To characterize clinical features, risk factors, and outcomes of vitamin A deficiency (VAD) among patients with gastrointestinal (GI) and/or hepatobiliary comorbidities. This retrospective study examined patients with GI or hepatobiliary disease who presented with ocular manifestations of VAD. Extracted data included patient demographics, underlying GI or hepatobiliary diagnoses, serum vitamin A levels, ophthalmic symptoms and examination findings, imaging features, and response to vitamin A repletion. 26 eyes from 13 patients were included. The most common systemic comorbidities were fatty liver disease (38.5%), prior gastric bypass surgery (23.1%), and cirrhosis (23.1%). Median serum vitamin A level at diagnosis was 19.1 mcg/dL (range, 2.5-36.1 mcg/dL, reference range 38-72 mcg/dL). Median presenting best visual corrected acuity (BCVA) was 20/50 (logmar 0.44, range, 20/20-light perception). Twenty-two eyes (84.6%) demonstrated anterior segment manifestations of VAD, including four eyes (15.4%) who presented with bilateral corneal ulceration and perforation. Posterior segment findings were present in 16 eyes (61.5%), including subretinal drusenoid deposits, RPE mottling, placoid macular changes, optic neuropathy, and a full-thickness macular hole. All patients reported bilateral vision loss, with 63.6% endorsing nyctalopia. All patients who underwent vitamin A repletion experienced subjective visual improvement and partial or complete resolution of ophthalmic findings, including regression of anterior and posterior segment pathology. Vitamin A deficiency occurs across a wide spectrum of GI and hepatobiliary diseases and is associated with diverse anterior and posterior segment ocular findings, ranging from subtle surface disease to severe, vision-threatening pathology. Visual symptoms and ocular findings improved following vitamin A repletion, highlighting the preventable and reversible nature of this condition when identified early. Given the risk of irreversible ocular sequelae with delayed diagnosis, serum vitamin A assessment with timely repletion should be considered in patients with at-risk gastrointestinal and hepatobiliary conditions. Early identification through multidisciplinary care may prevent avoidable, vision-threatening ocular complications.
Metal ions are indispensable for sustaining normal cellular functions and preserving tissue integrity, as they participate in enzymatic catalysis, signal transduction, and antioxidant defense. However, dysregulation of metal ion homeostasis, particularly during aging, disrupts cellular balance and significantly drives the development and progression of age-related ocular diseases, including age-related macular degeneration, glaucoma, diabetic retinopathy, and cataracts. Specifically, metal ions modulate key stress responses that are central to aging and ocular pathogenesis. Excessive accumulation of redox-active metals triggers the generation of reactive oxygen species that induce oxidative damage to lipids, proteins, and DNA. Meanwhile, deficiencies in essential metals, such as iron, zinc, copper, and calcium, impair antioxidant enzyme activity and disrupt DNA repair, exacerbating cellular dysfunction and senescence. The therapeutic potential of these metal chelators and antioxidants in restoring their balance, alleviating oxidative stress, and slowing the progression of age-related ocular diseases has been well documented. A deeper understanding of how metal ions influence these processes is crucial for developing more targeted and effective treatments. This article systematically reviews the roles of metal ions in age-related ocular diseases, with a focus on their effects on stress responses and potential therapeutic strategies.
Ocular surgery in patients with severe atherosclerotic disease represents a growing clinical challenge due to the increasing prevalence of cardiovascular comorbidities in aging populations. Atherosclerosis, characterized by endothelial dysfunction, inflammation, and arterial stiffness, compromises vascular autoregulation and reduces ocular perfusion, thereby increasing susceptibility to ischemic complications during perioperative hemodynamic fluctuations. In this context, patients undergoing ophthalmic procedures, even those considered low risk, such as cataract surgery, may experience significant cardiovascular and cerebrovascular events. A comprehensive preoperative evaluation is essential and should include detailed cardiovascular history, functional capacity assessment, frailty evaluation, and the use of validated risk indices. Targeted investigations such as electrocardiography, echocardiography, and carotid Doppler imaging allow for the identification of high-risk features and guide perioperative planning. The management of antithrombotic therapy requires an individualized approach that balances thrombotic and bleeding risks, particularly in patients receiving dual antiplatelet therapy or anticoagulation. The choice of anesthetic technique plays a critical role in maintaining hemodynamic stability. Techniques with minimal systemic impact, such as topical anesthesia and Sub-Tenon block, are generally preferred, while general anesthesia should be reserved for selected cases. Intraoperatively, maintaining stable mean arterial pressure, avoiding hypotension and hypertension, and ensuring normocapnia are key strategies to preserve cerebral and ocular perfusion. Postoperative care should focus on early detection of myocardial ischemia, arrhythmias, and neurological complications, as well as timely resumption of antithrombotic therapy. Ultimately, a multidisciplinary and individualized approach is essential to optimize perioperative safety and improve outcomes in this high-risk population.
Retinoblastoma (RB) survivors who have undergone enucleation and use ocular prostheses may face long-term challenges related to visual function and overall well-being. This study aimed to evaluate health-related quality of life (HR-QoL) and visual function in this population, addressing a gap in knowledge regarding their lived experiences and functional vision. This cross-sectional study included 12 unilateral and 3 bilateral RB survivors (10 girls, 5 boys; mean age 15.5 years, range 6.8-26.5), all treated with unilaterally enucleation and an ocular prosthesis at Sahlgrenska University Hospital, Sweden (2000-2019). HR-QoL was assessed using the Paediatric Quality of Life Inventory (PedsQL), both self- and parent-reports. Functional vision was evaluated by best-corrected visual acuity (BCVA) and structured history-taking of perceptual visual dysfunctions (PVDs). Results were compared with age-matched healthy controls. Self-reported PedsQL total score (82.5) equalled normative data (83.0) and parents' report (82.5). Parents' reports were comparable to published parental norms (82.5 vs. 87.6). Survivors with subnormal BCVA (≥ 0.2 LogMAR) had significantly lower self-reported HR-QoL scores than those with normal vision (64.1 vs. 88.0, p = 0.014), a difference not reflected in parent-reports. Survivors reported more PVDs ≥ 1 area (median 1, range 1-4) than controls (9/15 vs. 1/15, p = 0.005). The number of affected PVD areas correlated with age (r = 0.59, p = 0.022), but not with BCVA or PedsQL score. RB survivors with ocular prostheses require holistic care that includes assessment of HR-QoL and functional vision, beyond visual acuity, to identify unmet needs and guide interventions that support overall well-being and optimal long-term outcomes.
Oncocytomas of the ocular caruncle are rare benign epithelial tumors. Their clinical diagnosis is challenging, as they can mimic other benign or malignant lesions such as papilloma, nevus, squamous cell carcinoma, melanoma, or oncocytic carcinoma. For this reason, histopathological confirmation remains indispensable. The aim of this study was to test the ability of a multimodal large language model (ChatGPT, GPT-5, 2025 version) to generate diagnostic hypotheses directly from slit-lamp images, supported by brief clinical summaries. We retrospectively analyzed two cases of caruncular oncocytoma that had undergone surgical excision with subsequent histopathological confirmation. For each case, ChatGPT was provided only with slit-lamp photographs of the lesion and a concise clinical summary including age, sex, and the site of the lesion (caruncle). No histopathological data or additional clinical details were supplied. In both cases, ChatGPT proposed oncocytoma as the primary diagnostic hypothesis. The model also generated differential diagnoses including papilloma, nevus, as well as the possibility of a malignant lesion such as squamous cell carcinoma or melanoma. This proof-of-concept demonstrates, for the first time to our knowledge, that a general- purpose multimodal AI system can correctly recognize a rare ocular surface tumor from slit-lamp images. While preliminary and limited by the very small sample size, these findings suggest that large language models may assist clinicians in considering rare adnexal tumors during differential diagnosis. Further research on larger datasets is required, and histopathology will remain the gold standard for definitive diagnosis.
Frontalis sling surgery (FSS) is the standard treatment for congenital blepharoptosis with poor levator function; however, long-term failure and material-related complications are common, particularly with silicone slings. Evidence regarding optimal revision strategies after failed silicone FSS remains limited. This study evaluated the anatomical outcomes, ocular surface safety, and patient satisfaction following maximal levator resection surgery (MLRS) performed after silicone frontalis sling removal. This retrospective study included 20 eyes of 17 patients who underwent MLRS following silicone frontalis sling removal between 2019 and 2023. Preoperative and postoperative assessments included best-corrected visual acuity, margin reflex distance-1 (MRD-1), levator function, lagophthalmos, corneal fluorescein staining, punctate epithelial keratopathy, and patient satisfaction. Postoperative evaluations were performed at 1 week, 1 month, 3 months, and 6 months. Statistical analyses were conducted using paired and repeated-measures tests, with a significance level set at p < 0.05. The mean age at the time of MLRS was 11.05 ± 5.94 years, and the mean preoperative levator function was 4.85 ± 2.49 mm. Revision surgery was indicated for undercorrection in 18 eyes (90%) and conjunctival complications in 2 eyes (10%). Mean MRD-1 increased significantly from 0.25 ± 0.85 mm preoperatively to 2.55 ± 0.60 mm at 6 months postoperatively (p < 0.001), with stable values across follow-up visits. Lagophthalmos increased slightly postoperatively but did not differ significantly from preoperative measurements (p > 0.05). Mild corneal surface changes were observed in the early postoperative period and were successfully managed with medical treatment. Additional revision surgery was required in 2 eyes (10%). Most patients and their parents reported high satisfaction, with dissatisfaction primarily related to insufficient postoperative eyelid elevation. MLRS following silicone frontalis sling removal is associated with significant and stable improvement in eyelid position, with acceptable ocular surface safety and high patient satisfaction in selected patients across a range of levator function values. However, given the retrospective design, small sample size, and lack of a comparative control group, these findings should be interpreted with caution. MLRS may be considered as a potential revision option rather than a definitive or superior approach.
We report the case of a 30-year-old woman with no relevant medical history who presented with a new-onset headache associated with nausea, vomiting, photophobia, phonophobia, and right nasal hemianopsia. Ocular point of care ultrasound (POCUS) examination revealed a hyperechoic lesion adhered to the vascular layer that did not move with eye movements. The patient was referred to ophthalmology, where choroidal melanoma was confirmed. Extension studies showed no metastases, and enucleation was performed. This case highlighted the importance of ocular POCUS in the diagnostic approach to this patient.
This study aimed to investigate the effects of a 16-week recess-based ocular muscle regulation training program (OMRTP) on uncorrected visual acuity (VA) and noncycloplegic spherical equivalent (SE) in adolescents. This school-based controlled study enrolled Grade 10-11 students (U15-U16; n = 200) from Huzhou No. 2 High School in Huzhou, China. Students were assigned at the class-cluster level within the same school to an experimental group (EG, n = 100) or a control group (CG, n = 100). The experimental group completed a 16-week recess-based OMRTP, whereas the control group received routine vision health education only. VA and noncycloplegic SE were assessed at baseline (week 0) and post-intervention (week 17). Intervention effects were evaluated using linear mixed-effects models within a difference-in-differences (DiD) framework. Baseline VA and SE were comparable between groups (all P > 0.05). For SE, the EG demonstrated more favorable short-term functional shifts in noncycloplegic SE relative to the CG across age strata and eyes (DiD: U15 left 0.318 D, right 0.358 D; U16 left 0.268 D, right 0.210 D; all P < 0.001). For VA, the EG showed greater improvements than the CG across age strata and eyes (DiD: U15 left 0.115, right 0.074; U16 left 0.156, right 0.105; all P < 0.05). Overall, mixed-effects models confirmed a significant group × time interaction for both SE (F = 62.08, P < 0.001) and VA (F = 42.03, P < 0.001). A 16-week recess-based OMRTP was associated with improvements in uncorrected visual acuity and short-term functional changes in noncycloplegic spherical equivalent refraction among adolescents.
Retinoblastoma management has changed notably in the past 11 years. Here, four retinoblastoma experts in the USA and Europe report their management recommendations. Retinoblastoma is now the most curable of all pediatric cancers in developed countries, and major clinical trials are scarce; thus, the experience of these centers carries important information for clinicians worldwide. There is increasing use of intra-arterial chemotherapy for unilateral and bilateral disease in naïve and recurrent eyes. Intravitreal chemotherapy is increasingly being used, and high-dose topotecan for vitreous seeds, anterior chamber tumor (combined with intracameral injection), and recurrent retinal and subretinal tumors is becoming the standard approach.
This study aimed to identify the optimal postoperative ocular alignment that promotes the development of simultaneous perception - the most basic level of binocular vision - in children undergoing surgery for comitant esotropia. The research question focused on whether receiver operating characteristic (ROC) analysis could objectively determine the ideal alignment threshold to support binocular cooperation. A retrospective analysis was conducted on the medical records of pediatric patients diagnosed with childhood comitant esotropia. Among these, a subset underwent strabismus surgery. Postoperative outcomes were evaluated using ROC curve analysis to determine the alignment range most predictive of achieving simultaneous perception. Of the 99 patients reviewed, 87 underwent surgical correction. ROC analysis revealed that achieving a postoperative alignment within 8 prism diopters (PD) was strongly associated with the development of simultaneous perception. Specifically, alignment within this range yielded a sensitivity of 90% and a specificity of 87%, confirming its predictive value for binocular function recovery. Postoperative alignment within 8 PD represents a critical target for promoting simultaneous perception in pediatric patients treated surgically for comitant esotropia. ROC analysis proved to be a valuable tool for objectively defining surgical success in restoring foundational binocular cooperation.
To survey United States (US) cornea specialists on clinical factors that distinguish between microbial keratitis (MK) organism groups. This cross-sectional survey of US cornea specialists assessed whether 61 clinical factors, including history factors, ocular symptoms, and exam findings, distinguished a specific organism group in the typical patient with MK. MK organism groups included gram-positive bacterial keratitis (GPBK), gram-negative bacterial keratitis (GNBK), mold fungal keratitis (MFK), yeast fungal keratitis (YFK), parasitic keratitis (PK), and viral keratitis (VK). The survey was distributed via the Cornea Society's email listserv from March 11, 2024 to May 7, 2024. Descriptive statistical analysis was performed to identify the percentage of specialists identifying a clinical factor as distinguishing a specific MK organism group. A total of 67 specialists completed the survey. There were 20 factors (32.8% of 61) that >75% of specialists identified as distinguishing a specific MK group, including 9 factors for BK (eg copious ocular discharge, loose ocular sutures), 3 factors for FK (eg feathery infiltrate, ocular trauma with organic matter), 5 factors for PK (eg pain out of proportion, perineuritis), and 3 factors for VK (eg reduced/absent corneal sensation, prodromal symptoms). The remaining 41 factors had ≤75% of specialists identify them as distinguishing. Specialists agreed that 32.5% of clinical factors distinguished different MK organism groups, aligned with prior work demonstrating difficulty with interorganism differentiation. These 20 factors may aid clinicians in their initial MK diagnosis; however, more work is needed to validate their salience in diagnosis.
AUY922, a heat-shock protein 90 inhibitor, shows broad antitumor activity but is limited by dose-limiting ocular toxicity. In this study, we engineered FLIM02, a PLGA/DSPE-PEG2000 (1,2-Distearoyl-sn-glycero-3-phosphoethanolamine-N-[poly(ethylene glycol)-2000])-based nanoparticle via single-emulsion, and evaluated its physicochemical profile, biodistribution, ocular safety, and efficacy. FLIM02 formed ~100-nm particles with efficient encapsulation and retained stability after lyophilization. In tumor-bearing mice, LC-MS/MS biodistribution showed reduced ocular retention of AUY922 with preserved tumor exposure and comparable hepatic/renal distribution versus prototype. FLIM02 preserved retinal architecture as evidenced by reduced TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling)-positive cells and attenuated GFAP induction, while maintaining antitumor activity in xenograft tumor models. No overt systemic toxicity was observed, supported by stable body weight, normal serum biochemical parameters, and absence of apparent pathological abnormalities in major organs. These findings support that nanoparticle reformulation can decouple antitumor efficacy from tissue-specific toxicity. FLIM02 suggests potential to reduce ocular toxicity while preserving antitumor activity, meriting further mechanistic studies and longitudinal preclinical models.
The aim of this study was to report four cases of limbal stem cell deficiency in which oral antifungal therapy enabled successful generation of cultured oral mucosal epithelial sheets for ocular surface reconstruction. This case series included two patients with Stevens-Johnson syndrome and two with ocular cicatricial pemphigoid, all of whom were scheduled for cultivated oral mucosal epithelial transplantation (COMET). Initial oral mucosal biopsies resulted in fungal contamination during cell culture. Patients subsequently underwent targeted oral management, including dental cleaning, cessation of denture use, and antifungal therapy. All four patients (age range: 45-91 years) exhibited Candida albicans contamination in the primary cultures. After careful oral management, including oral hygiene, denture discontinuation, and oral amphotericin B syrup, the second biopsies were performed with uncontaminated cultures. Autologous COMET sheets were successfully generated and transplanted in all cases, resulting in improved ocular surface stability without postoperative infectious complications. This case series emphasizes the importance of preoperative dental assessment and oral antifungal treatment in preventing microbial contamination during epithelial sheet preparation for COMET.
As a core component of the human microecosystem, the gut microbiota modulates systemic immune-inflammatory responses, metabolic homeostasis, and neural signal transmission via the gut-eye axis. Dysbiosis of the gut microbiota has been closely linked to the onset and progression of multiple ophthalmic disorders in adults. Childhood represents a critical window for both gut microbial colonization and maturation, as well as a formative period for ocular development and visual function establishment. This review systematically examines the evidence connecting gut microbiota to several common pediatric ophthalmic diseases, including allergic conjunctivitis, myopia, retinopathy of prematurity, and postoperative inflammation following congenital cataract surgery. We conducted a narrative literature review analyzing the potential mechanisms underlying the gut-eye axis, including immune regulation, microbial metabolite signaling, crosstalk between the intestinal barrier and blood-ocular barrier, and neural pathways. A comprehensive search of PubMed, Web of Science, and Scopus databases was performed for literature published from January 2000 to October 2025 using search terms related to gut microbiota and pediatric ophthalmic diseases. Studies were selected based on clinical relevance and contribution to understanding gut-eye axis interactions in pediatric populations. The review identifies emerging associations between gut microbiota dysbiosis and various pediatric ophthalmic conditions, with evidence supporting immune dysregulation, metabolite imbalance, and barrier dysfunction as potential mechanistic pathways. Early disruptions to the gut microbiota may exert potential long-term effects on ocular health. This review aims to provide new insights into the etiology, early intervention, and precision management of pediatric ophthalmic diseases.
The southern tamandua (Tamandua tetradactyla) is a species vulnerable to environmental disturbances, largely due to increasing overlap between its natural habitat and anthropogenically modified landscapes. Detailed anatomical knowledge of the eye and orbital structures, supported by imaging and histological analyses, is essential to improve clinical, surgical and conservation practices for wild mammals. This study provides a comprehensive anatomical description of the eyeball and its adnexa in the southern tamandua. Twelve cadaveric specimens were examined using topographic dissection, orbital exenteration, bone maceration, ocular ultrasonography, computed tomography and histological processing. The orbit was incomplete and shallow, formed by the frontal, lacrimal, parietal, temporal and sphenoid bones, and exhibited a pronounced lateral projection of the eye. The eyeball was relatively small in proportion to the skull, globoid in shape, slightly elongated along the anteroposterior axis, and characterized by a high corneoscleral ratio. The eyelids were well developed, bearing eyelashes on both margins. The third eyelid was triangular and supported by hyaline cartilage. The lacrimal gland was reduced in size, whereas the Harderian gland was voluminous, lobulated and ring-shaped, extensively surrounding the eye and occupying a substantial portion of the orbital cavity. Distinctive features of the extraocular musculature included duplication of the dorsal rectus muscle and absence of the dorsal oblique muscle. Ultrasonography enabled visualization of intraocular structures, and computed tomography confirmed orbital dimensions. Histological analysis revealed tissue organization consistent with the general mammalian pattern, with no evidence of a tapetum lucidum. These findings expand anatomical knowledge of Xenarthra and provide relevant reference data for veterinary ophthalmology, comparative anatomy and surgery, and the conservation of wild mammals.
To evaluate the efficacy of Leptospermum spp (Manuka) honey eye drops in improving dry eye symptoms and reducing ocular inflammation after cataract surgery, compared to sodium hyaluronate eye drops. A prospective controlled study including 53 eyes undergoing cataract surgery was conducted. Patients were consecutively allocated to Manuka eye drops (n = 25) or sodium hyaluronate (n = 28). Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI) and CATQUEST-SF9 questionnaires. Objective parameters included non-invasive tear break-up time (NIBUT) and conjunctival redness measured with the Keratograph® 5M. Assessments were performed preoperatively and at 1 day, 1 week, and 1 month. A total of 53 eyes from 53 patients (18 males and 35 females) were analyzed, with a mean age of 72.1 ± 7.6 years. At 1 month, the Manuka group showed a greater reduction in OSDI score compared to the control group (-27.3 ± 20.3 vs -4.3 ± 17.4). After adjustment for baseline OSDI and sex, OSDI remained significantly lower in the Manuka group (adjusted mean difference: -18.7; 95% CI: -28.8 to -8.7; p = 0.007). Conjunctival redness was also lower in the Manuka group at 1 month (adjusted mean difference: -0.56; 95% CI: -0.91 to -0.21; p = 0.014). No significant differences were observed in NIBUT between groups. Manuka eye drops were associated with greater improvement in postoperative dry eye symptoms and reducing ocular surface inflammation compared to sodium hyaluronate. These findings should be interpreted with caution and considered hypothesis-generating.
The study aimed to compare the efficacy and safety of netarsudil (NET), alone or in fixed-dose combinations (FDC), in comparison with prostaglandin analogues (PGAs: bimatoprost [BIM], latanoprost [LAT], travoprost [TRA], and tafluprost [TAF]) for the treatment of primary open-angle glaucoma (POAG) or ocular hypertension. Literature search in PubMed, Embase, Cochrane Library, Web of Science (inception to July 2025). Identified 26 randomized controlled trials (RCTs) (5,390 patients). The primary outcome was the mean difference in intraocular pressure (IOP) reduction at 3 months; the secondary outcome was the incidence of conjunctival hyperemia. Pair-wise meta-analysis used Cochrane Review Manager 5.4, Bayesian network meta-analysis via Aggregate Data Drug Information System (ADDIS) with Markov Chain Monte Carlo (MCMC) simulations. Inconsistency assessed via node-splitting, convergence evaluated via Brooks-Gelman-Rubin method. Network meta-analysis showed 3-month IOP -lowering hierarchy: FDC > BIM > TRA > LAT > TAF > NET. Conjunctival hyperemia incidence (highest to lowest): TAF > FDC > NET > BIM > TRA > LAT. Node-splitting confirmed consistency (P ≥ 0.05), convergence was satisfactory. Funnel plots indicated no publication bias for IOP outcomes but potential bias for conjunctival hyperemia. Although NET ranked lower in IOP-lowering efficacy compared to most PGAs and FDC, it demonstrated a favorable safety profile, particularly with a relatively lower incidence of conjunctival hyperemia than TAF and FDC. These findings suggest that NET may serve as a valuable alternative in patients who are intolerant to PGAs or require adjunctive therapy, warranting further investigation in targeted populations.
To identify independent risk factors for dry eye disease (DED) and to develop and validate a predictive model for DED among myopic schoolchildren aged 8-16 years in northern China. A cross-sectional study was conducted among myopic children in Zhangjiakou, Hebei Province. The children underwent comprehensive ocular surface evaluations, including corneal fluorescein staining, tear film break-up time (FBUT), Schirmer I test, lipid layer thickness (LLT), and partial blink rate (PBR). DED was diagnosed using the 2022 Chinese Expert Consensus criteria. Behavioral and environmental risk factors were assessed via validated questionnaires. Logistic regression identified independent factors, and a nomogram was constructed and validated for individualized DED risk estimation. A total of 1,303 myopic children were included for analysis, and the prevalence of objectively diagnosed DED was 31.2%. Tear film instability, reduced LLT, and increased PBR were the predominant ocular surface abnormalities. The children were divided into training and validation sets according to the community. Among the 912 children in the training set, multivariate analysis identified orthokeratology (Ortho-K) lens use (OR = 4.74), daily screen time ≥ 4 h (OR = 4.21), near work ≥ 4 h (OR = 3.53), BMI ≥ 24 (OR = 3.20), and sleep duration < 6 h (OR = 2.26) as independent risk factors (all p < 0.05). The risk prediction nomogram demonstrated acceptable discriminative ability (AUC: 0.74 in the training set and 0.70 in the validation set). Dry eye disease is common and under-recognized among myopic children in northern China, with risk closely linked to modifiable behavioral and lifestyle factors and Ortho-K lens use. The developed nomogram can facilitate early identification and targeted interventions for high-risk children.
Aim: Dry eye disease (DED) is a chronic, multifactorial condition arising through loss of tear film and ocular surface homeostasis. Treatment aims to restore natural tear production and normalize ocular surface homeostasis. Several prescription medications are available in the US that increase tear production in patients with DED. In the absence of head-to-head trials, this study employed a matching-adjusted indirect comparison (MAIC) approach to estimate the comparative tear production efficacy of acoltremon 0.003% and cyclosporine 0.05% for the treatment of DED. Materials & methods: MAICs were conducted for the key outcome of categorized Schirmer test score (STS), where higher values indicate greater tear production. Patient data were available for acoltremon 0.003% (from COMET-2 and COMET-3 trials) and summary level data for cyclosporine 0.05%. Populations were matched on clinically relevant variables including age, race, sex and anesthetized categorized STS. The primary analysis compared mean change from baseline (CFB) categorized STS at day 90. An exploratory analysis investigated earlier onset of tear production (day 14) attributed to acoltremon 0.003% compared with the earliest available data (Day 90) for cyclosporine 0.05%. Results: After all adjustments, a greater mean CFB categorized STS was observed for acoltremon 0.003% compared with cyclosporine 0.05% (mean difference [MD]: 1.62 categories, 95% CI: 1.42-1.83, p < 0.001) at day 90. The exploratory analysis also demonstrated a greater mean CFB categorized STS for day 14 acoltremon 0.003% compared with day 90 cyclosporine 0.05% (MD: 1.62 categories, 95% CI: 1.42-1.82, p < 0.001). Conclusion: Our findings suggest that acoltremon 0.003% may provide a greater increase in tear production relative to cyclosporine 0,05% at day 90, with exploratory findings suggesting similar results at day 14. As this was an unanchored MAIC, results may be influenced by residual confounding from unmeasured differences between trials. A statistical comparison of two prescription eye drops (acoltremon 0.003% and cyclosporine 0.05%) for increasing tear production in patients with eye disease. What is the article about? Dry eye disease (DED) is generally associated with a deficiency in the quantity and/or quality of tears. We compared how well acoltremon 0.003% and cyclosporine 0.05% increase tear production in adults with DED. What was the methodology used? As there are no direct comparison trials between acoltremon 0.003% and cyclosporine 0.05%, we used a matching-adjusted indirect comparison approach using patient-level data for acoltremon 0.003% and published population data for cyclosporine 0.05%. This method reweights individual patient data from the acoltremon 0.003% trials to match published summary cyclosporine 0.05% data. This ensures the two groups are as similar as possible for a fair comparison. A categorized Schirmer test score was used as a measure of tear production, and we considered the average difference in the change from baseline in categorized Schirmer’s test result at day 90 for each treatment as the main end point in this analysis. What were the results? Our results suggest that after 90 days on the therapies, patients using acoltremon 0.003% had significantly greater tear production than patients using cyclosporine 0.05%, with a mean difference of 1.62 categories for the Schirmer test score. Why is this important? These results support acoltremon 0.003% as a valuable treatment option for the signs and symptoms of DED.