To investigate exposure to and comfort with advanced technology intraocular lenses (ATIOLs) and ascertain residency program characteristics predictive of increased exposure and comfort. A survey was created in REDCap and distributed to fourth-year (PGY-4) ophthalmology residents across the United States through the Association of University Professors in Ophthalmology (AUPO). The survey included questions on characteristics of ophthalmology residency training programs, understanding of preoperative counseling, intraoperative steps, and postoperative management pertinent to ATIOL implantation. Continuous and ordinal outcomes were analyzed using Kruskal Wallis or Wilcoxon Rank Sum Test and ordinal logistic regression, respectively. There were 72 residents who completed the survey. Programs with multiple faculty offering ATIOLs provided greater opportunity for residents to observe preoperative counseling for presbyopia-correcting IOLs (OR 9.49 [1.70-52.8]; p=0.010) and practice preoperative toric IOL counseling themselves (OR 9.89 [1.70-57.6]; p=0.011). These residents also reported greater comfort with patient selection for presbyopia-correcting IOLs (OR 5.15 [1.05-25.3]; p=0.044). Programs with 10-25 faculty offered greater opportunity for residents to observe pre-op toric IOL (OR 4.98 [1.17-21.13]; p=0.03) and presbyopia-correcting IOL counseling (OR 8.98 [1.98-40.84]; p=0.004) compared to those with 0-10 faculty. Programs with industry-subsidized ATIOL programs had greater number of resident cataract cases as primary surgeon (Mean 184 vs. 137; p=0.014). Incorporating exposure to ATIOLs into residency training curricula will equip trainees to be proficient with options that align with patients' expectations. This can be achieved by supporting clinician-educator faculty that use ATIOLs themselves and permitting industry representatives to interact with trainees.
The satisfaction of ophthalmology residents depends on various factors, such as the working environment, structured training, surgical training, working hours, and the work-life balance. The extent to which the situation is currently adapted to the needs of young colleagues was the subject of this study. A total of 1356 medical colleagues in specialist training were invited to answer a 16-question online questionnaire distributed via the German Society of Ophthalmology. Data were collected on demographics, structuring of training, and expectations of good education. In addition to a descriptive evaluation, variance analyses were carried out. Of the invited ophthalmology residents, 343 (25.3%) took part in the survey (64.7% female, 34.9% male). Of these respondents, 42.9% were employed at a university hospital, 23.9% at a non-university hospital, and 33.2% in a private practice. According to the majority of respondents, the most important factors for good training were clinical training (90.4%) and the leadership behavior of supervisors (66.4%). In contrast, pay and adherence to working hours were seen as less important factors. The majority (59.1%) of respondents stated that there were no structured guidelines for further training in their organizations. Training in laser treatments was provided to 91.7% of participants, training in intravitreal drug administration to 63.1%, and training in eyelid and extraocular surgery to 44.3%. Training in intraocular surgery was provided to 13.5% of participants. The present data collection shows once again that the achievement of the objectives of the specialist catalogue is of decisive importance for satisfied and successful specialist training. Furthermore, the majority of respondents denied the existence of structured specialist training, which underscores the need for a standardized curriculum. HINTERGRUND: Die Zufriedenheit der Assistenzärzt*innen der Augenheilkunde ist abhängig von verschiedenen Faktoren, wie Arbeitsumfeld, strukturierte Weiterbildung, chirurgische Ausbildung, Arbeitszeit sowie Vereinbarkeit von Beruf und Familie. Inwieweit die Situation gegenwärtig an die Bedürfnisse der jungen Kolleg*innen angepasst ist, war Gegenstand dieser Studie. 1356 ärztliche Kolleg*innen in der Facharztausbildung waren eingeladen, einen über die DOG (Deutsche Ophthalmologische Gesellschaft) verteilten Online-Fragebogen mit 16 Fragen zu beantworten. Es wurden Daten zur Demografie, Strukturierung der Ausbildung und zu den Erwartungen an eine gute Weiterbildung erhoben. Neben der deskriptiven Auswertung wurden Varianzanalysen durchgeführt. 343 (25,3 %) Assistenzärzt*innen haben an der Umfrage teilgenommen. 64,7 % waren weiblich, 34,9 % männlich. 42,9 % der Teilnehmenden waren an einer Universitätsklinik, 23,9 % an einem Haus in anderer Trägerschaft und 33,2 % in einer Praxis angestellt. Die wichtigsten Faktoren für eine gute Ausbildung waren dem Großteil der Befragten nach die klinische Ausbildung (90,4 %) sowie das Führungsverhalten der Vorgesetzten (66,4 %). Demgegenüber wurden die Bezahlung und die Einhaltung der Arbeitszeiten als weniger wichtige Faktoren gesehen. Im Kontrast dazu gaben 59,1 % der Befragten an, dass es in ihren Häusern keine strukturierten Vorgaben für die Weiterbildung gab. Die Ausbildung in Laserbehandlungen war bei 91,7 % gegeben, die in intravitrealen Medikamentengaben bei 63,1 %, in Lidoperationen sowie extraokulärer Chirurgie bei 44,3 %. Das Erlernen intraokularer Chirurgie lag bei 13,5 % der Teilnehmenden vor. Die vorliegende Datenerhebung zeigt einmal mehr, dass für die zufriedene und erfolgreiche Facharztausbildung die Erreichung der Ziele des Facharztkatalogs von maßgeblicher Bedeutung ist. Des Weiteren wurde das Vorliegen einer strukturierten Facharztausbildung von der Mehrheit der Befragten verneint, wodurch der Bedarf für ein standardisiertes Curriculum unterstrichen wird.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Spinal cerebrospinal fluid (CSF) leak is a disabling and often misdiagnosed condition characterised by CSF hypovolemia. Associated neurological symptoms are diverse and often leave individuals bed-bound due to their orthostatic nature. Prior literature describing the difficulties in diagnosis, treatment, and ongoing impact of CSF leak is, thus far, confined to Europe and North America. This study provides a novel account of lived experiences of spinal CSF leak in Australia and Aotearoa New Zealand (NZ). An online survey exploring symptoms, diagnosis, treatment, and effect on daily life of a person's "first" CSF leak was designed with consumer involvement. Responses were received from May to August 2025. Open-text responses were analysed using thematic analysis. In total, 106 surveys were completed. Over 70 symptoms were reported; the most common were orthostatic headache (95.3%), neck pain (85.8%), and brain fog (79.2%). Most people considered their diagnosis (73.6%) and treatment (65.3%) difficult, underscored by limited clinician awareness and access to care, leaving individuals to self-advocate. Amongst symptomatic participants (73.6%), median EuroQol Visual Analogue Scale score was 40 (interquartile range 25-64; indicating low health-related quality-of-life) and mean Headache Impact Test-6 score was 69 ± 5 (indicating severe impact). Other challenges identified included navigating change to social identity and daily functioning. The spinal CSF leak experience in Australia and NZ is comparable to reports from other high-income countries, highlighting the global need to increase awareness of spinal CSF leak, support timely diagnostic, referral and treatment pathways, and mitigate its impact on quality of life.
Facial palsy is a debilitating condition that can lead to significant functional, aesthetic, and psychosocial impairments. Thus, this study aimed to systematically explore treatment preferences and values among Korean patients with facial palsy and develop clinically applicable recommendations to enhance patient-centered care. A cross-sectional questionnaire survey was conducted between June and July 2025 at a facial palsy clinic in a secondary referral hospital. A total of 51 patients with peripheral facial palsy completed a structured 21-item survey addressing preferences related to assessment and diagnosis, treatment modalities, multidisciplinary care, communication, information sources, and recovery concerns. The internal consistency of the questionnaire was evaluated using Cronbach's alpha (α). Participants (mean age 43.1 ± 12.4 years; 68.6% female) prioritized objective assessment methods and accurate prognostic information, favoring standardized tools and electrophysiological testing. Regarding treatment preferences, 82.4% supported active steroid therapy and 74.5% preferred combined steroid-antiviral treatment. Surgery was generally viewed as a last resort, with 51.0% favoring non-surgical rehabilitation even in chronic cases-those persisting for more than six months. Multidisciplinary care and clear, detailed communication were highly valued. The primary recovery concern was permanent facial sequelae (64.7%). Meanwhile, the internal consistency of the survey, which covered diverse and independent domains, was rather poor (Cronbach's α = 0.548), reflecting the multidimensional nature of the patient preferences. Korean patients with facial palsy express a strong fear of permanent sequelae, which shapes the preferences of patients toward objective information and treatments with high efficacy. Moreover, the patients were found to favor comprehensive multidisciplinary care, clear and transparent communication, and collaborative relationships with healthcare providers. These findings provide important insights for developing patient-centered clinical guidelines tailored to Korean patients with facial palsy.
To investigate the association between endogenous estrogen exposure and intraocular pressure (IOP) in postmenopausal women stratified by glaucoma status. This population-based, cross-sectional study analyzed 1,823 postmenopausal women aged ≥50 years from the Korea National Health and Nutrition Examination Survey (2010-2011). Age at menarche, and menopause, reproductive span, and time since menopause were used as surrogate markers of lifetime estrogen exposure. Multivariate linear regression analyses were performed for the non-glaucoma and glaucoma groups, adjusting for confounders. Among women without glaucoma, indicators of longer estrogen exposure were significantly associated with higher IOP. Menopause at the age of ≥49 years and reproductive span of ≥33 years were associated with IOP increases of 0.79 mmHg and 0.88 mmHg, respectively. Conversely, in women with glaucoma, longer estimated estrogen exposure was associated with lower IOP. Menopause at ≥48 years of age and reproductive span at ≥31 years were not associated with IOP reduction. These findings demonstrate distinct associations between endogenous estrogen exposure proxies and IOP in women with and without glaucoma. Our results suggest a context-dependent role of estrogen in ocular physiology, with potential implications for glaucoma risk assessment and the development of preventive strategies in aging women.
Background/Objectives: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and a significant cause of severe visual impairment. Intermittent fasting (IF) has demonstrated metabolic benefits. We investigated the association between IF and DR risk in individuals with prediabetes and diabetes. Methods: This retrospective cohort study included participants of the Korean National Health and Nutrition Examination Survey 2017-2018 aged ≥40 years who were diagnosed with diabetes or prediabetes who had fundus photography and dietary pattern data. Participants were allocated to the IF (fasting for 24 h or skipping breakfast or dinner) and regular diet groups. Demographic, dietary pattern and clinical data, including DR prevalence, were compared between the groups. Multiple logistic regression assessed the association between IF and DR risk. Results: Of 922 participants, 831 followed a regular diet while 91 practiced IF. The participants in the IF group were significantly younger and more obese, had higher fat intake, and showed a lower prevalence of DR than those in the regular diet group (8.8% vs. 20.6%, p = 0.010). After adjusting for multiple covariates, including demographics, comorbidities, health behaviors, biochemical parameters, and nutritional intake profiles, IF was associated with a 70% reduced risk of DR (OR 0.30, 95% CI 0.12-0.65, p = 0.005). This association did not differ across subgroups (all p for interaction > 0.05). Conclusions: IF was significantly associated with reduced DR risk in this study. Further studies are needed to validate the effectiveness of IF as a dietary intervention for DR.
To examine organisational leave policies for clinical trial participation in England and compare willingness between the public and healthcare professionals (HPs) under varying leave conditions. Freedom of information (FOI) requests were submitted to 378 public-sector organisations to identify policies supporting leave for clinical trial participation. Parallel cross-sectional surveys of the public (n=503; working-age adults) and HPs (n=110) assessed willingness to participate as a healthy volunteer (HV) or patient (P) in scenarios requiring annual leave (AL) or unpaid leave (UL). Free-text responses were analysed thematically. Group comparisons used χ² tests, and multivariable logistic regression examined predictors of willingness, adjusting for demographic and employment characteristics. Five organisations (1.3%) reported an explicit policy addressing clinical trial leave while 336 (88.9%) reported none. Across all scenarios, public respondents were more willing to participate than HPs, particularly for HV participation using AL (78.9% vs 63.6%; p=0.001). In adjusted analyses, HPs had lower odds of willingness than public respondents for HV-AL (aOR 0.52, 95% CI 0.32 to 0.85), P-AL (aOR 0.67, 95% CI 0.44 to 0.98) and P-UL (aOR 0.61, 95% CI 0.38 to 0.96). Willingness declined when UL was required. No association was observed between Index of Multiple Deprivation decile and willingness. Financial concerns were the main barrier among the public, whereas HPs cited limited availability of AL. There is a widespread lack of organisational policies supporting clinical trial participation leave, and willingness is highly sensitive to whether leave is paid. This is particularly relevant in ophthalmology, where trials often involve repeated, time-intensive visits and reliance on working-age carers. Limitations include non-probability sampling, uncalculated survey response rates, self-reported willingness, a small regionally recruited HP sample and restriction to public-sector FOI data. Employment policy represents an under-recognised structural determinant of clinical trial participation, with implications for ophthalmology research.
A corneal ulcer prevention program trained Female Community Health Volunteers (FCHVs) to diagnose and treat corneal abrasions in Nepal. To understand community eyecare-seeking behavior, program awareness, and program perceptions. This mixed-methods study was conducted in program communities. Surveys assessed awareness in a random sample of 10-20 households per community at 6 and 18 months after program initiation. Focus group discussions (FGDs) with community members and FCHVs examined care-seeking behavior and perceptions at 9 months. Six communities were randomly selected for FGDs, and within each, a random sample of 10 males and 10 females were invited to participate. FCHVs from these communities participated separately. The intervention was modified based on the FGDs before the final survey. The pre-FGD survey found 3.1% (SD 7.2%) of participants were aware of the program. All 13 FGDs (92 participants) indicated eye trauma and delayed care-seeking were common. Participants from only four FGDs reported awareness of the FCHV program though participants from all FGDs indicated a willingness to seek eye care from the FCHVs. As FGDs identified word-of-mouth and door-to-door outreach as effective publicity approaches, two door-to-door campaigns were subsequently implemented. Household surveys 9 months after the FGDs found that program awareness increased to 32.9% (SD 26%, p-value <0.001). FGDs revealed that eye trauma and delayed care-seeking were common, underscoring the need to address barriers to timely care. Community engagement strategies identified during FGDs were successfully implemented. Program awareness was much higher post-FGDs, although causality cannot be established in this observational study. Main findings: Two key explanations for poor vision outcomes in Nepal were identified: eye trauma and delayed care-seeking.Added knowledge: Although initial awareness of the corneal ulcer prevention program was low, communities demonstrated strong receptivity to visiting FCHVs for eye health when adequately informed.Global health impact of policy and action: Focus group discussions revealed a willingness to use community health volunteers as a resource for eye health and informed changes to intervention publicity that may have been temporarily associated with increased awareness of the corneal ulcer prevention program.
The prevalence of the 2 types of horizontal strabismus, esotropia and exotropia, varies considerably between studies. This variability has been attributed to factors such as geography/environment, research methodology, age of study subjects, and/or ethnicity. Comprehensive estimates of regional and global prevalences of esotropia and exotropia are lacking, making it difficult to recognize true patterns, trends, and etiologies. We compile prevalences and ratios of esotropia to exotropia from 315 population-based studies and 374 clinic-based studies. We analyze data to assess effects of ethnicity, geography, age, and we identify generational changes of horizontal strabismus. Major ethnicities differ in patterns and ratios of esotropia and exotropia prevalence, not only in Caucasians and East Asians, but also Latinos/Hispanics, South Asians, Africans, and Native Americans. Compared to population-based studies, clinic-based studies underestimate exotropia frequency. By weighing prevalences according to the population size of ethnicities, we estimate the worldwide prevalence of horizontal strabismus in the current generation at 1.81% (138.5 million people), comprising 60.0 million people with esotropia (0.67%) and 87.5 million with exotropia (1.14%). In the previous generation, the worldwide prevalence of horizontal strabismus was 1.64% (86.5 million people), comprising 50.5 million with esotropia (0.96%) and 36.0 million with exotropia (0.68%). Esotropia and exotropia prevalences differ between generations within the same ethnicity, indicating that extrinsic factors can modify the underlying intrinsic (genetic) disposition.
Hereditary optic neuropathies are characterized by bilateral visual loss due to the degeneration of retinal ganglion cells, resulting in optic nerve degeneration and atrophy. Although the genetic origin of the main isolated and syndromic hereditary optic neuropathies has been characterized, the clinical phenotypes exhibit significant and poorly understood variability in both penetrance and expressivity. Additionally, the genetic and environmental factors that influence the onset of these optic neuropathies remain poorly understood, with limited biomarkers to predict disease progression or as readouts for therapeutic trials. Data-driven omics strategies allow deep phenotyping to improve our understanding of pathophysiological mechanisms and to search for new biomarkers and therapeutic targets. We explore whether the omics strategies applied to patients with hereditary optic neuropathies have provided such new insights. MEDLINE, Web of Science and EMBASE databases were screened for studies with terms relating to hereditary optic neuropathies, transcriptomics, epigenomics, proteomics, metabolomics and lipidomics in clinical studies exploring patients' samples. Out of 1244 references identified, 22 articles were included after double-masked data curation. These articles focused only on the 3 main forms of hereditary optic neuropathies, namely, OPA1-related dominant optic atrophy (n = 4), Leber hereditary optic neuropathy (n = 13), and Wolfram syndrome (n = 5). While the methodological designs and results of these studies were highly heterogeneous, they revealed molecular alterations that we have attempted to discuss at the integrated multi-omics level. This data integration highlighted several common pathophysiological mechanisms such as energetic impairment, endoplasmic reticulum stress, proteotoxic and oxidative stresses, lipid remodeling and altered amino acid and purine metabolisms, while suggesting potential new biomarkers and therapeutic targets. These findings underscore the potential of integrated multi-omics approaches to deepen our understanding of the phenotypic complexity of hereditary optic neuropathies and to support the development of innovative diagnostic and therapeutic strategies.
To gauge age-related macular degeneration (AMD) patient opinions on the potential acceptability of the PRIMA neurostimulation device for partial vision restoration during activities of daily living (ADLs). An international multisite survey study was completed by 196 visually impaired AMD individuals online through a foundation or society (United States, United Kingdom) or via telephone or in-person interviews (Italy, France, Germany) to inquire about ADLs for which retinal implant systems could potentially offer assistance. A high level of interest ("very likely") to use a vision restoration device was reported by approximately half of the respondents for completing documents, recognizing people, hobbies, identifying money, reading street signs and store names, and seeing signs in public. The odds of being very likely to use a vision restoration device for these tasks were not statistically significantly related to whether the participant had partial or severe sight loss. Odds of being very likely to use it for completing documents or reading mail (odds ratio = 2.33; 95% confidence interval, 1.2-4.5; P = 0.013) were significantly greater among those who had stopped doing these tasks or relied on others. The majority (66.5%) indicated that they would be comfortable wearing the vision restoration glasses around others. Participation in vision rehabilitation was acceptable if the training duration was not excessive. AMD respondents with varying vision loss indicated interest and acceptability of a vision restoration device for ADLs. In support of future research and development efforts, AMD respondents endorsed high levels of willingness to use a vision restoration system involving a surgically implanted device and electronic glasses.
Xerophthalmia is a vision-threatening eye condition caused by vitamin A deficiency (VAD). Cases of xerophthalmia in high-income countries (HICs) are vulnerable to misdiagnosis, causing delays in treatment and adverse visual outcomes. We define the features, causes and complications of VAD and xerophthalmia in children of HICs. Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42024492023). We performed a search for eligible articles on Scopus, Web of Science, Cochrane, PubMed and Medline. Cases reporting on children under 18 years of age residing in HICs with ocular features of VAD were eligible for inclusion. The search yielded 2474 results; 43 case reports and case series met the inclusion criteria consisting of a total of 61 cases (mean age 9.9 ± 4.2 years, range 3-17 years). Xerophthalmia was graded according to the most advanced finding for each case: 21.3% had night blindness only; 29.5% had conjunctival xerosis or Bitot spots; 29.5% had corneal xerosis, ulceration or scarring; 1.6% had xerophthalmia fundus only; and 18.0% had ocular manifestations associated with VAD that are not encompassed under the WHO classification. These features included swollen optic discs, optic neuropathy, or ocular dryness. Restrictive dietary practises were the most common mechanism of deficiency (75%), and autism was the most common underlying condition (49%). This shows that VAD remains a cause of severe visual impairment in HICs, especially when associated with delays in diagnosis and treatment. Further research is required to establish the prevalence of xerophthalmia in HICs.
Vision symptoms are frequent after concussion and can often persist and be disabling. Most studies on concussion with persisting concussion symptoms (PCS) provide limited attention to vision symptoms. Vision symptoms occur in 69-82% of patients with PCS and commonly include photophobia, blurred vision, and computer screen intolerance (CSI) - a syndrome induced by viewing electronic screens including computer, cell phone, tablet, or TV screens. We discuss the vision symptoms that may arise and persist after a concussion. Unfortunately, the pathophysiology of many of these symptoms is unknown, and we examine current views of the mechanisms potentially involved with a focus on CSI. We also evaluate the effectiveness of the currently available treatments. Our aim is to improve recognition and treatment of concussion induced vision symptoms through an understanding of their pathophysiology and the efficacy of available treatments. Enhanced recognition and understanding may facilitate improved treatment for these debilitating symptoms that compromise the quality of life and hinder return to school or work for many concussed individuals. We aim to aid ophthalmologists, optometrists, and other vision scientists who are frequently called upon to diagnose and treat patients with these symptoms.
Atropine is an emerging therapy for myopia, yet the optimal concentration for prescription remains uncertain. We searched PubMed, Embase, Web of Science, Cochrane Library, World Health Organization International Clinical Trials, and ClinicalTrials.gov registry platforms. We included the randomized clinical trials (RCTs) that compared any dose of atropine against a placebo in myopic children. Among 3566 studies assessed, we identified 33 eligible RCTs involving 6301 children aged 4-18 years, with 10 different concentrations and a mean follow-up time of 19.5 ± 12.3 months. A nonlinear relationship was observed between atropine dosage and treatment efficacy (P < 0.001). Compared to placebo groups, the mean differences in reducing annual spherical equivalent refraction progression for atropine concentrations of 0.01%, 0.02%, 0.03%, 0.04%, and 0.05% were 0.21 diopters (D) (95% CI, 0.13-0.28), 0.35 D (95% CI, 0.23-0.46), 0.42 D (95% CI, 0.28-0.56), 0.45 D (95% CI, 0.30-0.60), and 0.46 D (95% CI, 0.32-0.61) respectively For higher concentrations, the estimates were 0.49 D (95% CI, 0.34-0.63) for 0.1% and 0.99 D (95% CI, 0.66-1.31) for 1%, although these were based on fewer and smaller trials. Higher doses of atropine were associated with decreased amplitude of accommodation (P = 0.02), increased pupil diameters (P = 0.01) and a higher frequency of photophobia (P = 0.02). Our findings suggest that the increase in treatment efficacy with higher concentrations may plateau beyond a certain range, and that the current practice of increasing atropine concentrations for children who show inadequate responses to lower doses should be confined to a specific concentration range. This analysis is limited by the number, design heterogeneity, and sample sizes of available trials for higher concentrations, and by the frequent lack of pre-intervention refractive history in included studies. Therefore, estimates-particularly for doses exceeding 0.1%-should be interpreted with caution.
Thyroid eye disease (TED), the most common extrathyroidal manifestation of Graves' disease, requires individualized management that integrates medical, radiotherapeutic, and surgical interventions. In this article, we present a society-endorsed, survey-informed Korean clinical practice framework, including consensus elements, for TED management. This framework integrates the 2022 American Thyroid Association/European Thyroid Association consensus, the 2021 European Group on Graves' Orbitopathy (EUGOGO) guideline, and contemporary Korean specialist practice patterns. A 2025 nationwide survey of 32 members of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery characterized current Korean practice patterns in TED management. Korean oculoplastic surgeons showed high adherence to international recommendations, with 87.5% using both the clinical activity score and EUGOGO severity classification and 96.9% administering intravenous glucocorticoid therapy according to EUGOGO protocols. Distinctive features of Korean practice included frequent use of orbital radiotherapy (90.6%) and regional triamcinolone injections (81.2%) in selected clinical settings. For dysthyroid optic neuropathy, 59.4% of respondents reported using combined intravenous glucocorticoid therapy and orbital radiotherapy as the initial treatment approach. This framework stratifies treatment according to disease activity, severity, and predominant clinical phenotype to support context-adapted therapeutic decision-making. As emerging therapies such as teprotumumab become more accessible, this Korean clinical practice framework may provide practical guidance tailored to local clinical practice and healthcare-system constraints.
Literature on pediatric uveitis frequently describes the disease as noninfectious, bilateral, and anterior with a female sex predilection. This characterization misrepresents epidemiology studies from many parts of the world. This systematic review and Bayesian meta-analysis combines demographic and clinical data representing 43 studies from 26 countries over the last 10 years to create a global picture of the epidemiology of pediatric uveitis. We performed additional Bayesian meta-regression analyses to explore how geography, economy, and climate may have played a role in inter-study variability. While there was a greater proportion of females in studies from high-income countries, there was a male sex predilection in lower-middle-income countries. We found that climate had a greater bearing on proportion of infectious etiologies than economic or regional designation, and that these factors played varying roles with regards to specific infectious and noninfectious etiologies. Income alone proved to be a significant moderator of vision at presentation, with high-income countries having the highest proportion of patients with good vision and the lowest proportion of patients with poor vision. Our study helps to better characterize the complex global picture of pediatric uveitis.
Subretinal hyperreflective material (SHRM) is now recognized as a biomarker in neovascular age-related macular degeneration (nAMD), with potential prognostic value for visual and structural outcomes. We synthesize and critically evaluate the evidence on the prognostic role of SHRM characteristics in patients with nAMD. We conducted a systematic search of PubMed, Scopus and Web of Science for studies published between March, 2015, and March, 2025. Eligible studies included human participants with nAMD, under anti-vascular endothelial growth factor (anti-VEGF) treatment, in which SHRM was assessed using optical coherence tomography and outcomes included best-corrected visual acuity (BCVA), fibrosis and macular atrophy. Thirty-three studies met the inclusion criteria. Most of the studies demonstrated a significant association between the presence of SHRM and worse BCVA over time, particularly correlated to SHRM thickness, width or persistence after anti-VEGF therapy. Well-defined and hyperreflective SHRM was repeatedly linked to poorer functional outcomes. Twelve studies reported SHRM as a strong predictor of subretinal fibrosis, with larger size, defined borders and persistence conferring the greatest risk. The relationship with macular atrophy was less clear; while some studies suggested that thicker or persistent SHRM increased the likelihood of atrophy, others found no association. Overall, the evidence suggests that SHRM is a strong imaging biomarker of poor prognosis in nAMD. While this review highlights consistent patterns, differences in how SHRM is measured remain a limitation. It will be important for future research to standardize SHRM assessment and establish its use in personalized treatment decisions.
Schlaegel lines (SL) represent distinctive curvilinear patterns of chorioretinal atrophy that have emerged as a distinctive, yet non-pathognomonic, funduscopic sign across diverse ocular disorders. First described as related to presumed ocular histoplasmosis syndrome in the early 1980s in Histoplasma-endemic regions, these peripheral fundus lesions have since been documented across numerous other etiologies. The majority of SL arise in the context of inflammatory chorioretinal disorders, with idiopathic multifocal choroiditis and punctate inner choroiditis constituting the most frequent underlying causes. SL can also occur in a subset of inherited retinal diseases, where they may represent a secondary acquired sign of outer retinal damage. SL demonstrate a predilection for young to middle-aged myopic women. On fundus examination, SL appear as linear atrophic spots or streaks with variable pigmentation. Optical coherence tomography demonstrates retinal pigment epithelium-Bruch membrane-choriocapillaris complex disruption or, when SL are detected during the active inflammatory phase, hump-like hyperreflective RPE elevations. The differential diagnosis of SL requires recognition of the characteristic multimodal imaging patterns to distinguish them from mimicking conditions, such as Verhoeff lines and West Nile chorioretinitis. A comprehensive understanding of the diverse etiologies of SL is essential for accurate diagnosis and appropriate clinical management.
Glaucoma is a group of irreversible, blinding eye diseases characterized by progressive loss of retinal ganglion cells, leading to gradual visual field defects that severely impact patients' quality of life. Its complex pathophysiological mechanisms remain incompletely understood, limiting the development of early diagnostic and effective therapeutic strategies. Advances in omics technologies have provided new insights into elucidating the pathophysiology of glaucoma. We summarize specific alterations in genomics, transcriptomics, proteomics, metabolomics, epigenomics, and microbiomics associated with glaucoma. We emphasize the systematic analysis of disease mechanisms, identification of clinically applicable biomarkers, and discovery of novel therapeutic targets through the integration of these data. This approach paves new pathways for glaucoma subtype diagnosis and personalized treatment, while also outlining future research directions and challenges.