搜索结果：Taiwan journal of ophthalmology

This diagnosis study evaluated the diagnostic validity of Neuro-ophthalmology Disorder Early Screening (NODES), a telemedicine-based smartphone application that integrates structured anamnesis and simple neuro-ophthalmology examination for early detection of neuro-ophthalmological disorders. This study was conducted at Sardjito Eye Center Neuro-ophthalmology subdivision, assessing the diagnostic validity of the NODES mobile application of 16 neuro-ophthalmology diagnoses compared to confirmative diagnoses of neuro-ophthalmologists. A total of 126 participants meeting inclusion criteria underwent two treatments: simple examination using the NODES application, compared to confirmative examination by neuro-ophthalmologists. Standard protocols were integrated into both treatments to evaluate the diagnosis accuracy of the examination. NODES showcase promising results as a new diagnostic tool for these four disorders; myasthenia gravis (MG) with the area under the curve (AUC) =0.951, multicranial nerve palsy orbital apex (MNP OA) with AUC = 0.900, monocranial nerve palsy N.III (MNP N.III) with AUC = 0.824, and monocranial sixth nerve palsy (MNP N.VI) with AUC = 0.764. The NODES application can be used as a new diagnostic screening tool for several euro-ophthalmology diagnoses including MG, multicranial nerve palsy orbital apex, monocranial nerve palsy N.III, and monocranial sixth nerve palsy. The high specificity of NODES in other neuro-ophthalmology diagnoses can be quite useful to identify individuals without the condition, reducing the occurrence of false positives and crucial in preventing unnecessary stress, further testing, and potential misdiagnoses for those who do not actually have the condition.

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.

This study aims to evaluate and compare the performance of generative pretrained transformer (GPT)-4o and GPT-4 in answering Taiwan's National Medical Licensing Examination (NMLE) ophthalmology questions from 2014 to 2023, focusing on both answer accuracy and explanation quality. A total of 169 ophthalmology questions from Taiwan's NMLE over the past decade were selected. GPT-4o and GPT-4 were tested on each question, and their performance was measured by correct answers and explanations. The results were categorized by ophthalmologic subspecialty and analyzed using statistical methods to determine significant differences between the two models. GPT-4o achieved a significantly higher overall correct answer rate (92.9%) compared to GPT-4 (69.2%) across all ophthalmology questions from 2014 to 2023 (P < 0.01). GPT-4o outperformed GPT-4 in most subspecialties, including retina (95.8% vs. 58.3%, P < 0.01), external disease and cornea (96.3% vs. 77.8%, P = 0.04), and neuro-ophthalmology (87.5% vs. 50%, P = 0.02). GPT-4o and GPT-4 performed similarly in glaucoma and uveitis, with no significant differences observed. In terms of explanation quality, GPT-4o provided accurate explanations for 90.7% of the questions, with the highest accuracy in pediatric ophthalmology and strabismus (100%) and the lowest in uveitis (83.3%). GPT-4o exhibited superior performance in both answering and explaining ophthalmology questions from Taiwan's NMLE compared to GPT-4. These results suggest that GPT-4o may be a more reliable tool for educational and diagnostic purposes in ophthalmology.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1&#xb7;3 billion (95% uncertainty interval [UI] 1&#xb7;2 to 1&#xb7;4) individuals were estimated to be living with MASLD (ie, 16&#xb7;1% of the global population), with an age-standardised prevalence rate of 14&#x2009;429&#xb7;3 (95% UI 13&#x2009;268&#xb7;3 to 15&#x2009;990&#xb7;6) per 100&#x2009;000 population, representing a percentage increase of 142&#xb7;7% (95% UI 139&#xb7;2 to 146&#xb7;7) in crude numbers from 1990 (0&#xb7;5 billion [0&#xb7;5 to 0&#xb7;6]) and of 28&#xb7;6% (27&#xb7;8 to 29&#xb7;5) in the rate (11&#x2009;217&#xb7;2 [10&#x2009;276&#xb7;8 to 12&#x2009;467&#xb7;0] per 100&#x2009;000 in 1990). An estimated 3&#xb7;6 million (2&#xb7;8 to 4&#xb7;5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39&#xb7;6 (31&#xb7;2 to 49&#xb7;9) per 100&#x2009;000 population. Despite a 116&#xb7;3% (93&#xb7;3 to 139&#xb7;4) increase in crude DALYs (from 1&#xb7;7 million [1&#xb7;3 to 2&#xb7;1] in 1990), its age-standardised estimate remained consistent (1&#xb7;8% [-8&#xb7;6 to 12&#xb7;8]) from 1990 (38&#xb7;9 [30&#xb7;1 to 49&#xb7;8] per 100&#x2009;000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29&#x2009;246&#xb7;1 [26&#x2009;848&#xb7;3 to 32&#x2009;048&#xb7;7] per 100&#x2009;000) and Andean Latin America showed the highest DALY rate (152&#xb7;3 [114&#xb7;1 to 194&#xb7;7] per 100&#x2009;000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653&#xb7;5 [7923&#xb7;7 to 9592&#xb7;8] per 100&#x2009;000) and east Asia had the lowest DALY rate (16&#xb7;3 [13&#xb7;5 to 19&#xb7;9] per 100&#x2009;000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15&#x2009;616&#xb7;4 [14&#x2009;349&#xb7;2 to 17&#x2009;263&#xb7;3] per 100&#x2009;000 people in 2023) than in females (13&#x2009;245&#xb7;2 [12&#x2009;132&#xb7;0 to 14&#x2009;692&#xb7;6] per 100&#x2009;000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2&#xb7;2 [95% UI 1&#xb7;6 to 3&#xb7;1] per 100&#x2009;000 people), followed by high BMI (1&#xb7;4 [0&#xb7;6 to 2&#xb7;4] per 100&#x2009;000 people) and smoking (1&#xb7;0 [0&#xb7;3 to 1&#xb7;8] per 100&#x2009;000 people). Our forecasting model estimates that 1&#xb7;8 billion (95% UI 1&#xb7;6 to 2&#xb7;0) individuals are likely to have MASLD by 2050, representing a 42&#xb7;0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15&#x2009;774&#xb7;9 (95% UI 14&#x2009;613&#xb7;9 to 17&#x2009;336&#xb7;2) per 100&#x2009;000 people in 2050, representing an average annual percentage change of 0&#xb7;3% (95% UI 0&#xb7;3-0&#xb7;3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16&#xb7;1% and approximately 1&#xb7;3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.

Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2&#xb7;30 million (95% uncertainty interval [UI] 2&#xb7;01 to 2&#xb7;61) breast cancer incident cases, 764&#x2008;000 deaths (672&#x2008;000 to 854&#x2008;000), and 24&#xb7;1 million (21&#xb7;3 to 27&#xb7;5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44&#xb7;2 per 100&#x2008;000 person-years [31&#xb7;2 to 58&#xb7;4]), the age-standardised mortality rate (ASMR) was the highest (24&#xb7;1 per 100&#x2008;000 [16&#xb7;8 to 31&#xb7;9]). The highest ASIR was in the high-income group (75&#xb7;7 per 100&#x2008;000 [67&#xb7;1 to 84&#xb7;0]), and the lowest ASMR was in the upper-middle-income group (11&#xb7;2 per 100&#x2008;000 [10&#xb7;2 to 12&#xb7;3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147&#xb7;2% (38&#xb7;1 to 271&#xb7;7), compared with a 1&#xb7;2% (-11&#xb7;5 to 17&#xb7;2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29&#xb7;9% (-33&#xb7;6 to -25&#xb7;9), but increased by 99&#xb7;3% (12&#xb7;5 to 202&#xb7;9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28&#xb7;3% (16&#xb7;6 to 38&#xb7;9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3&#xb7;56 million (2&#xb7;29 to 4&#xb7;83), with 1&#xb7;37 million (0&#xb7;841 to 2&#xb7;02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2&#xb7;5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.

The rise of generative artificial intelligence (GenAI) has profoundly influenced medical research and academic writing, particularly in ophthalmology. Despite its growing relevance, there is a noticeable gap in the literature regarding its application in medical writing, including practical uses and associated limitations. This review seeks to fill in this gap by first systematically reviewing the current literature on GenAI in medical paper writing. It identifies and discusses nine key applications and considerations, including idea generation, literature review, institutional review board preparation, data collection, data analysis, image generation, manuscript drafting, writing refinement, and peer review. In the second part, we explore publicly available AI tools that currently assist with medical manuscript writing. We also introduce several generative AI detection tools and discuss their accuracy and reliability. Finally, the review addresses the limitations and ethical challenges associated with the use of GenAI in medical paper writing. While GenAI has streamlined many aspects of medical paper writing, and an increasing number of AI tools have been developed for research, significant model limitations and ethical concerns persist, necessitating careful human oversight and clear guidelines. By providing a comprehensive yet focused overview, this article offers valuable insights into the effective use of GenAI in medical paper writing while acknowledging its limitations and risks. It aims to support researchers in producing high-quality, AI-enhanced publications in the field of ophthalmology.

The authors evaluated the alterations of applying artificial intelligence (AI) diagnostic system for diabetic retinopathy screening in real-world practice. This retrospective study included 11,713 diabetic patients from the government-led Diabetes Shared Care Network. The AI system VeriSee DR was integrated into the clinical workflow to identify referable diabetic retinopathy (RDR). Its performance was compared with ophthalmologist grading at the patient level using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Subgroup analysis was performed by age and sex, with additional referral diseases identified by ophthalmologists. VeriSee DR achieved a sensitivity of 0.88, specificity of 0.86, accuracy of 0.86, positive predictive value of 0.58, negative predictive value of 0.97, and area under the receiver operating characteristic curve of 0.87 in detecting RDR. Performance declined with increasing age, whereas sex distribution remained consistent across age groups. The AI system identified a higher proportion of RDR than ophthalmologists (27.45% vs. 18.15%). In addition to 1,818 patients with RDR, ophthalmologists identified other referral-warranted ocular conditions in 4.5% of cases. The AI system referred age-related macular degeneration (Grades 2-4), whereas referral decisions for macular hole and macular edema (Grades 1-2) varied; however, glaucoma (Grades 0-1) identified by clinicians was not consistently referred. VeriSee DR demonstrated high accuracy in detecting RDR but exhibited reduced performance in older patients. It had a higher referral rate than ophthalmologists yet missed certain conditions such as glaucoma. Despite effectiveness in diabetic retinopathy screening, further refinement is required to support broader ophthalmic disease detection.

Chronic kidney disease (CKD) is common and ranks among the leading causes of mortality and morbidity. This analysis aimed to present global CKD estimates using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to inform evidence-based policies for CKD identification and treatment. This analysis focused on adults aged 20 years and older over the period 1990 to 2023, from 204 countries and territories. Data sources used were published literature, vital registration systems, kidney failure treatment registries, and household surveys. Estimates of CKD burden, including deaths, incidence, prevalence, and disability-adjusted life-years (DALYs), were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool. A comparative risk assessment approach estimated the proportion of cardiovascular deaths attributable to impaired kidney function and estimated risk factors for CKD. Globally, in 2023, 788 million (95% uncertainty interval 743-843) people aged 20 years and older were estimated to have CKD, up from 378 million (354-407) in 1990. The global age-standardised prevalence of CKD in adults was 14&#xb7;2% (13&#xb7;4-15&#xb7;2), a relative rise of 3&#xb7;5% (2&#xb7;7-4&#xb7;1) from 1990. The region with the highest age-standardised prevalence was north Africa and the Middle East (18&#xb7;0%; 16&#xb7;9-19&#xb7;4). Most people had stage 1-3 CKD, with a combined prevalence of 13&#xb7;9% (13&#xb7;1-15&#xb7;0). In 2023, CKD was the ninth leading cause of death globally, accounting for 1&#xb7;48 million (1&#xb7;30-1&#xb7;65) deaths, and the 12th leading cause of DALYs, with an age-standardised DALY rate of 769&#xb7;2 (691&#xb7;8-857&#xb7;4) per 100&#x2009;000. Impaired kidney function as a risk factor accounted for 11&#xb7;5% (8&#xb7;4-14&#xb7;5) of cardiovascular deaths. High fasting plasma glucose, body-mass index, and systolic blood pressure were all leading risk factors for CKD DALYs. CKD is a major global health issue, with rising prevalence and increasing importance as a cause of death and as a risk factor for cardiovascular death. A better understating of aetiology, appropriate screening, and implementation programmes are needed to translate advances in CKD treatment into improved patient outcomes. Gates Foundation, Wellcome, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.

Diabetic retinopathy (DR) is a common comorbidity of diabetes involving the formation of abnormal vascular structures in the retina. Tissue inhibitor of metalloproteinases 2 (TIMP2), initially identified as a key mediator of extracellular matrix turnover, is pivotal for inflammatory processes and tissue homeostasis. The current study examined the influence of TIMP2 gene variations on the risk for DR. We investigated the association of TIMP2 gene variations with DR by analyzing four single-nucleotide polymorphisms (SNPs) of the TIMP2 gene (rs16971783, rs2889529, rs7220980, and rs8068674) in a cohort of 672 patients with DR and 919 diabetic controls with normal ophthalmoscopic findings. Our results showed that rs16971783 of TIMP2 gene was associated with a higher risk for DR (TA vs. TT, AOR=1.445, p=0.028; TA+AA vs. TT, AOR=1.179, p=0.046). We further demonstrated that the association of rs16971783 with DR was exclusively observed in diabetic individuals with proliferative DR (TA vs. TT, AOR=1.827, p=0.035; TA+AA vs. TT, AOR=1.351, p=0.027), whereas not detected among those who suffered from non-proliferative DR. In addition, preliminary exploration of gene expression data from public resources reveald that rs16971783 regulated TIMP2 gene expression in various human tissues. Allele-specific expression of TIMP2 gene might contribute to the progression of DR.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates health loss from migraine, tension-type headache, and medication-overuse headache. This study presents updated results on headache-attributed burden from 1990 to 2023, along with clinical and public health implications. Data on the prevalence, incidence, or remission of migraine, tension-type headache, and medication-overuse headache were extracted from published population-based studies. We used hierarchical Bayesian meta-regression modelling to estimate global, regional, and country-level prevalence of headache disorders. For the first time in GBD 2023, age-specific and sex-specific estimates of time in symptomatic state were applied by meta-analysing individual participant data from 41&#x2008;653 individuals from the general populations of 18 countries from all parts of the world. Disability weights were applied to calculate years lived with disability (YLDs). Since medication-overuse headache is a sequela of a mistreated primary headache (due to medication overuse), its burden was reattributed to migraine or tension-type headache, informed by a meta-analysis of three longitudinal studies. In 2023, 2&#xb7;9 billion individuals (95% uncertainty interval 2&#xb7;6-3&#xb7;1) were affected by headache disorders, with a global age-standardised prevalence of 34&#xb7;6% (31&#xb7;6-37&#xb7;5) and a YLD rate of 541&#xb7;9 (373&#xb7;4-739&#xb7;9) per 100&#x2008;000 population, with 487&#xb7;5 (323&#xb7;0-678&#xb7;8) per 100&#x2008;000 population attributed to migraine. The prevalence rates of these headache disorders have remained stable over the past three decades. YLD rates due to headache disorders were more than twice as high in females (739&#xb7;9 [511&#xb7;2-1011&#xb7;5] per 100&#x2008;000) as in males (346&#xb7;1 [240&#xb7;4-481&#xb7;8] per 100&#x2008;000). Medication-overuse headache contributed 58&#xb7;9% of the YLD estimates for tension-type headache in males and 56&#xb7;1% in females, as well as 22&#xb7;6% of the YLD estimates for migraines in males and 14&#xb7;1% in females. Headache disorders, in particular migraine, continue to be a major global health challenge, emphasising the need for effective management and prevention strategies. Much headache-attributed burden could be averted or eliminated by avoiding overuse of medication (including over-the-counter medication), underscoring the importance of public education. Gates Foundation.

The objective is to differentiate choroidal metastases (CM) arising from various primary cancer sites based on clinical presentation and imaging. A retrospective, observational study of 67 eyes (58 patients). The mean age at presentation was 60 years (range, 29-83 years). At presentation, 37 patients (64%) with CM had a known primary systemic cancer, whereas in 21 patients (36%) CM was the first manifestation of systemic cancer. Overall, the primary cancer sites were lung (n = 32, 55%), breast (n = 12, 21%), gastrointestinal tract (n = 6, 10%), genitourinary tract (n = 3, 5%), and others (n = 5, 9%). Most choroidal lesions were creamy yellow in color (84%), while 5 eyes (7%) displayed orange-colored lesions secondary to lung neuroendocrine tumors. On multimodal imaging, A-scan showed medium-high internal reflectivity in 35 eyes (69%), and medium-low reflectivity in 16 eyes (31%). Fundus fluorescein angiography (FFA) demonstrated late hypofluorescence in 17 eyes (94%), whereas indocyanine green angiography (ICG) demonstrated hypofluorescence throughout all phases in 11 eyes (69%). Optical coherence tomography (OCT) showed the presence of a lumpy-bumpy choroid with compression of the overlying choriocapillaries (n = 52, 91%), subretinal fluid (n = 40, 75%), and hyperreflective foci (HRF) (n = 25, 47%). Factors such as right eye involvement, orange tumor, the presence of HRF, increased tumor thickness, CM as the first presentation, and a shorter interval between diagnosis of primary cancer and CM were found to be strongly correlated with the origin of primary cancer from the lung compared with breast (P < 0.05). Ancillary imaging along with clinical presentation can provide clues to the origin of CM from various cancer sites, thereby aiding in the early diagnosis, staging, and treatment of primary cancer. CM from lung cancer is more likely to precede the diagnosis of a primary tumor than breast metastases.

Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377&#x2008;000 incident childhood cancer cases (95% UI 288&#x2008;000-489&#x2008;000), 144&#x2008;000 deaths (131&#x2008;000-162&#x2008;000), and 11&#xb7;7 million (10&#xb7;7-13&#xb7;2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27&#xb7;0% (15&#xb7;5-36&#xb7;1) globally, from 197&#x2008;000 (173&#x2008;000-218&#x2008;000) in 1990, but increased in the WHO African region by 55&#xb7;6% (25&#xb7;5-92&#xb7;4), from 31&#x2008;500 (24&#x2008;900-38&#x2008;500) to 49&#x2008;000 (42&#x2008;600-58&#x2008;200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26&#xb7;5% (26&#xb7;5-26&#xb7;5) in GBD 2017 to 10&#xb7;5% (8&#xb7;1-13&#xb7;1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47&#xb7;3% (42&#xb7;2-52&#xb7;0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.

The purpose of the study was to evaluate factors influencing outpatient follow-up adherence among patients receiving ophthalmology consultations in the emergency department (ED). This retrospective cohort study collected data from the Chang Gung Research Database. Patients who received ophthalmology consultations at the ED of Chang Gung Memorial Hospital Linkou Medical Center from January 1, 2010, to December 31, 2019, were included. Patients were divided into two groups based on whether they completed outpatient follow-up within 28 days, a timeframe consistent with our hospital's scheduling policy. Demographics, ED visit timing, triage categories, ophthalmic diagnoses, prior visits, and ED stay durations were analyzed using logistic regression. A total of 42,530 patients were included (mean age 38.6 &#xb1; 20.2 years; 59.2% male), with 38.4% adhering to follow-up and 61.6% not. Nonadherence was associated with younger age (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.92-0.93), evening (OR: 1.28; 95% CI: 1.22-1.34) or midnight (OR: 1.94; 95% CI: 1.83-2.06) ED visits, not likely emergent diagnoses (OR: 2.09; 95% CI: 1.96-2.22), and shorter ED stays (<1 h: OR: 3.73; 95% CI: 3.46-4.03). Patients with prior ophthalmology outpatient visits (OR: 0.48; 95% CI: 0.46-0.52) and longer ED stays (more than 3 h) demonstrated better adherence. Over 10 years, emergent diagnoses increased from 51.1% to 69.5%, while non-emergent diagnoses declined from 23.1% to 13.2%. Adherence to outpatient follow-up after ophthalmic ED visits was low. Younger age, evening or midnight visits, non-emergent diagnoses, and short ED stays predicted non-adherence, whereas prior outpatient visits and longer ED stays improved adherence.

Binocular diplopia is a distressing clinical condition that prompts clinicians to investigate underlying etiologies, particularly cranial nerve (CN) III, IV, or VI palsies. These may arise from microvascular ischemia, inflammation, trauma, compression, or neuromuscular junction disorders. This study aims to explore the association factors of these three ocular motor cranial nerve palsies and to compare their respective all-cause mortality rates using the real-world TriNetX Clinical Research Database (TriNetX CRD). TriNetX is a global federated administrative database with real-time updates of electronic medical records (EMRs). We used the US Collaborative Network within the TriNetX platform to establish the patient cohorts. This network contains electronic health record data from more than 100&#xa0;million patients across 68 US healthcare organizations (HCOs). This study utilized TriNetX platform to analyze the demographics and associated factors of ocular motor cranial nerve palsies, including diabetes, hypertension, acute myocardial infarction (AMI), overweight status, blood glucose and lipid profiles, body mass index (BMI), and history of brain aneurysm surgery, through intergroup comparisons using paired t-tests. All-cause mortality was assessed using Cox proportional hazards modeling and Kaplan-Meier survival analysis. The average age at presentation was 63, 57, and 60 years for CN III, IV, and VI palsies, respectively, with a slight male predominance. CN VI palsy was the most common, followed by CN IV and CN III palsies. CN III and CN VI palsy cohorts were more commonly associated with diabetes, hypertension, AMI, overweight, and brain aneurysm surgery, suggesting a microvascular or compressive etiology. In contrast, the CN IV palsy cohort was younger and more similar to the general population in clinical and laboratory characteristics. Regarding all-cause mortality, the CN III palsy cohort had the poorest survival, followed closely by the CN VI group, while the CN IV group exhibited the most favorable survival outcome. This study confirmed that CN VI palsy is the most frequent cause of ocular motor nerve palsy leading to binocular diplopia. Notably, CN III and VI palsies shared similar vascular and compressive association factors, while CN IV palsy appeared to be more frequently linked to congenital or traumatic origins. These differences were reflected in the mortality analysis, where CN III palsy showed the worst prognosis, CN VI a slightly better but comparable pattern, and CN IV the best survival outcome. Using the TriNetX CRD, this study delineated the demographic profiles, associated clinical factors, and survival outcomes of patients with ocular motor cranial nerve palsies. The typical demographic was males in their late 50s to early 60s, with CN VI being the most frequently affected nerve. CN III and VI palsies were more often associated with microvascular and compressive conditions, which correlated with higher mortality. Conversely, CN IV palsy was associated with a younger population and more benign clinical profiles, reflected in better survival outcomes.

The objective of this review was to provide a summary of the literature on the etiologies and management of positive (PD) and negative dysphotopsia (ND) which are optical phenomena that occur after routine cataract surgery. A search of PubMed and Google Scholar identified 36 relevant papers. There is a consensus on the etiology of PD, which is attributed to the edge design of the intraocular lens (IOL). A truncated square edge can cause light of an oblique incidence to reflect onto the retinal surface and cause streaks and haloes in the visual field. Other causes of PD include diffractive multifocal IOLs and IOLs with a high index of refraction. The causes of ND are multifactorial; however, the majority of the evidence from experimental and clinical studies supports the "illumination gap" of the nasal retina which may arise from the anterior capsule overlying the IOL. Other factors such as pupil size, a high-angle kappa, and increased posterior chamber depth may also play a role. Regarding surgical management, ND has been successfully treated with reverse optic capture, neodymium-doped yttrium aluminum garnet laser capsulectomy, nasal IOL optic truncation, piggyback IOL, and an ND ring. Both PD and ND can be surgically managed by replacing the IOL using in-the-bag exchange or bag-to-sulcus exchange. Technological advancements have presented new avenues for developing antidysphotopsia lenses. Novel approaches utilize anterior capsulotomy fixation using IOL phalanges and a recent diffractive spiral lens that provides smooth full-range vision without dysphotopsia.

Allergic rhinitis (AR) is a common chronic inflammatory condition of the upper respiratory tract that can significantly diminish quality of life. AR contributes to dry eye disease (DED) and meibomian gland alterations due to ocular surface inflammation triggered by repeated exposure to environmental allergens. This study aims to evaluate DED and meibomian gland loss (MGL) in patients with AR. A comparative cross-sectional study was conducted involving 79 patients with AR at Hospital Universiti Sains Malaysia. The subjects underwent a detailed evaluation of dry eye parameters using noninvasive ocular surface analyzer including assessment of noninvasive tear breakup time (NIBUT), lipid layer thickness (LLT), and tear meniscus height (TMH). MGL was assessed by meibography. The results were compared with those of a control group of 81 age-matched healthy individuals without AR. Patients with AR showed statistically significantly lower NIBUT, LLT, and TMH values compared to the control group (P < 0.001). Meibomian gland analysis revealed a statistically significant MGL in patients with AR compared to controls. A significant negative correlation was observed between MGL and TMH and NIBUT (P < 0.001). Patients with AR are at an increased risk of DED with a notable change in dry eye parameters and MGL. These findings underscore the importance of early detection and management of DED in patients with AR to prevent further ocular surface damage and improve their quality of life.

Diabetic retinopathy (DR) is a major cause of preventable blindness, but current diagnostic tools rely on expensive imaging devices, specialized expertise, and, in some cases, invasive procedures, limiting accessibility in resource-constrained settings. There is an unmet need for rapid, non-invasive, and affordable point-of-care methods for early DR detection. We developed a portable lateral flow microfluidic chip integrated with a photonic crystal (PhC) biosensor to enhance immunofluorescence detection of lipocalin-1 (LCN-1), a biomarker associated with DR. The PhC surface provided a 2.7-fold fluorescence enhancement compared to non-PhC substrates, and the microfluidic flow was optimized using an absorbent paper design to ensure uniform fluid distribution and sufficient antigen-antibody interaction time. Analytical performance was validated using sandwiched immunoassays with carboxylate-modified particles, followed by clinical evaluation in 30 tear samples from healthy individuals, non-proliferative DR (NPDR), and proliferative DR (PDR) patients. The PhC microchip achieved a detection limit of 136 pg &#x3bc;L-1 and delivered quantifiable results within 15 min. In clinical testing, elevated LCN-1 levels were observed in both NPDR and PDR patients compared with healthy controls. The biosensor achieved 100% sensitivity, specificity, and accuracy in distinguishing PDR from healthy individuals, as well as 100% sensitivity with 90% specificity for NPDR versus healthy individuals, resulting in an overall diagnostic accuracy of 95%. The PhC-integrated microchip enables rapid and non-invasive detection of DR from tear samples. Its high sensitivity, specificity, and capability to differentiate between NPDR and PDR demonstrate strong potential for future adaptation into a portable point-of-care screening platform, particularly suited for low-resource settings to facilitate early intervention and reduce vision loss in diabetic patients.

Diabetic retinopathy (DR) is a leading cause of vision impairment in patients diagnosed with Type 2 diabetes mellitus (T2DM). Awareness of risk factors is necessary to reduce or prevent harmful effects of DR such as irreversible vision loss, and to help ensure early treatment. This study aimed to evaluate associations between initial HbA1c at diabetes diagnosis, longitudinal changes, and medication adherence (MR), and the severity and progression of sight-threatening diabetic retinopathy (STDR). From July 2022 to January 2024, 300 patients with T2DM aged &#x2265;&#x2009;20&#x2009;years were recruited, and the data of 178 patients with complete data were analyzed, focusing on initial HbA1c levels at DM diagnosis, subsequent HbA1c changes at ophthalmologic visits, and MR using the Taiwanese version of the Morisky Medication Adherence Scale-8 (MMAS-8). Patients with persistently high or fluctuating HbA1c levels had a higher risk of severe DR compared to those with consistently low HbA1c. High initial HbA1c was more strongly associated with DR severity in females, patients aged <&#x2009;65&#x2009;years, and those without diet or exercise control. Poor or moderate MR was associated with higher HbA1c at follow-up and increased STDR risk. In contrast, patients aged &#x2265;&#x2009;65&#x2009;years were less likely to develop severe DR. Findings of this study accentuate the importance of initial glycemic control and HbA1c trends during ophthalmologic care in managing DR progression, suggesting that patients with high initial HbA1c may benefit from closer early ophthalmic monitoring.

Orbital cyst formation following previous orbital fracture surgery is an uncommon complication, yet it poses a significant concern related to permanent implant use. This complication may result in a pronounced mass effect that leads to deformation of the orbital bony walls. We present the three cases of orbital implantation cysts associated with orbital wall deformity, where bony alignment normalized after complete cyst removal. Patients exhibited ocular symptoms, including proptosis, diplopia, and hyperglobus. Surgical management involved total resection of the orbital cyst, removal of the prior implant, and placement of a new absorbable implant. Serial orbital computed tomography imaging performed over a 2-year postoperative period revealed progressive restoration of the orbital wall contour through ongoing bony realignment, with no evidence of implant migration or cyst recurrence. To the best of our knowledge, these cases provide the first documented radiological proof that bony remodeling after mass effect from an orbital implantation cyst is reversible, indicating that bone deformation caused by chronic compression can return to normal anatomy. This series underscores the necessity of thorough cyst excision and highlights the potential for anatomical correction following surgical intervention.