Clinical medicine postgraduates are expected to attain competencies equivalent to senior resident physicians. However, ophthalmology graduate students often struggle to integrate optometry theory with clinical practice during rotations. To address this gap, we developed and evaluated a blended clinical internship model combining Massive Open Online Courses (MOOC) and digital twin-supported high-fidelity surgical simulation (HFS) technology. A randomized controlled trial was conducted with 54 ophthalmology graduate students and 16 trained teachers. Students were randomly assigned to an experimental group (n = 27) receiving the MOOC-HFS blended internship and a control group (n = 27) receiving traditional teaching. Outcomes included an initial assessment after the MOOC phase (henceforth referred to as Test 1), a post-class assessment (Test 2), and a final examination (Test 3) as well as scores on the Course Experience Questionnaire (CEQ), Revised Two-Factor Study Process Questionnaire (R-SPQ-2 F), and a teacher satisfaction questionnaire. Data were analyzed using t-tests and non-parametric tests. The experimental group achieved significantly higher scores in all assessments (P < 0.05), with greater improvements in practical skill-focused Refractive Classroom than memory-based Amblyopia Classroom. They also demonstrated superior CEQ scores, deeper learning approaches in R-SPQ-2 F, and higher teacher satisfaction (all P < 0.001). The MOOC-HFS blended model, structured as "theory → simulation → practice," effectively synergizes MOOC flexibility with HFS realism, significantly enhancing academic performance, deep learning, course experience, and teaching satisfaction. This model redefines teacher roles and establishes a competency-based framework, providing an evidence-based reference for optometry clinical education optimization. Further multi-center and long-term studies are needed to confirm generalizability.
This study aimed to determine the region-specific distribution of nonaxonal cells and capillaries within the circumpapillary retinal nerve fiber layer (RNFL) in a nonhuman primate experimental glaucoma model. Five rhesus macaques (age range: 4.5-9.0 years) with varying degrees of unilateral laser-induced experimental glaucoma were imaged with optical coherence tomography (OCT), euthanized and perfusion fixed for histological analysis. Eyes were enucleated, and six circumpapillary regions (60° apart), approximately 300-1000 µm from the optic disc margin, were dissected and prepared for serial block face scanning electron microscopy. A series of 400 images (0.098 µm/pixel) were obtained at 500 nm intervals to construct a volume of 200 × 200 × 200 µm. Inside the nerve fiber layer, nonaxonal nuclei and capillary lumen were manually outlined. The nearest vessel distance for each nonaxonal cell was determined as the Euclidean distance in 3-dimensional space from each nucleus center to the nearest capillary. At endpoint, OCT circumpapillary RNFL thickness in the experimental eyes ranged between 49 and 99 µm (control: 103-111 µm). In control eyes, the distribution of nonaxonal cells at the six circumpapillary regions was nonuniform (F5,24 = 4.05 and p < 0.01). However, the total cell count was similar between the two eyes (control: 858 ± 173, experimental: 960 ± 245, and p = 0.51), and for each region (p > 0.05). Although capillary volume was reduced in experimental eyes (p = 0.02), the capillary volume density was similar between control (0.58 ± 0.31%) and experimental eyes (0.58 ± 0.32% and p = 0.99). Correspondingly, the nonaxonal cells had a shorter vessel distance in experimental compared to control eyes (15.92 ± 4.89 μm, 18.61 ± 5.48 μm, and p = 0.05). The number of nonaxonal cells and capillary volume density in the circumpapillary RNFL are similar for stable glaucomatous eyes compared to the healthy eyes. Regional differences and changes in nonaxonal contribution to the nerve fiber layer thickness should be considered when assessing clinical RNFL thickness measures.
There may be considerable untapped potential in using large-scale electronic primary care optometry referral data to understand referral patterns. This study aims to evaluate the feasibility of using different analytical methods for this type of dataset. A total of 12,339 electronic referrals made by primary care optometrists in November 2023 were examined. The dataset contained 36 demographic and clinical variables. Preprocessing involved categorising and normalising referral conditions and merging similar attributes to enhance consistency. The feasibility of descriptive evaluations of referral conditions to both ophthalmology in secondary care and within primary care was explored, and a regression analysis was conducted to investigate potential associations between patient sex and referral patterns. A spatial analysis was also conducted to map the geographic distribution of referrals and their association with social deprivation. Of all referrals, 77.3% were directed to ophthalmology in secondary care, 14.1% within primary eyecare optometry and non-optometric services, with the remaining 8.5% being unspecified. Cataracts (17.2%), glaucoma (13.5%) and YAG laser capsulotomy (12.1%) emerged as the most frequent referral reasons. Regression analysis identified significant sex differences, where referral proportions for female patients were higher than males for conditions such as glaucoma and neuro-ophthalmology (p = 0.001). Spatial analysis revealed no significant difference between the referral ratio and the deprivation level. This study demonstrated viability for evaluating electronic optometry referrals. Despite data limitations, these findings indicate that data quality and scope can support established analytical methods. Moreover, the scale of data variables suggests expanding sample sizes and extending time windows could reveal clinically informative patterns in referrals. Future investigations may further validate findings, helping to understand local, regional or national referral patterns within optometry and potentially address inequalities in eyecare.
Autoimmune uveitis is a sight-threatening disease mainly caused by immune dysregulation. Most existing clinical and biomedical studies still rely on subjective inflammatory assessment and semiquantitative molecular evaluation, and there is very little fairness research on multidimensional uveitis characterization exploration. With the advent of noninvasive and high-resolution imaging technology, there is a growing demand for objective, quantitative, and traceable indicators to support mechanistic investigation, accurate staging, precision therapy, and early relapse detection. In this study, we implemented a multiparametric, multimodal imaging platform to longitudinally monitor experimental autoimmune uveitis (EAU). Changes in retinal structure, vascular networks, and visual function were evaluated within 2 weeks after EAU induction. Based on quantitative analysis of optical coherence tomography (OCT), OCT angiography (OCTA), vascular density (VD), and vascular tortuosity (VT) were shown to correlate with retinal thickness, clinical scores, histopathological scores, and may be added as potential objective and noninvasive candidate indicators for uveitis detection.
BACKGROUND: To evaluate the application effect of the video-based feedback teaching method in the practical teaching of orthokeratology lens fitting. METHODS: Twenty-three optometry interns were assigned via stratified randomization to an experimental group (video-based feedback, n = 12) and a control group (traditional verbal feedback, n = 11). Both groups received identical theoretical lectures led by the same instructor. The experimental group’s practice sessions were video recorded with structured feedback provided. Assessments included theoretical examinations, practical skill assessments and questionnaires. Independent sample t-tests and Mann–Whitney U tests were used to compare theoretical examination scores, practical skill assessments, and questionnaire results between the two groups to evaluate the teaching effectiveness. Theoretical examinations tested cognitive understanding of orthokeratology principles. Practical skills were evaluated using standardized assessments focusing on fluorescence evaluation techniques. Students completed questionnaires assessing course experience and metacognitive awareness. RESULTS: Theoretical knowledge scores showed no significant difference between groups (P = 0.060); however, the experimental group achieved a significantly higher pass rate (100.0% vs. 45.5%, Fisher’s exact test, P = 0.004). The experimental group achieved significantly higher practical skills scores (90.33 ± 6.29 vs. 81.91 ± 7.94; P = 0.010), particularly in static fluorescence evaluation (median 32, IQR: 29.5–36 vs. median 30, IQR: 21–32; P = 0.027) and dynamic fluorescence evaluation (median 14, IQR: 12–14 vs. median 10, IQR: 7–12; P = 0.004). The experimental group also demonstrated significantly higher satisfaction in self-awareness of performance (P = 0.048), perceived course helpfulness (P = 0.014), detail of practical demonstration (P = 0.008), and timeliness of instructor guidance (P = 0.019). CONCLUSION: This pilot study provides preliminary evidence that video-based feedback effectively enhances orthokeratology fitting skills and promotes reflective learning, offering a practical approach for clinical skills education in optometry. Future studies with larger sample sizes and long-term follow-up are warranted.
To evaluate the value of three-dimensional visualization preoperative planning based on the open-source software 3D Slicer in endoscopic endonasal optic nerve decompression for traumatic optic neuropathy. A prospective randomized controlled study was conducted. A total of 48 patients with traumatic optic neuropathy who underwent endoscopic endonasal optic nerve decompression at the Affiliated Eye Hospital of Nanchang University between January 2023 and June 2025 were enrolled and randomly assigned to an experimental group (3D Slicer-based three-dimensional visualization planning, n = 25) and a control group (conventional two-dimensional CT planning, n = 23). The primary outcome measures included operative time, intraoperative misjudgment rate, complication rate, surgeon's subjective score (5-point Likert scale), and visual improvement at 3 months postoperatively. Continuous data were analyzed using independent-sample t-test or Mann-Whitney U test, and categorical data were analyzed using Fisher's exact test. There were no statistically significant differences in baseline characteristics or preoperative visual acuity grade between the two groups (P > 0.05). The operative time was significantly shorter in the experimental group than in the control group (129.4 ± 11.6 min vs. 150.7 ± 20.4 min, P < 0.001). Postoperative visual acuity improved significantly compared with preoperative values in both groups (experimental group: P < 0.001; control group: P = 0.003), but the intergroup difference in the grade of visual improvement was not statistically significant (P = 0.439). The intraoperative misjudgment rate was 0% (0/25) in the experimental group and 13.0% (3/23) in the control group, with no statistically significant difference (P = 0.24). The incidence of cerebrospinal fluid leakage was 4.0% (1/25) in the experimental group and 21.7% (5/23) in the control group, and the difference did not reach statistical significance (P = 0.08). The surgeon's subjective score was significantly higher in the experimental group than in the control group [5 (5,5) vs. 4 (4,4), P < 0.001]. No severe complications such as major vessel injury or direct optic nerve injury occurred in either group. Three-dimensional visualization preoperative planning based on 3D Slicer can significantly shorten the operative time of endoscopic endonasal optic nerve decompression, enhance the surgeon's confidence, and a potential reduction in cerebrospinal fluid leakage that warrants further investigation. This approach is low-cost, highly generalizable, and has good clinical application value.
Suppression is the cortical inhibition of visual information from one eye. This scoping review identifies and collates the different methods, techniques, and tools used to measure and quantify suppression in the clinical management of amblyopia. PRISMAScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Reviews) guidelines were followed to include peer-reviewed papers that describe methods to quantify suppression in patients with amblyopia. From 75 included papers, results show that suppression quantification is feasible in children as young as 3-years old. Only three randomized clinical trials have used suppression as a quantified outcome measure. Methodologies are broadly categorized by target size, electrophysiology, or contrast. Common clinical tools are primarily size-based (e.g. the worth four-dot test at varying distances) or contrast-based (e.g. neutral density filters). Conversely, most experimental assessments are software-driven contrast-based paradigms such as dichoptic motion coherence tests. Clinical implementation of suppression quantification remains limited. However, available clinical tools for quantifying suppression on a fine-graded continuous scale are minimal. Such finer tools for the quantification of suppression are used in lab-based research and are yet to be made commercially available. Future studies should focus on developing better clinical tools for quantifying suppression.
High myopia is the leading cause of visual impairment worldwide, driven by excessive axial elongation resulting in biomechanical weakening of the sclera, and increasing the risk of complications such as posterior staphyloma, myopic macular degeneration, retinal detachment, cataract, and glaucoma. Conventional myopia management strategies aim to slow axial elongation in childhood, leaving patients with high myopia at risk of vision-threatening complications as they age. For these individuals, targeted therapies that strengthen the weakened sclera represent a promising, yet still experimental, approach. This review provides an overview of the role of the sclera in myopia progression, emphasizing changes in extracellular matrix composition, collagen organization, biomechanical integrity, and signaling pathways. Investigational scleral therapies are discussed, including posterior scleral reinforcement techniques, crosslinking modalities, pharmacological strategies, and tissue engineering approaches, with discussion of their mechanisms, preclinical and clinical evidence, and translational challenges. Particular attention is given to translational barriers, such as safe delivery to the posterior pole, retinal safety, and the absence of standardized outcome measures that link biomechanical reinforcement to functional benefit. Advances in imaging and in vivo biomechanical assessment, such as polarization-sensitive optical coherence tomography, Brillouin microscopy, and ultrasound-based elastography, hold promise for earlier risk stratification and treatment monitoring. By integrating insights from biomechanics, molecular biology, and therapeutic innovation, this review highlights the sclera as both a key driver of myopia pathology and a promising therapeutic target. Continued interdisciplinary collaboration will be essential to translate these experimental approaches into clinically viable treatments capable of reducing the growing burden of high myopia worldwide.
Multiple sclerosis (MS) is a highly disabling chronic autoimmune disease of the central nervous system with neuroinflammatory and neurodegenerative alterations found in the white and grey matter of the brain. The pathogenesis of MS is complex and not fully understood. Mitochondrial dysfunctions are suspected to play an important role. The visual system is often affected in MS. Optic neuritis is a frequent symptom, but also the retina itself, including retinal synapses appear compromised in MS independent from demyelination of the optic nerve. A previous study demonstrated synapse-specific alterations of mitochondria in photoreceptor synapses in the Experimental Autoimmune Encephalomyelitis (EAE) mouse model of MS at day 9 after injection, an early time point in pre-clinical EAE. In the present study, we analysed even earlier stages of pre-clinical EAE for possible alterations of synaptic mitochondria. For this purpose, we performed qualitative and quantitative immunolabelling analyses of the mitochondrial cristae organising protein MIC60 at retinal synapses and functional analyses by measuring synaptic mitochondrial membrane potential (during rest and depolarisation-induced exocytosis) and visually guided behaviour (optometry analyses). At day 3 after injection, morphological and functional data were indistinguishable between MOG/CFA-injected EAE mice and CFA-injected control mice. But already on day 5 after injection, we observed a decreased expression of the mitochondrial MIC60 protein at synaptic mitochondria, a decreased synaptic mitochondrial membrane potential at rest, an enhanced drop of mitochondrial membrane potential during stimulated exocytosis and a decreased visual performance of the respective EAE mice. These data argue that synaptic pathology in the EAE retina begins as early as day 5 after injection. Our data propose that dysfunctions of mitochondria play an important role already at the very early stages of synaptic pathology in EAE.
The exacerbation of chemoresistance and metastasis by synthetic cytotoxic reagents hinders effective cancer therapy, as these events often coincide and lead to poor clinical outcomes, yet are rarely targeted through a shared molecular mechanism. To address this, we established a mechanism-informed natural compound discovery strategy to identify a non-cytotoxic candidate with dual functionality, namely re-sensitizing drug-resistant tumor cells and preventing metastasis. Western blot, RT-qPCR, and flow cytometry were used for evaluating protein and mRNA expression, as well as cell apoptosis, while GC/MS and HPLC analyses for identifying active phytochemicals from extracts of traditional Chinese medicines. Therapeutic potential was validated in multiple mouse cancer models, including K-rasLSL-G12D/+; p53fl/fl mice. Clinical relevance was investigated via meta-analysis of associated gene signatures. Mulberroside A (Mul A) from Cortex Mori Radices was identified as an ideal compound that inhibits P-glycoprotein 1 (Pgp1) in adherent tumor cells and pericellular fibronectin (periFN) assembly on suspended tumor cells (STCs), which drive drug resistance and metastasis, respectively. Using a paclitaxel (PTX)-resistant Lewis lung carcinoma cell line, we demonstrated that ERK-dependent Pgp1 functions as a shared upstream regulator of both chemoresistance and metastatic competence. Accordingly, Mul A inhibited Pgp1 mRNA and protein levels in an ERK-dependent manner, thereby differentially restoring PTX sensitivity both in vitro and in vivo, without intrinsic cytotoxicity, and significantly inhibiting lung metastasis by reducing the Pgp1-XIAP-periFN axis in STCs. Oral administration of Mul A achieved these dual anti-cancer effects in both experimental and spontaneous mouse models. Importantly, meta-analysis of clinical datasets further linked co-elevated FN and Pgp1 expression with poor prognosis and relapse in early-stage cancer patients, underscoring the translational relevance of targeting this shared pathway. These findings identify Mul A as a promising non-cytotoxic therapeutic candidate and elucidate the shared upstream molecular mechanism linking distinct downstream chemoresistance and metastasis.
Diabetes mellitus, particularly type 2 diabetes, has been associated in some studies with increased osteoarthritis (OA) risk, greater symptom burden, and structural progression; however, epidemiological evidence remains heterogeneous, and the extent to which diabetes independently contributes to OA after accounting for obesity, adiposity, physical inactivity, and other metabolic confounders remains debated. In metabolically susceptible patients, chronic hyperglycemia, insulin resistance, carbonyl stress, and low-grade inflammation may contribute to disruption of the joint microenvironment. One proposed mechanism involves the accumulation of advanced glycation end products (AGEs), which can cross-link with type I/II collagen and may increase extracellular matrix crosslinking and stiffness. Through these biochemical and biomechanical effects, the AGE-collagen axis may influence chondrocyte mechanotransduction, inflammatory signaling, matrix turnover, and cell survival, thereby providing a plausible but not yet fully validated link between systemic metabolic dysfunction and OA-relevant structural degeneration. Recent advances in biomaterials may offer experimental and translational strategies to modulate the glycated, inflamed, and mechanically altered joint microenvironment. These approaches include stiffness-tunable and stimuli-responsive hydrogels, nanocarriers designed to deliver anti-AGE agents or AGE-cleaving enzymes, osteochondral gradient scaffolds that mimic native tissue transitions, and immunomodulatory materials that may attenuate local inflammation. At present, these interventions should be viewed primarily as preclinical or early translational strategies rather than established disease-modifying therapies. This review discusses the potential molecular and biomechanical implications of the AGE-collagen axis in diabetes-related OA, critically evaluates emerging biomaterials-based therapeutic approaches, and highlights preclinical evaluation models and outcome measures. Finally, we outline key translational challenges-including targeted delivery, long-term safety of degradation products, metabolic heterogeneity, patient stratification, and integration with systemic therapies-and propose methodological frameworks to support the future development of clinically testable biomaterials interventions.
Environmental biotoxins, such as mould, are linked to neurological and visual dysfunction, including impaired visual contrast sensitivity (VCS). Testing VCS alterations is recommended as a biomarker for biotoxicity. This study compared four VCS tests in detecting VCS deficits in individuals with clinical signs of biotoxicity. VCS was measured in 28 biotoxin-exposed individuals and 30 controls using four VCS tests: Shoemaker handheld chart, Online Contrast Sensitivity Test (OCSTTM), Clinic CSF App, and an Experimental VCS test. Neurotoxicity symptoms were assessed with the modified Q16 questionnaire, and pupil size was measured under standard lighting. Biotoxin-exposed participants had smaller pupil diameters (mean difference: 0.703 mm, p < 0.0001) and higher neurotoxicity scores (45.50 ± 13.0 vs. 22.00 ± 7.7). Contrast sensitivity was significantly reduced in exposed participants on digital VCS tests only. The Experimental VCS test demonstrated the highest diagnostic performance (100% sensitivity; 60-80% specificity), followed by OCSTTM and the Clinic CSF App. The Shoemaker handheld chart did not distinguish between groups. These results highlight the effectiveness of digital VCS testing and symptom questionnaires as practical tools for detecting visual and neurological impairments in individuals with suspected biotoxin exposure.
Central serous chorioretinopathy (CSC), a prevalent disease characterized by choroidal vascular abnormalities, has extremely limited treatment options. This study investigates the effects of the selective adenosine A2A receptor (A2AR) antagonist KW6002 on choroidal vascular hyperpermeability and the blood-retinal barrier (BRB), and explores its therapeutic potential in experimental CSC. We examined A2AR expression in the retinal pigment epithelium (RPE)-choroid-sclera complex using quantitative real-time PCR (qPCR) and Western blotting (WB) in mice with an established aldosterone-induced acute CSC model. Before modeling and after model establishment, mice were administered 5 mg/kg KW6002 or a vehicle control via intraperitoneal injection. The retinal and choroidal thickness was assessed by optical coherence tomography (OCT) and hematoxylin-eosin (H&E) staining. We observed Müller cells activation, retinal microglia infiltration, and proinflammatory cytokine expression via immunofluorescence and qPCR. Next, we employed the effects of the A2AR antagonist KW6002 and genetic A2AR knockout (A2AR-KO) on BRB integrity using immunofluorescence and WB. Finally, to clarify how A2AR knockout confers therapeutic benefits in CSC, we assessed activation of the TNF-α/NF-κB-MMP-2/9 signaling pathway. We found that A2AR signaling was significantly upregulated in the RPE-choroid-sclera complex in CSC models, and both A2AR antagonist KW6002 and A2AR-KO significantly inhibited the aldosterone-induced central retinal and choroidal pathologic thickening. Moreover, the KW6002 intervention decreased the activation of Müller cells and the proliferation of microglia, inhibited the secretion of proinflammatory cytokines (TNF-α, IL-6, and IL-1β), and ameliorated the retinal damage caused by aldosterone; in contrast, A2AR-KO resulted in significant upregulation of key tight junction proteins (ZO-1, Claudin-1, and Claudin-5). In summary, these results suggest that the protective effects may be correlated with the suppression of the TNF-α/NF-κB-MMP-2/9 signaling axis. Our findings show that the A2AR antagonist KW6002 or A2AR-KO offers a protective effect in experimental CSC, reduces inflammation, and maintains the integrity of the BRB, which may be associated with the inhibition of the TNF-α/NF-κB-MMP-2/9 pathway. These findings present a new method for preventing and treating CSC, which will guide our future clinical strategy development.
Corneal cross-linking (CXL) has emerged as an important therapeutic strategy for enhancing the biomechanical stability of corneal tissues. Originally introduced to slow or halt the progression of keratoconus (KC), its indications have expanded to include a variety of corneal ectatic and infectious disorders, alongside a growing interest in scleral reinforcement for progressive myopia. Recent advances in cross-linking technologies focused on optimizing reagent formulations, refining delivery strategies, and incorporating functional biomaterials such as nanoparticles, hydrogels, and microneedle-based systems to enhance stromal penetration, achieve controlled release, and reduce procedural invasiveness. Despite these developments, key challenges remain, particularly in achieving consistent treatment depth, maintaining long-term biosafety, and ensuring stable clinical outcomes. This review summarizes the mechanisms of action and classification of contemporary ophthalmic cross-linking methods and agents, evaluating their clinical and experimental outcomes in corneal and scleral cross-linking while weighing their respective strengths and limitations. Furthermore, this review identifies key constraints of current protocols and highlights emerging strategies aimed at improving treatment precision, safety, and reproducibility, thereby providing a conceptual framework for the development of next-generation ophthalmic cross-linking therapies.
To determine the effects of contact lens-induced full-field and peripheral-field myopic defocus on choroid thickness and variation with time of day in young adults. In this prospective, randomized, crossover study, 16 adults (age 28.2±6.3 years) participated in four experimental sessions (two morning and two evening). At each session, optical coherence tomography (OCT) was performed before and 60 min after distance viewing with either full-field or peripheral-field +2.50 D contact lens-induced defocus in the left experimental eye and distance correction in the right eye. Recovery was assessed after 20 min with distance correction in both eyes. Choroidal thickness was analyzed using a custom MATLAB program and two-factor repeated-measures ANOVAs. Mean spherical equivalent refraction was -1.7±1.7 D in right eyes and -1.9±2.0 D in left eyes (P=0.20). Baseline choroidal thickness was greater in the morning (326±71 μm) than evening (316±72 μm, P=0.006). No significant changes occurred after 60 min for either full field or peripheral-field in the morning or evening (P>0.05 for all). One-hour exposure to full-field or peripheral myopic defocus did not alter choroidal thickness, irrespective of time of day, in young adults with a range of refractive errors. Studies in children, particularly with longer durations of imposed defocus, are needed to determine whether short-term structural responses may serve as clinically meaningful biomarkers.
This study evaluated the performance of four popular large-scale language models (ChatGPT o3-mini, Gemini 2.0 pro experimental, Deep Seek Thinking R1, and Kimi Thinking K1.5) in addressing frequently asked patient questions about cataracts and cataract surgery in Chinese. DeepSeek Thinking R1 performed comparably to Gemini 2.0 pro experimental in accuracy, while outperforming both ChatGPT o3-mini and Kimi Thinking K1.5. In terms of completeness and consistency, DeepSeek Thinking R1 showed superior performance over the other three LLMs. Regarding legibility and safety, DeepSeek Thinking R1, Gemini 2.0 pro experimental, and ChatGPT o3-mini exhibited comparable results, all performing better than Kimi Thinking K1.5. Deep Seek Thinking R1 demonstrated the strongest overall performance among the four LLMs in this comparative evaluation. The modern LLMs are promising tools for public education in ophthalmology while human oversight is still required.
To evaluate the effects of extracorporeal ultra-high-fluence corneal cross-linking (ECO-CAIRS) on the dehydration and rehydration behavior of porcine corneal stromal ring segments in an experimental model simulating the preparation of corneal allogenic intrastromal ring segments. ELZA Institute, Zurich, Switzerland. Corneal ring segments (two per cornea) were prepared from freshly enucleated porcine corneas (n=48) and randomly divided into three groups: controls (no CXL, Jerky technique), extracorporeal ultra-high-fluence CXL at 30 J/cm2, and 60 J/cm2 (n=32 each). After epithelial removal and ring preparation, segments in the control group were soaked in balanced salt solution (BSS), while those in the experimental groups were soaked in riboflavin solution (Ribo-Ker, EMAGine AG, Zug, Switzerland) for 10 minutes. Each group subsequently underwent a total dehydration period of 45 minutes, which included both UV-A irradiation and waiting phases for the CXL-treated groups, followed by a 10-minute rehydration phase using BSS. Segment thickness was measured by calibrated imaging at baseline, after dehydration, and after rehydration. Baseline structural thickness values did not differ significantly between groups. Both CXL-treated groups demonstrated significantly greater dehydration (p<0.01) and reduced rehydration (p<0.01) when compared to controls. No significant differences were found between the two CXL-treated groups. Ultra-high-fluence cross-linking enhanced segment dehydration and slowed rehydration. ECO-CAIRS effectively modulates the dehydration and rehydration of corneal ring segments, which may improve handling and implantation characteristics during surgery. These findings support the potential clinical benefit of CXL in CAIRS procedures. Further in vivo studies are required to confirm long-term behavior and biomechanical impact.
Regulatory T cells (Tregs, CD4+ CD25+ Foxp3+) play a crucial role as a core cell subset in maintaining immune homeostasis in the ocular immune-privileged microenvironment. This review systematically summarizes the stage-specific regulatory mechanisms of Treg cells in common inflammatory diseases such as keratitis, uveitis, and dry eye syndrome, including intercellular interactions, signal pathway mediation, and cytokine network regulation, as well as key experimental evidence (animal/cell models and clinical sample data) and research progress in targeted therapy. Studies have shown that Treg cells maintain ocular immune balance by secreting anti-inflammatory cytokines (such as IL-10 and TGF-β), regulating signaling pathways (STAT, PI3K/AKT, SIRT1, etc.), and interacting with immune cells (macrophages, dendritic cells). Their functions are regulated by multiple factors such as cytokine networks, epigenetic modifications, and delivery vectors. Targeted interventions based on Treg cells (cell therapy, drug intervention, and signaling pathway regulation) and combined treatment strategies have shown good anti-inflammatory potential. This article, in light of current research limitations (such as insufficient analysis of cell heterogeneity and the disconnect between basic and clinical research), proposes future research directions, providing a theoretical basis for the understanding of the pathogenesis of inflammatory eye diseases and the development of new immunomodulatory therapies, and establishing a complete research framework of "mechanism-evidence-treatment".
Uveitis is an autoimmune disease with a high rate of blindness. Clinically, treatments of uveitis mainly rely on corticosteroids and immunosuppressants, which are prone to recurrence and carry significant side effects. Quercetin, a natural flavonoid compound, exhibits anti-inflammatory, antioxidant, and immunomodulatory effects. However, its potential role in uveitis through regulating neutrophil extracellular traps (NETs) by modulating the cGAS-STING pathway remains unclear. This study investigated the therapeutic effects and mechanisms of quercetin in uveitis by establishing an experimental autoimmune uveitis (EAU) rat model and analyzing peripheral blood samples from uveitis patients. The results showed that quercetin significantly reduced ocular inflammation and retinal structural damage in EAU rats, lowered histopathological scores, and decreased blood flow density. Mechanistically, quercetin improves mitochondrial dysfunction, inhibits cGAS-STING pathway activation, and reduces NF-κB phosphorylation and pro-inflammatory factor release, ultimately suppressing NET marker expression and formation. Molecular docking revealed strong binding affinities between quercetin and cGAS, STING, and MPO. Furthermore, the STING inhibitor H151 exhibited similar effects to quercetin, further confirming the pivotal role of the cGAS-STING pathway in NET formation. Collectively, this study first elucidates the regulatory role of quercetin in modulating the cGAS-STING pathway to inhibit NET release, thereby alleviating the degree of inflammation in uveitis. This study provides experimental evidence and theoretical support for quercetin as a potential anti-uveitis therapeutic agent.
To investigate potential optical cues underlying myopia control effects by examining how lenslet-array spectacle lenses influence peripheral refraction and image contrast. Three commercial lenslet-array spectacle lenses-MiyoSmart, Stellest, and diverse segmented defocus optics-were reconstructed in Zemax OpticStudio, together with a conventional single vision (SV) lens as a reference. The reconstructed lenses were coupled with the Navarro eye model to simulate spectacle wearing after experimental validation of the lens models. Optical performance was evaluated under both distance and near viewing conditions with accommodative lags of 0.50 diopters (D) and 1.00 D. Peripheral refraction components (M and J0) were derived from wavefront data. Point spread functions and modulation transfer functions were obtained, with the area under the modulation transfer function curve subsequently calculated. Simulated and experimental point spread functions showed strong agreement, confirming the reliability of the constructed spectacle models. Compared with the SV lens, the lenslet-array introduced M fluctuations (within ±0.25 D), manifesting as alternating positive and negative shifts relative to the SV baseline. Only the Stellest lens exhibited minimal myopic defocus over a limited eccentricity range, while the other designs failed to induce peripheral myopic defocus. In the horizontal meridian between 12.5° and 17.5° eccentricity, lenslet-array lenses exhibited reduced contrast at low spatial frequencies (≤6 cycles/degree) but increased cutoff frequencies and relatively enhanced contrast at higher frequencies (9-15 cycles/degree). Similar patterns were observed under near viewing with a 0.50 D accommodative lag. The myopia control efficacy of lenslet-array lenses may not be fully explained by the peripheral myopic defocus hypothesis. Instead, the observed reduction in low spatial frequency contrast, coupled with an elevated cutoff frequency that preserves high-frequency information, may provide the critical optical cues for slowing myopia progression. These hypothesized mechanisms warrant further clinical investigation.