Acute Retinal Pigment Epitheliitis (ARPE), also known as Krill’s disease, is a rare, idiopathic, self-limiting inflammatory disorder affecting the macula of otherwise healthy young adults. It classically presents with sudden visual disturbances—most often a painless central scotoma—corresponding to focal disruption of the outer retinal layers, particularly the interdigitation and ellipsoid zones, as seen on spectral-domain optical coherence tomography (OCT) EyeWikiEyeWiki. First described by Krill and Deutman in 1972, ARPE lesions appear on fundus exam as fine, dark gray pigment stippling surrounded by a yellow-white halo in the foveal region. Vision typically recovers spontaneously over 6–12 weeks without treatment EyeWikiPubMed.
Although no definitive treatment exists, multimodal imaging—including OCT, fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICGA)—is essential to confirm the diagnosis, distinguish ARPE from overlapping “white dot” syndromes, and exclude other maculopathies SpringerOpenEyeWiki.
Types
ARPE Type 1 (Adult Unilateral ARPE)
Predominantly affects young adults presenting unilaterally. On OCT, there is a dome-shaped hyperreflective lesion at the photoreceptor outer segment disrupting the ellipsoid and interdigitation zones, occasionally extending into the outer nuclear layer. ICGA may be unremarkable or show a faint halo of late hyperfluorescence. Vision typically returns to baseline within weeks SpringerOpen.
ARPE Type 2 (Pediatric/Bilateral ARPE)
Seen chiefly in minors or younger adults with bilateral involvement. OCT shows similar interdigitation-zone disruption often extending into the outer plexiform layer. FA/ICGA usually reveal focal late hyperfluorescence. Some cases, especially in children, may have incomplete visual recovery and persistent OCT abnormalities SpringerOpen.
Causes & Associations
(While most ARPE cases are idiopathic, various triggers have been documented or hypothesized.)
Idiopathic Origin
The majority of ARPE presentations have no identifiable trigger, arising spontaneously in healthy individuals. Its “unknown cause” underscores its classification as idiopathic PubMed.Viral Prodrome
Approximately 17% of patients report flu-like symptoms 1–2 weeks before ARPE onset, suggesting a post-viral inflammatory mechanism EyeWiki.COVID-19 Infection
A case of bilateral ARPE following confirmed SARS-CoV-2 infection in a 19-year-old female highlights COVID-19 as a potential viral trigger Longdom.COVID-19 Vaccination
ARPE has been reported one month after the second dose of BNT162b2 mRNA vaccine, indicating immune-mediated retinal injury post-vaccination PubMed.Influenza Vaccination
In the same report, an influenza vaccine administered five days before ARPE onset suggests that different immunizations may act as triggers PMC.Intravenous Bisphosphonates
ARPE has occurred after pamidronate infusion for osteoporosis, implicating drug-induced immunotoxicity of the RPE BioMed Central.Dopamine D₂ Agonists
A 28-year-old woman on cabergoline for hyperprolactinemia developed ARPE, suggesting dopaminergic modulation of photoreceptor function may contribute PubMed.MerTK (Mer Tyrosine Kinase) Deficiency
Reports propose that genetic defects in MerTK—critical for RPE phagocytosis—could predispose to ARPE by impairing outer segment clearance Via Medica Journals.Choriocapillaris Perfusion Changes
Adaptive-optics and OCT-angiography studies implicate transient choriocapillaris flow deficits in the outer retina as a pathogenetic factor Eco-Vector Journals Portal.Drug-Induced Immunogenicity
Beyond bisphosphonates and dopamine agonists, ARPE may follow other systemic medications that elicit retinal toxicity or hypersensitivity PMC.White-Dot Syndrome Overlap
ARPE shares features with MEWDS and AMN; immune mechanisms common to these white-dot syndromes may also underlie some ARPE cases EyeWikiEyeWiki.Phototoxic Injury (Hypothesized)
Intense solar or laser exposure can damage photoreceptors and RPE, potentially precipitating ARPE-like lesions in susceptible individuals EyeWiki.Autoimmune Mechanisms (Hypothesized)
Dysregulated autoimmunity against retinal antigens—analogous to autoimmune retinopathies—may occasionally manifest as ARPE Wikipedia.Systemic Inflammatory Diseases (Hypothesized)
Conditions such as sarcoidosis or vasculitis might rarely involve the outer retina in an ARPE-like pattern Nature.Genetic Predisposition (Hypothesized)
Unidentified genetic variants beyond MerTK may confer susceptibility to RPE inflammation under environmental or immunologic stress Eco-Vector Journals Portal.
Symptoms
Acute Painless Visual Loss
Most patients notice a sudden decrease in central vision without eye pain, often described as “blurriness.” EyeWikiCentral Scotoma
A dark or gray spot in the center of vision, confirmed by Amsler-grid testing, is the hallmark symptom. EyeWikiMetamorphopsia
Straight lines appear wavy or bent, reflecting macular distortion from outer-retinal lesions SciELO.Dyschromatopsia
Altered color perception—particularly for red and green hues—has been reported, especially when the fovea is involved PubMed.Mild Photopsia
Brief flashes of light (photopsias) may accompany the central scotoma in some cases ScienceDirect.Photophobia (Occasional)
Increased light sensitivity can occur, likely due to RPE disruption and altered photoreceptor function.Reading Difficulty
Patients often struggle with near tasks—such as reading—due to central vision loss.Gray or Dark Spots
Besides scotomas, some describe a persistent spot in the field of vision.Mild Ocular Discomfort
Although typically painless, a vague sense of ocular fullness or discomfort can be reported.Transient Headache (Occasional)
A mild headache around the time of visual onset may reflect systemic prodromal symptoms.
Diagnostic Tests
Physical Examination
Visual Acuity Testing
Quantifies the degree of central vision loss; most ARPE patients present with ~20/30 to 20/100. EyeWikiAmsler Grid
Detects central scotomas and metamorphopsia; patients indicate areas of distortion or missing squares. EyeWikiFundus Examination (Direct Ophthalmoscopy)
Reveals fine pigment stippling in the macula bordered by a pale halo and occasional white dots. EyeWiki
Manual Ophthalmic Tests
Slit-Lamp Biomicroscopy
Assesses the anterior segment to exclude uveitis or other anterior pathology; typically unremarkable in ARPE. EyeWikiIndirect Ophthalmoscopy
Provides a wide-field view to confirm the macular lesion and rule out peripheral retinal disease.Pupillary Light Reflex
Ensures normal afferent and efferent pathways; absence of a relative afferent pupillary defect helps differentiate ARPE from optic neuropathies.
Laboratory & Pathological Tests
Complete Blood Count (CBC)
Typically normal; helps exclude systemic infection or inflammation. PubMedC-Reactive Protein (CRP)
Assesses systemic inflammation; usually low in isolated ARPE.Syphilis Serology (VDRL/FTA-ABS)
Rules out syphilitic maculopathy in atypical cases.Viral Serologies (e.g., HSV, VZV)
Considered if a viral prodrome is prominent.
Electrodiagnostic Tests
Electro-oculogram (EOG)
May show a mildly reduced Arden ratio, indicating RPE dysfunction. EyeWikiFull-Field Electroretinogram (ERG)
Generally normal, confirming localized rather than diffuse photoreceptor involvement.Multifocal ERG (mfERG)
Detects localized macular amplitude depressions correlating with lesion site. EyeWiki
Imaging Tests
Fundus Photography
Documents the characteristic pigment stippling and hypopigmented halo for baseline comparison. EyeWikiOptical Coherence Tomography (OCT)
The investigation of choice, showing a dome-shaped hyperreflective lesion at the ellipsoid/interdigitation zones with possible outer nuclear layer extension. SpringerOpenEyeWikiFundus Autofluorescence (FAF)
Highlights areas of increased autofluorescence corresponding to RPE disruption and pigment stippling. EyeWikiFluorescein Angiography (FA)
Reveals a transmission window defect (hyperfluorescence) without dye leakage at the fovea in most cases. EyeWikiIndocyanine Green Angiography (ICGA)
Often normal initially; may later show focal or halo-like late hyperfluorescence. EyeWikiOCT Angiography (OCTA)
Detects transient choriocapillaris flow voids underlying the lesion, aiding subtype classification. SpringerOpenAdaptive Optics Flood Illumination Ophthalmoscopy (AO-FIO)
Provides high-resolution imaging of cone photoreceptor disruption and recovery over time. PMC
Non-Pharmacological Treatments
Because ARPE resolves spontaneously, non-drug approaches focus on supportive care, visual rehabilitation, and patient education.
Photobiomodulation Therapy (PBM)
Description: Low-level red to near-infrared light (500–1000 nm) applied externally over the closed eyelids.
Purpose: Enhance mitochondrial function in RPE cells to reduce oxidative stress and inflammation.
Mechanism: Light absorption by cytochrome c oxidase boosts ATP production and modulates inflammatory pathways PMCPMC.
Subthreshold Micropulse Laser Therapy
Description: Tissue-sparing laser (usually 577 nm) delivered in micropulses to the macular area.
Purpose: Stimulate RPE repair without causing retinal burns.
Mechanism: Brief “ON-OFF” laser pulses induce cellular heat shock responses, promoting RPE healing Nature.
Transpalpebral Electrical Stimulation (TpES)
Description: Microcurrent delivered through adhesive electrodes on the eyelids (20 Hz, 800 µA, 20 min).
Purpose: Preserve retinal function and slow degeneration.
Mechanism: Electrical currents increase neurotrophic factor release, improve retinal blood flow, and reduce pro-inflammatory cytokines PubMed.
Transdermal Electrical Stimulation (TdES)
Description: Skin patch electrodes around the orbit delivering biphasic pulses (1 mA, 10 ms, 20 Hz).
Purpose: Enhance visual acuity in degenerative retinal conditions.
Mechanism: Stimulates release of IGF-1, CNTF, BDNF; modulates apoptosis pathways; increases chorioretinal perfusion Nature.
Non-Invasive Electrical Stimulation (NES)
Description: External microcurrent applied near the eye.
Purpose: Neuroprotection of RPE and photoreceptors.
Mechanism: Promotes neurotrophin secretion, anti-inflammatory effects, and anti-apoptotic signaling BioMed Central.
Low-Level Laser Therapy (LLLT)
Description: Continuous-wave laser (600–1000 nm) at low power directed at closed eyelids.
Purpose: Reduce RPE oxidative injury.
Mechanism: Similar to PBM, enhances mitochondrial resilience and modulates cytokine profiles Wikipedia.
Ocular Acupuncture
Description: Fine-needle insertion at periocular acupuncture points.
Purpose: Improve ocular blood flow and reduce inflammation.
Mechanism: Stimulates release of endothelial nitric oxide and endogenous opioids; evidence limited.
Vitreous Hydration Massage
Description: Gentle ocular massage over the closed eyelid.
Purpose: Promote micro-circulation in choroid.
Mechanism: Mechanical pressure modulates ocular blood flow; anecdotal support.
Eye Warm Compresses
Description: Warm, moist cloth over closed eyes for 5–10 min.
Purpose: Soothe eye discomfort, improve local circulation.
Mechanism: Heat induces vasodilation and metabolic clearance of inflammatory mediators.
Environmental Light Control
Description: Use of dim ambient lighting and polarized lenses.
Purpose: Reduce glare and phototoxic stress on RPE.
Mechanism: Limits blue-light-induced oxidative damage.
Saccadic Eye Movement Exercises
Description: Rapid gaze shifts between fixed targets (e.g., “saccade pyramids”).
Purpose: Enhance oculomotor control and contrast detection.
Mechanism: Trains cortical-subcortical pathways for improved visual scanning PMC.
Smooth Pursuit Training
Description: Follow a moving target slowly with the eyes.
Purpose: Improve tracking of moving objects and reduce transient blur.
Mechanism: Reinforces smooth pursuit neuronal circuits.
Accommodation Flexibility Drills
Description: Alternating focus between near and far targets.
Purpose: Maintain lens flexibility and reduce visual fatigue.
Mechanism: Exercises ciliary muscle dynamics.
Peripheral Awareness Training
Description: Monitor objects entering peripheral vision field.
Purpose: Enhance detection of paracentral scotomas.
Mechanism: Strengthens peripheral retinal–cortical connections.
Contrast Sensitivity Tasks
Description: Identify low-contrast symbols or letters.
Purpose: Improve ability to discern subtle changes in luminance.
Mechanism: Stimulates contrast-sensitive neurons.
Mindfulness Meditation
Description: Guided breath-focus sessions (10–20 min daily).
Purpose: Reduce stress-induced inflammatory cytokines.
Mechanism: Downregulates HPA axis and systemic inflammation.
Guided Imagery
Description: Visualization of calm, healing imagery.
Purpose: Promote relaxation and coping.
Mechanism: Activates parasympathetic responses, lowering cortisol.
Yoga Nidra (Yogic Sleep)
Description: Systematic body awareness relaxation practice.
Purpose: Alleviate anxiety about vision changes.
Mechanism: Induces deep relaxation, reduces systemic oxidative stress.
Amsler Grid Self-Monitoring
Description: Daily home use of Amsler grid to chart visual distortions.
Purpose: Early detection of scotoma changes.
Mechanism: Empowers timely medical review.
Patient Education & Self-Management Workshops
Description: Structured sessions on ARPE, symptom tracking, lifestyle adjustments.
Purpose: Enhance adherence to supportive measures.
Mechanism: Improves health literacy and self-efficacy.
Pharmacological Treatments
Although ARPE is self-resolving, steroids have been trialed without clear benefit; antivirals and NSAIDs are used empirically in some cases.
Oral Prednisone (Class: Systemic corticosteroid)
Dosage: 1 mg/kg/day for 7–14 days, then taper.
Timing: Start at onset of symptoms.
Side Effects: Weight gain, hypertension, hyperglycemia, mood changes.
Evidence: Did not shorten recovery; may slow visual improvement EyeWiki.
Intravenous Methylprednisolone (Class: Systemic corticosteroid)
Dosage: 1 g/day for 3 days.
Timing: Administered at acute presentation.
Side Effects: Fluid retention, immunosuppression, insomnia.
Evidence: Case reports suggest faster symptom resolution in some patients Lippincott Journals.
Prednisolone Acetate 1% Ophthalmic Suspension (Class: Topical corticosteroid)
Dosage: 1 drop QID for 2–4 weeks.
Side Effects: Increased IOP, cataract formation with long-term use.
Evidence: Anecdotal use; no controlled trials PMC.
Difluprednate 0.05% Ophthalmic Emulsion (Class: Topical corticosteroid)
Dosage: 1 drop BID for 2 weeks.
Side Effects: Similar to prednisolone.
Evidence: Off-label in posterior segment inflammation.
Intravitreal Triamcinolone Acetonide (Class: Injectable corticosteroid)
Dosage: 4 mg/0.1 mL single injection.
Side Effects: Ocular hypertension, endophthalmitis.
Usage: Empirical for persistent cases. SAGE Journals.
Dexamethasone Intravitreal Implant (Ozurdex) (Class: Injectable corticosteroid implant)
Dosage: 0.7 mg implant.
Side Effects: Similar to intravitreal triamcinolone.
Usage: Long-acting anti-inflammatory. Wikipedia.
Ketorolac Tromethamine 0.5% Ophthalmic Solution (Class: Topical NSAID)
Dosage: 1 drop QID for 2 weeks.
Side Effects: Burning, stinging.
Usage: Adjunct to reduce mild inflammation.
Oral Acyclovir (Class: Antiviral)
Dosage: 400 mg five times daily for 7–10 days.
Side Effects: Gastrointestinal upset, headache.
Rationale: Empirical use when viral prodrome present.
Oral Valacyclovir (Class: Antiviral)
Dosage: 1 g TID for 7–10 days.
Side Effects: Nausea, renal toxicity (rare).
Oral Famciclovir (Class: Antiviral)
Dosage: 500 mg TID for 7–10 days.
Side Effects: Headache, diarrhea.
Dietary Molecular Supplements
Many antioxidants and nutrients support RPE health and may aid recovery.
Vitamin C (Ascorbic Acid) – 500 mg daily
Function: Potent antioxidant scavenging free radicals.
Mechanism: Regenerates oxidized vitamin E; supports collagen stabilization in Bruch’s membrane AAO.
Vitamin E (α-Tocopherol) – 400 IU daily
Function: Lipid-soluble antioxidant protecting photoreceptor membranes.
Mechanism: Interrupts lipid peroxidation chains AAO.
Zinc (Zinc Oxide) – 80 mg daily
Function: Cofactor for antioxidant enzymes (SOD, CAT).
Mechanism: Stabilizes cell membranes, supports RPE metabolism AAO.
Copper (Cupric Oxide) – 2 mg daily
Function: Prevents zinc-induced copper deficiency; cofactor for cytochrome c oxidase.
Mechanism: Balances trace mineral homeostasis AAO.
Lutein – 10 mg daily
Function: Macular pigment carotenoid filtering blue light.
Mechanism: Quenches singlet oxygen; reduces light-induced RPE damage AAO.
Zeaxanthin – 2 mg daily
Function: Complementary macular pigment.
Mechanism: Similar to lutein, localizes to central fovea AAO.
Omega-3 DHA – 500 mg daily
Function: Structural component of photoreceptor outer segments.
Mechanism: Anti-inflammatory via resolvin production; supports membrane fluidity Verywell Health.
Omega-3 EPA – 500 mg daily
Function: Precursor to anti-inflammatory eicosanoids.
Mechanism: Competes with arachidonic acid for COX/LOX pathways Verywell Health.
Bilberry Extract (Anthocyanins) – 80 mg daily
Function: Antioxidant vascular support.
Mechanism: Enhances microcirculation; scavenges free radicals Verywell Health.
Astaxanthin – 4 mg daily
Function: Super-antioxidant carotenoid.
Mechanism: Protects lipids and proteins from peroxidation Verywell Health.
Advanced/Experimental Therapies
Primarily studied in other retinal diseases; not standard for ARPE.
Pamidronate IV Infusion (Bisphosphonate)
Dosage: 30 mg IV weekly.
Function: Anti-inflammatory modulation of macrophages.
Mechanism: Inhibits farnesyl pyrophosphate synthase; alters cytokine release PMC.
Healon-H (Sodium Hyaluronate) (Viscosupplementation)
Dosage: 0.1 mL of 1.4% intravitreal.
Function: Mechanical cushion and hydrating agent.
Mechanism: Protects RPE from traction and oxidative injury PubMed.
Ciliary Neurotrophic Factor (CNTF) Implant
Dosage: 20 ng/day subretinal implant reservoir.
Function: Neuroprotection of RPE and photoreceptors.
Mechanism: Activates JAK/STAT survival pathways (studied in RP).
hESC-RPE Cell Suspension (Regenerative)
Dosage: 100,000 cells subretinal injection.
Function: Replace damaged RPE monolayer.
Mechanism: Engraftment and trophic support PMC.
CD34⁺ Stem Cell Injection (Regenerative)
Dosage: 1 × 10⁶ CD34⁺ cells subretinal.
Function: Pro-angiogenic and neuroprotective.
Mechanism: Homing to damaged retina; paracrine factor release UC Davis Health.
RPESC-RPE-4W Therapy (Stem Cell)
Dosage: 0.05 mL RPE cell patch subretinal.
Function: Structural and functional support of macula.
Mechanism: Direct cell replacement; secretion of survival factors Foundation Fighting Blindness.
Surgical Interventions
All are experimental in ARPE; mostly applied in other RPE diseases.
Subretinal RPE Transplantation
Procedure: Harvest autologous RPE-choroid graft; implant under retina via retinotomy.
Benefits: Potential restoration of RPE integrity and visual acuity Nature.
Pars Plana Vitrectomy with Cell Delivery
Procedure: Standard vitrectomy followed by subretinal injection of stem cells or growth factors.
Benefits: Direct delivery to macular area; removes vitreous cytokines.
Photodynamic Therapy (PDT)
Procedure: Intravenous verteporfin + 689 nm laser activation at macula.
Benefits: Localized RPE modulation; used in focal RPE disorders.
Subthreshold Micropulse Laser
Procedure: As above in non-drug section.
Benefits: Stimulates RPE repair without scarring Retina Today.
Argon Laser Photocoagulation
Procedure: Conventional threshold laser spots around lesion.
Benefits: Accelerates resolution of focal RPE lesions (historic use) PMC.
Prevention Strategies
Wear UV-blocking sunglasses outdoors to reduce blue-light damage
Avoid prolonged staring at screens; use 20-20-20 rule (every 20 min look 20 ft away for 20 sec)
Quit smoking to lower oxidative stress
Maintain blood pressure in normal range for retinal perfusion
Eat a diet rich in leafy greens, fruits, and fatty fish for antioxidants and omega-3s
Stay well-hydrated to preserve ocular fluid balance
Manage systemic infections promptly (e.g., treat flu-like illnesses early)
Schedule annual dilated eye exams during symptomatic period
Avoid high-impact eye activities (e.g., no contact sports without protective eyewear)
Practice stress reduction to limit inflammatory cytokine surges
When to See a Doctor
Sudden onset of central blind spot or blurred vision persisting > 48 hours
New floaters or flashes accompanying vision change
Worsening scotoma after two weeks of observation
Severe eye pain or redness
Visual acuity dropping by more than three lines on Snellen chart
Diplopia (double vision) onset
Signs of uveitis (cells/flare on slit lamp)
Any systemic symptoms suggesting broader inflammatory disease
Inability to perform daily activities due to vision loss
Recurrence of symptoms after initial resolution
“What to Do” & “What to Avoid”
| What to Do | What to Avoid |
|---|---|
| Rest eyes frequently; follow 20-20-20 rule | Rubbing or pressing on the eyes |
| Use prescribed lubricating eye drops as needed | Overuse of topical steroids beyond recommended duration |
| Apply warm compresses to soothe discomfort | Bright direct sunlight without UV protection |
| Perform brief ocular exercises (saccades, pursuits) | Long sessions at digital screens without breaks |
| Maintain balanced hydration and diet | Smoking and exposure to secondhand smoke |
| Monitor vision daily with Amsler grid | Self-medicating with over-the-counter steroid creams |
| Wear UV-blocking eyewear outdoors | High-caffeine beverages in excess (may dehydrate) |
| Engage in mindfulness or relaxation exercises | Sudden high-intensity eye strain (e.g. extended night driving) |
| Keep systemic illnesses (e.g. hypertension, flu) well-managed | Ignoring persistent or worsening visual symptoms |
| Schedule regular follow-up exams until full recovery | Abrupt cessation of any prescribed ocular treatment |
Frequently Asked Questions (FAQs)
What causes ARPE?
The exact cause is unknown. Often follows a mild viral prodrome, suggesting an immune-mediated reaction targeting the RPE cells DoveMed.Is ARPE hereditary?
No clear genetic inheritance; cases are sporadic.How long does ARPE last?
Typically self-resolves in 6–12 weeks; 90% of patients regain normal vision within 8 weeks DoveMed.Will I lose vision permanently?
Most recover fully; some may have mild RPE changes on imaging, but functional vision loss is rare.Can ARPE recur?
Rarely; most cases are monophasic, though bilateral or recurrent presentations have been reported.How is ARPE diagnosed?
Diagnosis is clinical, supported by OCT showing RPE disruption and fundus autofluorescence/angiography confirming typical lesions EyeWiki.Do I need treatment?
No specific therapy is required; observation is standard. Steroids have not shown clear benefit EyeWiki.Should I take steroids?
Routine steroid use is not recommended due to lack of efficacy and potential side effects.Can antivirals help?
Antivirals are used empirically if there is strong suspicion of viral involvement but lack definitive proof.Is ARPE contagious?
No; it is not an infectious condition.Can I drive with ARPE?
Only if visual acuity meets legal requirements; central scotoma may impair driving safety.Are there long-term complications?
Permanent RPE changes may persist on imaging, but functional vision typically remains good.What lifestyle changes help recovery?
Eye rest, UV protection, stress reduction, and a nutrient-rich diet support healing.Can photography or OCT monitoring speed up management?
Yes; serial OCT helps confirm lesion resolution without invasive testing.When should I see a specialist?
If symptoms worsen after two weeks, vision drops significantly, or if additional ocular signs appear.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: July 10, 2025.
