To estimate probabilities of high myopia-associated glaucomatous/glaucoma-like optic neuropathy (GLON) and non-glaucomatous optic neuropathy (NGON). Participants of four population-based investigations (Beijing Eye Study (n=3316 participants; age: 40+ years), Ural Eye and Medical Study (n=5372; age: 40+ years), Ural Very Old Study (n=586; age: 85+ years), Ural Children Eye Study (n=4328; age: 6+ years), Central India Eye and Medical Study (n=4374; age: 30+ years) underwent medical and ophthalmological examinations. The study population (n=35 167 eyes; 17 996 individuals) was randomly divided (ratio: 1:1) into a development and validation subgroup. In the development subgroup, the GLON prevalence equation was: -20.221+0.359×Axial Length+0.083×Age+0.706×Indian Ethnicity+0.198×Intraocular Pressure (IOP)+0.780×NGON-Presence. The NGON prevalence equation was: -38.136+1.202×Axial Length+0.038×Age-2.745×Indian Ethnicity+0.566×Myopic Macular Degeneration Stage+1.300×GLON Presence. In the validation subgroup, these equations had an area under the receiver operating characteristic curve for GLON prevalence and NGON prevalence of 0.881 and 0.964, respectively. Applying the equations, a non-Indian individual (axial length: 28 mm; IOP: 22 mm Hg) had a GLON probability of 3.5% and 60.2% at the ages of 30 years and 75 years, respectively, and an NGON probability of 3.42% and 16.4%, respectively. With an axial length of 30 mm, GLON probability and NGON probability increased from 6.9% to 75.6% and from 28.2% to 68.4% from age 30 years to 75 years. The equations offer a rough estimate of optic nerve damage probability at present and at older age, based on axial length, IOP, ethnicity and ocular comorbidity. The calculated probability of GLON and NGON (IOP: 22 mm Hg, age: 75 years) at an axial length of 28 mm was 60.2% and 16.4%, respectively, and 75.6% and 68.4%, respectively, for an axial length of 30 mm.
To investigate the effect of switching to a different type of myopia control spectacles on myopia progression. This retrospective matched-cohort study involved 1012 children or adolescents who were prescribed myopia control spectacles. Participants were divided into two groups: the change-of-type group (n=253), who switched to a different spectacle type, and the type-maintenance group (n=759), who retained the same type, using 1:3 propensity score matching. The primary outcome was the annual rate of spherical equivalent refraction progression (D/year) compared between and within groups before and after the switch. The initial prescription of myopia control spectacles occurred at a mean age of 9.46±2.11 years. Subsequent prescription (renewing the same type or switching to a new type) was provided at a mean age of 10.63±2.16 years. Before switching spectacles, the change-of-type group exhibited a significantly faster myopia progression rate than the type-maintenance group (-0.66±0.40 D/year vs -0.37±0.49 D/year; p<0.001). After switching, the progression rate slowed in the change-of-type group (mean reduction 0.18 D/year, p<0.001), narrowing the intergroup difference from 0.30 D/year to 0.08 D/year (-0.48±0.61 vs -0.40±0.50 D/year; p<0.001). However, the improved effect in the change-of-type group was not sustained, with myopia progression accelerating again with prolonged use (early vs late phase, -0.33 vs -0.53 D/year, p=0.024). Switching to a different type of myopia control spectacle may help slow myopia progression for children exhibiting suboptimal response to their initial spectacles. However, this beneficial effect tends to wane over time with prolonged wear.
To examine trends in corneal transplantation in Europe over an 18-year period from 2007 to 2024 by using data from the annual reports of the European Eye Bank Association (EEBA) regarding transplantation procedure type and quality control parameters in eye banking. Data were extracted from annual EEBA reports, and a longitudinal analysis of the categories-type of transplant, storage methods, issuance and contamination rates was conducted. The analysis included 443 237 corneas issued for transplantation from 116 different eye banks across 25 countries. The total number of keratoplasty procedures grew by 108%. A shift towards lamellar procedures was noted. Penetrating keratoplasties decreased from 85% (2007) to 34% (2017). A significant increase in posterior lamellar grafts was seen, reaching 47% in 2017, which were increasingly produced in eye banks. Issuance rates improved over time, with 59% of procured corneas issued for transplantation in 2024. Contamination rates remained low at 1-2% for bacterial and 0.3 to 0.96% for fungal contamination. Comparison with other international studies confirms the observed trend favouring lamellar procedures, while countries with differing socioeconomic conditions deviate from this trend. This study provides a comprehensive overview of the shifting landscape of corneal transplantation in Europe, reflecting a move towards lamellar procedures and bank-prepared transplants. These findings align with broader international trends, underscoring the importance of continued advancements in surgical techniques and eye banking practices. Low contamination rates are indicative of already successful procedures in eye banking in Europe, and reports of lower rates warrant further investigation and improvement.
To determine whether a progressive reduction in Choroidal Vascularity Index (ΔCVI) is independently associated with unexplained visual loss (UVL) in highly myopic (HM) eyes without pathologic myopia (PM), and to evaluate the predictive utility of baseline CVI as a structural biomarker. This longitudinal study included 126 HM eyes (axial length ≥26.0 mm or SE ≤-6.00 D) without PM and with ≥5 years of optical coherence tomography (OCT) follow-up, including 35 eyes with UVL-defined as ≥0.1 logarithm of the minimum angle of resolution best-corrected visual acuity loss in the absence of new anatomical, refractive or media-related changes- and 91 control eyes with stable vision. A 1:2 propensity score analysis was performed matching 32 eyes from UVL group and 62 control eyes. CVI was computed from subfoveal OCT B-scans acquired with Heidelberg Spectralis at baseline and at 60 months. ΔCVI was defined as the difference between follow-up and baseline. Multivariate logistic regression and ROC analyses were performed on the whole cohort to identify independent predictors of UVL. ΔCVI was significantly greater in UVL eyes (mean -1.87%) than in controls (-0.61%, p < 10⁻¹³). Baseline CVI did not differ significantly after matching (p = 0.12). In multivariate analysis, ΔCVI emerged as the strongest predictor of UVL (OR=10.4 per 1% CVI decrease; p < 0.001), with an area under the curve (AUC) of 0.90 and a Youden index of 0.66. In contrast, baseline CVI had poor predictive power (AUC=0.69) and did not improve model performance when added. Longitudinal reduction in CVI, but not baseline CVI, is strongly associated with UVL in HM eyes without PM. ΔCVI may represent an early biomarker of functional decline before visible macular damage.
To characterise the distribution of retinal non-perfusion and its relationship with neovascularisation elsewhere (NVE) and visual acuity (VA) in referable diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA). Eyes with treatment-naïve moderately severe non-proliferative DR (NPDR) to proliferative diabetic retinopathy (PDR) (Diabetic Retinopathy Severity Scale (DRSS) level 43-60) with available UWFA were included in this study. Total and zonal non-perfusion and NVE area were manually delineated across concentric zones (central 1-10 mm, extended posterior >10-20 mm and mid-peripheral >20-30 mm diameter). The Non-Perfusion Index (NPI) was calculated as the ratio of non-perfused area to total area per zone. Associations between NPI, NVE, DR severity and best-recorded VA (BRVA) were assessed. A total of 133 eyes (60.9% NPDR, 39.1% PDR) were analysed. The highest NPI occurred in the mid-periphery (20-30 mm) and posterior pole (15-20 mm) zones, with nasal preponderance. NVE was most frequently observed in the posterior pole (66%) and nasal quadrants. Central and mid-peripheral NPI correlated with NVE area in corresponding zones, showing quadrant-specific associations. Receiver operating characteristic analysis identified a total NPI threshold of 0.23 to differentiate PDR from NPDR (area under the curve=0.798), with the lowest threshold in the superior quadrant. Neither NPI nor NVE area correlated with BRVA. NVE represents a localised response to adjacent ischaemia predominantly affecting the nasal and extended posterior retina. NPI threshold of 0.23 distinguishes proliferative from non-proliferative stages, with the superior quadrant showing greater susceptibility to NVE at lower ischaemic levels. No significant correlation found between NPI, NVE area and visual acuity.
Dry age-related macular degeneration (dAMD) is the leading cause of irreversible vision loss in older adults, with no approved treatment to modify progression in early and intermediate stages. Photobiomodulation (PBM), which targets mitochondrial dysfunction and retinal inflammation, has shown promise in early studies. This study aims to evaluate the anatomical and functional efficacy of PBM in eyes with early and intermediate dAMD. In this 12-month, multicentre, randomised double-masked controlled trial, 138 eyes from 78 patients with early or intermediate dAMD were included. The primary outcome was change in mean drusen volume (MDV) from baseline to 12 months. Secondary outcomes included change in best-corrected visual acuity (BCVA) and adverse events. Multilevel mixed-effects regression was used to analyse treatment-time interactions. MDV decreased significantly in the PBM group (-0.03±0.05 mm³) while increased in the sham group (+0.02 ± 0.04 mm³; p<0.001) at 12 months. The PBM group also showed a significant improvement in BCVA (+1.31 ± 6.7 letters) compared with a decline in the sham group (-2.62±7.1 letters), yielding a between-group difference of +3.75 letters (95% CI 1.16 to 6.34; p=0.0001). Female sex and higher Age-Related Eye Disease Study (AREDS) category were associated with MDV increase over time (p=0.030 and p=0.003; respectively), while older age was associated with MDV reduction (p=0.049). Four eyes in the sham group developed macular neovascularisation, compared with none in the PBM group (p=0.044), while one eye in the PBM group developed geographic atrophy (p=1.00). No cases of retinal phototoxicity were observed. PBM significantly reduced drusen burden and improved visual function in early and intermediate dAMD over 12 months, with an excellent safety profile. These findings support PBM as a promising therapeutic option for patients with non-neovascular age-related macular degeneration, despite further studies with longer follow-up are needed to confirm the role of PBM in potentially slowing the natural course of the disease.
Inherited retinal diseases (IRDs) are a rare but severe cause of vision loss on a population level. This study provides a comprehensive assessment of IRD epidemiology, including incidence, prevalence and patient characteristics in Sweden over two decades. This population-based cohort study used data from the Swedish national administrative registers including the National Patient Register. Patients with a registered diagnosis of IRD between 2006 and 2021 were identified, and age-matched and sex-matched comparators were sampled from the total population. Incidence rates and annual average prevalence stratified by age, sex and diagnostic subgroups were calculated per 100 000 individuals, standardised to the 2021 Swedish population. The sociodemographic and comorbidity profile was compared between patients and comparators. We identified 6544 IRD prevalent cases in Sweden from 2006 to 2021 and estimated a cumulative overall prevalence of 62.6/100 000 persons. Applying a 5-year washout period (2001-2005), we identified 5599 newly diagnosed IRD cases between 2006 and 2021, estimating an overall average incidence rate of 3.4/100 000 individuals/year. Unspecified IRD accounted for over half of all prevalent cases, followed by retinitis pigmentosa-like conditions (0.6/100 000 persons), pigment epithelial dystrophy (0.1/100 000 persons), unspecified hereditary retinal dystrophy (0.1/100 000 persons), other hereditary retinal dystrophy and vitreoretinal dystrophy. This nationwide population-based study provides the first comprehensive estimates of IRD prevalence and incidence in Sweden. The findings indicate a stable incidence of IRD over the past two decades. These results underscore the need for ongoing surveillance and targeted healthcare planning to address the evolving burden of IRDs.
To describe a technique for treating extraocular muscle adherence after failed fracture repair(s). Retrospective review of patients referred with persistent diplopia after prior release of inferior rectus from an orbital fracture. The muscle was freed from all adhesions, intraconal fat mobilised on either side of the affected muscle and the two pedicled fat pads sutured together in the extraconal space. 17 patients had markedly restricted motility after fracture repair, with 13 having had 2-4 prior interventions. After 'fat-wrapping', 10/17 patients showed a major improvement and 3/17 moderate improvement in ocular ductions, binocular single vision (BSV) fields and ocular deviations-together with reduced contralateral overactions. To improve late BSV position, a single strabismus procedure was performed in 3 of these 13 patients (23%). Tissues from seven patients showed muscle infiltrated by gross fibrosis extending from the capsule around the underlying implant. Four patients had poor outcomes due to major parabulbar adhesions, with two out of four being referred with longstanding surgical fistulae in the lower fornix and/or lacrimal sac. After release from adhesions at the site of prior fracture repair(s), fat-wrapping of the outer surface of the inferior rectus muscle can markedly improve BSV fields, ocular ductions and deviations. Restoration of a viable extraconal fat layer appears to provide a 'fluid' medium between freed muscle and the orbital wall and block further adhesion between the two raw surfaces but the technique has limited results where prior surgery has caused adhesions involving the lower fornix or pre-equatorial tissues.
Retained intraocular foreign bodies (IOFBs) are important causes of vision-threatening ocular trauma and preventable visual impairment. This systematic review and meta-analysis evaluated the clinical manifestations, diagnostic approaches, surgical management and visual outcomes associated with IOFBs. A systematic search of PubMed, Embase, Scopus and Web of Science identified studies published between 1 January 2000 and 30 November 2025. Eligible studies reporting clinical presentation, imaging findings, management strategies or outcomes of retained IOFBs were included. Data were synthesised using a random-effects meta-analysis model. A total of 59 studies involving 4289 patients were included of which 42 were eligible for quantitative meta-analysis. Reduced visual acuity (78%), ocular pain (42%) and intraocular inflammation (36%) were the most common clinical manifestations. Endophthalmitis occurred in 12.4% and retinal detachment in 9.8% of cases. Favourable visual outcomes (Best Corrected Visual Acuity-BCVA≥20/40) were achieved in 65.7% of patients. CT demonstrated the highest diagnostic accuracy (91.2%), while ultrasonography showed 83.6% sensitivity particularly in media opacity. Pars plana vitrectomy was the predominant surgical approach, with an overall surgical success rate of 96.5%. Early IOFB removal (≤24 hours) was associated with improved visual recovery and reduced complications. Early diagnosis and timely surgical intervention are critical for optimising outcomes in retained IOFBs. CT and pars plana vitrectomy remain central to management, while delayed intervention increases the risk of severe complications. Standardised protocols and prospective multicentre studies are needed to strengthen evidence and improve patient care.
Errors in intravitreal fluorinated gas selection or dilution can result in unintended expansile concentrations, causing irreversible visual loss. We aimed to quantify the problem using national incident reporting, published literature and a UK surgeon survey, developing expert consensus recommendations on safe storage, handling and intraocular use. NHS England patient safety incident repositories (National Reporting and Learning System and Learn from Patient Safety Events) were searched for events related to intravitreal gas use (2010-2025), followed by thematic analysis. A targeted literature review identified sight-threatening complications associated with incorrect gas concentration. In parallel, a national survey of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) assessed preparation practices, complications, management strategies, storage and environmental considerations. An expert panel synthesised findings into consensus recommendations. National reporting identified 47 relevant incidents; 29 cases involved incorrect gas concentration due to preparation errors. 14 cases resulted in at least moderate harm, including eight with blindness or severe visual impairment; pure gas concentration (100%) administration was documented in six cases. The literature review identified 20 severe cases across 11 publications. Among 108 BEAVRS respondents, 38.9% recalled at least one significant complication related to incorrect gas concentration; 16.7% reported witnessing sight-threatening outcomes, most commonly central retinal artery occlusion. Recommendations focused on clear labelling/colour coding, standardised dilution protocols, staff training, mandatory two-person checks, appropriate use and segregation of pre-mixed iso-expansile gases and adjunctive safety measures (gas cards/wristbands). Incorrect intraocular gas concentration is likely under-reported but can cause devastating, preventable harm. Standardised systems for storage, preparation, verification and postoperative review may reduce risk while supporting environmentally responsible practice.
Herpes zoster ophthalmicus (HZO) is a viral infection that affects the ophthalmic branch of the trigeminal nerve. HZO is potentially sight-threatening, affecting 4%-20% of all zoster cases. The reported incidence of zoster has quadrupled in the past 60 years, affecting approximately 1 million people per year in the USA and 12.2 per 1000 population in those aged >85 years in the UK.The incidence and severity of vision-threatening complications are moderated by prompt antiviral therapy. Valaciclovir has numerous advantages over aciclovir, including superior bioavailability, higher blood antiviral activity, a longer half-life and simpler dosing regimen. Suppressive antivirals are commonly used as secondary prophylaxis following an episode of HZO, but the evidence to support this practice is weak.Varicella zoster virus is the only human herpesvirus for which highly effective vaccines are available. The recombinant zoster vaccine (Shingrix, GlaxoSmithKline) is a highly effective vaccine in preventing zoster, HZO and postherpetic neuralgia, with vaccine effectiveness of 70%-86%, 67%-93% and 76%, respectively. In this update, the current evidence for the prophylaxis and management of HZO, including keratitis, is evaluated.
To determine the long-term effects of vitreoretinal surgery to treat myopic traction maculopathy (MTM) and to determine the differences in the postoperative results between fovea-sparing internal limiting membrane (ILM) peeling (FSIP) and total ILM peeling (TP). We studied 209 eyes of 189 patients with high myopia (refractive error >6.0 dioptres (D) or an axial length ≥26.5 mm) that had undergone pars plana vitrectomy (PPV) for MTM. The inclusion criteria were high myopia and a postoperative follow-up period of >5 years. Surgical outcomes were compared between eyes treated with FSIP and those with TP. There were 28 eyes in the FSIP group and 38 eyes in the TP group. The preoperative and 1, 3 and 5 years postoperative best-corrected visual acuity was not significantly different between the FSIP group and the TP group. For eyes with a postoperative full-thickness macular hole (MH), there were 4 (14.3%) eyes in the FSIP group and 3 (7.9%) eyes in the TP group. The rate of the development of a postoperative MH was not significantly different between the two groups (p=0.668). There were 0 eyes in the FSIP group and 4 (10.5%) eyes in the TP group that developed postoperative macular atrophy (MA). This difference was not significant (p=0.212). Fovea sparing is useful both for improving vision and preventing complications. We suggest that FSIP has the possible benefit of avoiding postoperative MA.
To investigate the prevalence and determinants of subretinal drusenoid deposits (SDDs; also known as reticular pseudodrusen, RPDs) in the European general population. Altogether 18 931 adults from eight population-based studies were included. SDDs/RPDs were determined on optical coherence tomography and/or infrared photography. The prevalence of SDDs/RPDs and associated ocular and systemic determinants using multivariable logistic regression modelling per study and pooled results using random effects meta-analysis were analysed. Mean age ranged from 58.7±10.6 to 88.4±0.0 years in the different studies and prevalence of SDDs/RPDs ranged from 0.6% to 56.0%. Meta-analyses showed that increasing age (OR 1.09 per year, 95% CI 1.04 to 1.13; p<0.001), prevalent early/intermediate and late age-related macular degeneration (AMD) (OR 10.93, 95% CI 5.55 to 21.51; p<0.001 and OR 11.65, 95% CI 4.78 to 28.40; p<0.001, respectively) and AMD genetic risk score (OR 1.21 per unit, 95% CI 1.05 to 1.39; p=0.008) are associated with prevalent SDDs/RPDs. Sex, smoking, education and cardiovascular disease showed borderline association at some cohort levels but not in the meta-analysis. In sensitivity analyses, only age and AMD genetic risk score remained associated with SDDs/RPDs prevalence among participants without any AMD. This multi-cohort analysis emphasises the wide range of SDDs/RPDs prevalence and determinants. Besides age, presence of AMD and AMD genetic risk variants increase the risk of SDDs/RPDs. These cross-sectional findings are compatible with the hypothesis that SDDs/RPDs may not represent a separate disease entity but be an additional sign of retinal pigment epithelium and photoreceptor stress.
To investigate the association between choroidal vascular hyperpermeability (CVH) and the occurrence of submacular haemorrhage (SMH) in polypoidal choroidal vasculopathy (PCV). This retrospective, cross-sectional study included 189 eyes of 159 patients with treatment-naïve PCV. Eyes were categorised into haemorrhage (n=84) and non-haemorrhage (n=105) groups based on the extent of subretinal or subretinal pigment epithelium haemorrhage. Nine-field indocyanine green angiography (ICGA) was performed to evaluate the presence, number, topographic distribution and area of CVH. Logistic regression and correlation analysis were performed to identify factors associated with SMH. The cohort comprised predominantly male patients (67.3%), with a mean age of 65.4±7.6 years. The haemorrhage group showed significantly lower CVH prevalence (32.1% vs 68.6%; p<0.001) and median CVH count (0 vs 1; p<0.001) compared with the non-haemorrhage group. Multivariate model demonstrated that both the presence (p<0.001) and higher count (p=0.004) of CVH were independently associated with a reduced likelihood of SMH. Topographically, this negative association was most pronounced for CVH located in the posterior pole, central nasal and central superior quadrants (all p<0.05). A weak but significant inverse correlation was also observed between the total area of CVH and the area of haemorrhage (Spearman's r=-0.248). The presence and counts of CVH are inversely associated with the occurrence of SMH in PCV, suggesting CVH may serve as a 'pressure-relief window' to dissipate suddenly elevated choroidal vascular pressure which predisposes to vessel rupture.
To develop prediction models for identifying cases with poor visual outcomes after surgery for primary rhegmatogenous retinal detachment (RRD). All data were obtained from the Japan-Retinal Detachment Registry. Patients with visual acuity (VA) recorded at 6 months after the surgery for primary RRD were included. For identifying the cases with poor VA defined as the logarithm of the minimum angle of resolution VA≥1.0 at 6 months post-surgery, 47 clinical features were selected out of 288 features, then three different machine learning (ML) algorithms (LightGBM, XGBoost and Random Forest) and logistic regression were used to construct models. Discriminative accuracies of the constructed models were compared with the Primary Retinal detachment Outcomes (PRO) score, a previously proposed scoring system for the same purpose. We also estimated the continuous VA using the same three ML algorithms and linear regression model to detect individuals with poor postoperative VA. A total of 2658 patients were included. We observed that all the constructed ML models showed high discriminative accuracies (area under the receiver operating characteristic curve; AUROC: 0.876-0.901). Of the constructed models, the Random Forest model achieved the highest discriminative accuracy (AUROC: 0.901; 95% CI 0.881 to 0.921). The performance of this model appeared to be superior to the PRO score (AUROC: 0.794, 95% CI 0.744 to 0.839). ML models predict poor visual prognosis after primary RRD surgery with high discriminative accuracy.
This systematic review and meta-analysis summarised the distribution of outdoor time among children and adolescents and examined its temporal trends and associated factors. We systematically searched PubMed, Web of Science and Embase for studies published between 2005 and 2025 that reported the distribution and associated factors of outdoor time among children and adolescents aged 3-18 years. The risk of bias in the included studies was assessed using the Effective Public Health Practice Project tool. Meta-analysis was performed for major factors associated with outdoor time. A total of 35 studies involving 131 091 participants were included. The overall mean outdoor time was 123.1 min/day (95% CI 109.9 to 136.2). Regionally, the higher mean value was observed in Africa (200.9 min/day, 95% CI 44.4 to 467.7), followed by South America (190.5 min/day, 95% CI 57.6 to 323.4), Oceania (129.4 min/day, 95% CI 3.2 to 466.4), Europe (128.0 min/day, 95% CI 108.4 to 147.5) and North America (116.4 min/day, 95% CI 79.9 to 152.8), while Asia showed the lowest estimates (99.7 min/day, 95% CI 79.7 to 119.6). Outdoor time was generally lower among girls, myopic individuals, urban areas and on weekdays. In terms of time trends, outdoor time has shown a declining tendency during the 2010s. The associated factors of outdoor time span multiple levels, including individual, family, school, societal and environmental factors. In regions and populations with a higher prevalence of myopia, outdoor time is also relatively short. It is recommended to further promote initiatives to increase outdoor activity time in order to achieve better myopia control. CRD420251088008.
To evaluate the progression rate of severe non-proliferative diabetic retinopathy (sNPDR) in eyes treated with microinvasive pars plana vitrectomy (PPV) versus panretinal photocoagulation (PRP) over 12 months. 55 eyes of 55 diabetic patients aged >18 years with sNPDR were randomised 1:1 to the PPV group (n=27) or the PRP group (n=28). Standard 25G PPV was performed by an experienced surgeon within 4 weeks of enrolment. Standard PRP was performed in three sessions within 4 weeks of enrolment. The primary outcome was the proportion of eyes progressed from sNPDR to proliferative diabetic retinopathy (PDR) over 12 months. A total of 27 participants (mean (SD) age, 61.19 (8.89) years; 16 male (59.3%)) in the PPV group and 28 participants (mean (SD) age, 60.50 (7.93) years; 11 male (39.3%)) in the PRP group were analysed. At 12 months, no patients in the PPV group progressed to PDR, compared with 2 of 28 patients (7.1%) in the PRP group (p=0.49). The mean (SD) change in total visual field point score was -16.70 (415.23) dB in the PPV group and -314.00 (404.59) dB in the PRP group (p=0.02). For the peripheral 60-4 test, the mean (SD) change was -11.39 (167.99) dB in the PPV group versus -207.05 (308.66) dB in the PRP group (p=0.02). In patients with sNPDR, PPV and PRP showed no significant difference in PDR progression during the 12-month follow-up, whereas the PPV group preserved better peripheral visual function. NCT04103671.
To develop and validate a novel set of ocular-centric diagnostic criteria for Behçet's uveitis (BU). A case-control study was designed to develop the BU-specific diagnostic criteria (BU-SDC). The International Criteria for Behçet's Disease were adopted as the reference standard for diagnostic performance evaluation. The ocular findings of BU-SDC were weighted as two points for vitreous cells or haze and retinal vasculitis identified by fluorescein fundus angiography, respectively, and one point for anterior cell-flare dissociation, sterile hypopyon, diffuse retinal atrophy, optic nerve atrophy, superficial retinal infiltrates, retinal haemorrhages, retinal vascular sheathing and retinal ghost vessels, respectively. The systemic features, including recurrent oral ulceration, multiform skin lesions and genital ulceration were weighted as 4 points, 3 points and 2 points, respectively. Primary assessment was based on ocular features alone. An ocular score ≥5 supported a BU diagnosis in patients without signs of granulomatous uveitis or evidence of sarcoidosis or syphilis. For patients with ocular score <5 but high clinical suspicion (the presence of one or more characteristic ocular signs, including vitreous cells or haze, retinal vasculitis identified by fluorescein fundus angiography, superficial retinal infiltrates or retinal vascular sheathing), a secondary assessment incorporating systemic variables was applied, and a combined score ≥5 supported diagnosis. Validation in the independent cohort showed that the area under the receiver operating characteristic curve for BU-SDC (0.954) significantly outperformed the International Study Group criteria (0.911; p<0.01) and the Standardization of Uveitis Nomenclature (0.881; p<0.01) criteria. The BU-SDC provides a validated ocular-centric diagnostic framework for BU, prioritising ocular signs while retaining flexibility through selective systemic integration.
Ophthalmology manages a substantial share of its patients through prolonged observation, spanning nearly every subspecialty, from choroidal nevi and glaucoma suspects to optic disc drusen and diabetic retinopathy. Yet surveillance schedules rarely face the scrutiny of cost, benefit and harm demanded of treatment. This article reframes observation as an intervention in its own right, with direct costs, patient burden, psychological harm and downstream testing cascades that are seldom quantified when monitoring protocols are created. It introduces the concept of surveillance inertia, whereby protocols specify when to start watching but rarely when to stop, and proposes a Surveillance Value Assessment built around six questions: number needed to observe (NNO), incremental cost-effectiveness, patient burden, downstream cascade, stopping rules and actionability and time-sensitivity. NNO is offered as a surveillance analogue of number needed to treat. Drawing on models from oncology and radiology, where structured risk-stratified surveillance with explicit exit criteria is already established, the article contends that ophthalmology should connect its existing risk-prediction tools to explicit surveillance-value metrics and define its own standards before external payers impose them.
To characterise the clinical and morphological features of ocular surface toxicity induced by human epidermal growth factor receptor 2 (HER2)-targeted antibody-drug conjugates (ADCs) in patients with HER2-positive breast cancer, guiding clinical intervention. 21 HER2-positive breast cancer patients receiving HER2-ADC therapy were enrolled. Assessments included best corrected visual acuity, the Ocular Surface Disease Index, conjunctival lissamine green staining, tear break-up time, tear meniscus height, Meibomian Gland Score, Strip Meniscometry Tube (SMTube strips), corneal sensitivity (Cochet-Bonnet esthesiometry), anterior segment optical coherence tomography and in vivo confocal microscopy (IVCM) to evaluate morphology, corneal nerve fibre density and length, and endothelial cell density. Transmission electron microscopy (TEM) was performed in selected cases. All parameters were compared from baseline to follow-up. Ocular surface toxicity occurred in 85.7% (18/21) of patients after HER2-ADC therapy, with a mean onset at 28.0±8.4 days. Vortex-like keratopathy progressed from inferior subepithelial microcysts to linear deposits and a vortex pattern. IVCM revealed severe subepithelial nerve fibre fragmentation and loss. TEM revealed epithelial extracellular matrix fibrosis, mitochondrial damage (swelling, disordered cristae, vacuolisation), nuclear alterations (chromatin dispersion, electron-dense deposits) and suspected endocytic vesicles. Lesions appeared dose- and time-dependent and showed partial reversibility. After 12 cycles, corneal structure and transparency showed restoration trends. HER2-ADC-induced ocular surface toxicity presents as vision loss, dry eye and selective damage to corneal epithelium (vortex-like keratopathy) and nerves (nerve fibre loss and reduced sensitivity), which is dose- and time-dependent and partially reversible.