tomography (iOCT) technology that will facilitate adoption and utilization during ophthalmic surgery. METHODS: We developed a second-generation prototype microscope-integrated iOCT system that interfaces directly with a standard ophthalmic surgical microscope. Novel features for improved design and functionality included improved profile and ergonomics, as well as a tunable lens system for optimized image quality and heads-up display (HUD) system for surgeon feedback. Novel material testing was performed for potential suitability for OCT-compatible instrumentation based on light scattering and transmission characteristics. Prototype surgical instruments were developed based on material testing and tested using the microscope-integrated iOCT system. Several surgical maneuvers were performed and imaged, and surgical motion visualization was evaluated with a unique scanning and image processing protocol. RESULTS: High-resolution images were successfully obtained with the microscope-integrated iOCT system with HUD feedback. Six semi-transparent materials were characterized to determine their attenuation coefficients and scatter density with an 830 nm OCT light source. Based on these optical properties, polycarbonate was selected as a material substrate for prototype instrument construction. A surgical pick, retinal forceps, and corneal needle were constructed with semi-transparent materials. Excellent visualization of both the underlying tissues and surgical instrument were achieved on OCT cross-section. Using model eyes, various surgical maneuvers were visualized, including membrane peeling, vessel manipulation, cannulation of the subretinal space, subretinal intraocular foreign body removal, and corneal penetration. CONCLUSIONS: Significant iterative improvements in integrative technology related to iOCT and ophthalmic surgery are demonstrated.