To evaluate the growth and prescribing patterns of community-based independent prescribing (IP) optometrists managing acute eye conditions in Wales between 2020 and 2024, a period that saw the introduction and subsequent commissioning of National Health Service (NHS) funded acute eye care with prescribing in primary care optometry throughout Wales. Monthly prescribing data from NHS Wales Shared Services Partnership were analysed for all IP optometrists in Wales from 1st February 2020 to 31st January 2024. Data included drug name, British National Formulary classification, quantity, cost and health board location. Descriptive and correlational statistics were used to assess prescribing activity, regional distribution and cost trends. The number of active IP optometry practices increased from eight in February 2020 to 68 in January 2024, with 20,980 prescriptions (49,162 items) issued at a total cost of £339,426. Corticosteroids, anti-infective agents and ocular lubricants were the most frequently prescribed drug classes. Ocular lubricants accounted for 34.0% of the total spend. Regional variation in prescribing activity was observed, with positive correlations between the number of active practices and both prescription volume and cost. Generic prescribing accounted for 47.0% of prescriptions, lower than national averages. NHS commissioning of IP services in Wales has significantly expanded the role of optometrists in managing acute eye conditions in primary care. The findings highlight the potential of IP optometry to reduce pressure on general medical practice and hospital eye services. Further research is needed to evaluate clinical outcomes, cost-effectiveness and the broader therapeutic use of ocular lubricants in acute care.
Male jelly fig (Ficus pumila L. var. awkeotsang) syconia are an underutilized by-product in Taiwan. This study evaluated male fig powder (0-2%, w/v) as a substrate for producing male fig-altered kombucha (FK) using a defined co-culture of Komagataeibacter xylinus and Saccharomyces cerevisiae. Fermentation markedly reshaped FK metabolites. Glucuronic acid increased in a dose-associated manner, reaching 6.63 g/L in 2% FK, whereas vitamin C declined during fermentation but remained highest in 2% FK. Gallic acid increased and peaked at 0.5% FK (320.75 mg/L), while acetic and succinic acids showed formulation-dependent patterns; conversely, caffeine decreased in all male fig-containing groups. FK also exhibited concentration-dependent color divergence from the control at day 9 (ΔE* up to 17.81 at 2% FK). Numerical increases in DPPH and TPC were observed; however, no significant differences were detected among the treatments. Importantly, male fig supplementation substantially enhanced kombucha bacterial cellulose (KBC) yield (0.56 to 7.28 g/L from 0 to 2% FK) without compromising high water content (~96-99%) or swelling (~90-94%). FTIR confirmed retention of the cellulose backbone, SEM showed formulation-dependent fibril diameters, and TGA indicated higher early-stage thermal stability with dose-dependent shifts in main degradation behavior. Collectively, male figs can be valorized to produce FK with altered metabolite profiles and improved KBC productivity.
Tactile information in congenitally blind (CB) individuals is funneled to the visual cortex through both via a fast thalamo-cortical and a strengthened polysynaptic cortico-cortical pathway. Auditory inputs can also activate the visual cortex in CB individuals, but whether these signals rely on the same dual route remains unclear. We used magnetoencephalography (MEG) to map the spatiotemporal dynamics and measure directed functional connectivity between regional brain responses to monaural auditory cues in eight CB and eight sex and age-matched sighted control (SC) participants. In both groups, a distinct sequential activation pattern was observed, initiating in the thalamus 10-20 ms after stimulus onset, followed by auditory cortex (A1) at approximately 35 ms, and visual cortex (V1) at 45-50 ms post-cue. Because monosynaptic cortico-cortical transmission typically occurs within about 10-15 ms, this temporal sequence suggests that auditory inputs reach the visual cortex through a direct, likely monosynaptic pathway between A1 and V1 in both CB and SC participants. Effective connectivity in the alpha band (8-12Hz) was stronger in CB, birectionally between the thalamus and V1 and unidirectionally from A1 to V1, indicating functional strengthening of these pathways in congenital blindness. These findings suggest that, in CB, auditory signals are relayed to the occipital cortex primarily through an enhanced monosynaptic A1-to-V1 pathway that is also present, though weaker, in sighted individuals. This organization contrasts with tactile information processing in CB, which additionally engages a novel thalamo-cortical route to V1. Our results provide MEG-based evidence for a rapid, likely monosynaptic, A1-to-V1 pathway that is strengthened in congenital blindness.
To use volumetric analysis applied to total deviation (TD) perimetric data to characterize the presence of residual sensitivity measurable using the 10-2 in lieu of the 24-2 test grid in glaucoma (the functional vulnerability zone [FVZ]) and develop a prototype end-user application for clinical guidance. Cross-sectional study. Six hundred twenty-six pairs of Humphrey Field Analyzer 10-2 Swedish Interactive Thresholding Algorithm (SITA)-Fast and 24-2 SITA-Faster test results of 160 subjects. Total deviation values located within 10° from fixation (10-2, 68 locations; 24-2, 12 locations) were extracted. Volumetric analysis was performed to calculate the difference in TD "volume" (10-2 - 24-2) for each pair of results. Then, 24-2 test locations were interpolated across the central 10° to obtain "equivalent" 10-2 test locations used to calculate number of test locations gained (10-2 - 24-2). A positive TD volume difference and positive gain represented the presence of an FVZ. Linear regression and principal components analysis were used to identify 24-2 test features that may predict the presence of an FVZ. Volumetric differences in visual field TD as a surrogate for a FVZ. Visual field global indices and the number of central 24-2 defects predicted TD volume difference (P < 0.0001), with 24-2 mean deviation (MD) showing the highest R 2 (0.32). All parameters had low R 2 values when predicting gain. A simplified model comprising 24-2 MD and number of central 24-2 TD probability (TDP) defects (P < 0.01) provided a method for clinically identifying the likelihood of an FVZ. Principal components analysis revealed 2 principal components (24-2 global indices and pointwise probability scores) that accounted for 79.7% of the variance, with principal component 1 accounting for 69.3% and comprising 24-2 MD and number of central 24-2 TDP scores at P < 2%. The FVZ offers a data-driven approach to identifying residual dynamic range using the 10-2 test grid. A prototype model for predicting the likelihood of 10-2 utility in progression analysis is proposed. The authors have no proprietary or commercial interest in any materials discussed in this article.
Long-term adherence to glaucoma medication is often suboptimal, compromising treatment efficacy and increasing the risk of glaucoma progression. Existing interventions have limited success. This study explored behavioral factors influencing adherence from the perspectives of United Kingdom (UK)-based patients with glaucoma and eye care professionals (ECPs), using the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with adults prescribed intraocular pressure-lowering eyedrops whose adherence status was classified based on self-reported medication use and UK-registered ECPs involved in glaucoma care. Interview data were analyzed using deductive and inductive thematic analysis guided by the TDF to identify key barriers and enablers influencing adherence-related behaviors. Twenty-six participants were interviewed (13 patients and 13 ECPs). For patients, adherence was influenced by factors relating to knowledge and understanding of glaucoma, skills required to administer and obtain medication, memory and routine formation, beliefs about treatment necessity, social support, and healthcare system factors such as medication availability. ECPs identified time constraints, limited resources, and uncertainty in assessing adherence as key challenges, whereas communication skills, multidisciplinary support, and tailored decision-making were viewed as important enablers. Glaucoma medication adherence is shaped by a complex interplay of behavioral, professional and systemic factors. Applying the TDF highlights modifiable influences on adherence and supports the development of targeted, theory-informed interventions to improve glaucoma outcomes.
Retinopathy of prematurity (ROP), the leading cause of childhood blindness, is considered a vascular retinopathy; however, clinical studies have reported persistent electrophysiological dysfunctions in some ROP patients with remitted vasculopathy, resulting in severe visual impairments. Therefore, this study sought to unravel the mechanisms underlying persistent electrophysiological dysfunctions and identify a neuronal target in a murine model of oxygen-induced retinopathy (OIR), a widely used animal model for ROP. Retinal vascular morphology and leakage were examined by isolectin B4 staining and fluorescein fundus angiography in the OIR mouse model at P17 and P25. Full-field electroretinogram (ERG) was performed. Moreover, P17 retinas were analyzed with metabolomics and transcriptomics, and the results were validated by quantitative PCR (qPCR) and Western blotting (WB). Whole-cell patch clamp was used to evaluate phototransduction. Lentiviral particles carrying guanylate cyclase activator 1A (Guca1a) cDNA driven by a mouse rod opsin promoter were intravitreally injected into OIR mice, and immunofluorescence, ERG, patch clamp, cGMP measurement, and TUNEL staining were performed for assessments. Vascular lesions in OIR retinas peaked at P17 and recovered at P25. However, a wave and b wave amplitudes in dark- and light-adapted ERGs under all light intensities were deficient at both developmental stages, and electrophysiological dysfunctions persisted in P32 OIR retinas. Multiomics indicates phototransduction defects in isolated photoreceptors. QPCR and WB validated the reduced Guca1a mRNA and its encoding protein levels in P17 and P25 OIR retinas. Patch clamp demonstrated impaired light responses of single rods. Furthermore, lentivirus-mediated photoreceptor-specific expression of GUCA1A recovered electrophysiological functions, improved single rod phototransduction, increased cGMP concentration, and reduced cell death in P17 and P25 OIR retinas. The reduced GUCA1A in photoreceptors is mainly responsible for persistent electrophysiological dysfunctions in OIR mouse retinas, even after the recovery of vessel damage. The photoreceptor GUCA1A may serve as a neuronal target for ROP intervention.
Sensor-based systems and virtual reality (VR) technologies provide new opportunities for the objective, technology-driven assessment and training of visuomotor performance in applied contexts such as sport. This study examined the effects of an integrated visual training program combining stroboscopic stimulation, VR-based vergence exercises, and instrumented reaction-light tasks in adolescent handball players. Twenty-eight adolescent handball players (under-18 competitive level) completed two baseline assessments separated by six weeks, followed by a six-session training program (approximately 15 min per session) integrated into regular team practice. The intervention targeted visuomotor reaction speed, accommodative dynamics, and peripheral visual responsiveness using sensor-based and virtual reality-assisted stimuli. Compared with both baseline measurements, the intervention produced selective improvements in accommodative facility (cycles per minute, cpm)-particularly near-far focusing speed-and in multiple reaction-time conditions (milliseconds, ms) involving manual and decision-based responses. Specific peripheral-field locations showed increased response scores, whereas binocular alignment, AC/A ratio, near phoria, and stereoscopic acuity remained unchanged. These findings indicate that technology-supported visual training protocols incorporating sensor-based reaction systems and VR stimuli were associated with measurable adaptations in dynamic visuomotor processing while preserving fundamental binocular vision parameters.
To evaluate peripheral-central epithelial thickness (ET) gradients in eyes with keratoconus and regular astigmatism, and to determine their potential utility as a non-invasive biomarker for disease detection in early-stage keratoconus. This retrospective cross-sectional analyzed ET with spectral-domain OCT at the cone apex and at 3 mm in the superior, temporal, nasal, and inferior directions. Epithelial thickness gradients (ΔET) were calculated as the difference between peripheral and central ET. Statistical comparisons were performed using non-parametric tests, with significance set at p < 0.05. A total of 396 eyes (208 keratoconus, 188 regular astigmatism) were analyzed. Central ET was significantly reduced in KC (38.55 ± 5.42 µm) vs controls (48.78 ± 3.94 µm; p < 0.001). While peripheral thickness showed minor differences, the ET gradients (ΔET) were markedly steeper in KC across all quadrants (temporal, superior, nasal, inferior, p < 0.001). Within Stage I KC, eyes with more advanced disease exhibited steeper ΔET values, particularly in the nasal and temporal directions. Mean ΔET, demonstrated significant differences between KC (8.43 ± 4.97 µm) and controls (- 1.55 ± 1.77 µm; p < 0.001), and correlated positively with steep keratometry (r = 0.521, p < 0.001) and negatively with thinnest corneal thickness (TCT) (r =  - 0.641, p < 0.001). ΔET is markedly steeper in keratoconus than in regular astigmatism-even in Stage I-and correlates with steep keratometry and TCT. With areas under the curves (AUCs) up to 0.976, ΔET provides a rapid, non-invasive epithelial-based biomarker for early detection and staging of keratoconus. Its utility for monitoring progression remains to be established in prospective longitudinal studies.
Access to communication and information during the informed consent process for clinical research is essential for empowered decision-making. To build awareness of accessibility practices, this study aimed to explore current enablers and barriers experienced by potential research participants during informed consent procedures. A multimodal survey, capturing quantitative and qualitative data, was distributed through industry networks in Australia. The survey was open to people who had been involved in an informed consent process for a clinical research study. We collected survey data from August 2024 to January 2025. Quantitative data were reported descriptively, while qualitative data were analyzed using content analysis, with barriers and facilitators mapped to the Theoretical Domains Framework. Half of the respondents (52%) disclosed having an information access challenge impacted by vision, intersectional disability, or neurodiversity. Five themes around information access were identified: communication, information quality, assistive technology, trusted supports, and information intervals. Our research highlights some suggested actions that can support researchers and research organizations in providing accessible communication and information formats, thereby enhancing equity and inclusion in informed consent practices.
Background: Tirzepatide is a novel therapeutic option for the management of metabolic disorders which has started to be implemented in routine practice. The study aimed to analyze the effectiveness of tirzepatide use and patient education in the field of healthy eating and weight loss, based on real-life data from the practice of a primary care physician, in metabolic syndrome (MetSyn) patients during a one-year follow-up period. Methods: This is a retrospective study based on real-life data of 118 MetSyn patients who were under the supervision of a general practitioner (GP). Analysis was conducted on 62 patients supported by trizepatide (2.5 mg for 4 weeks, then 5 mg for 4 weeks and 7 mg for 46 weeks) with dietary education and 56 patients that underwent dietary education with motivation only. Lipid profile, glucose level and blood pressure were assessed. Body Mass Index (BMI), waist-to-height ratio (WHtR), A Body Shape Index (ABSI), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Body Roundness Index (BRI) were calculated. The KomPAN® questionnaire was used for dietary assessment and WHO Quality of Life-BREF for the quality of life assessment at 52 weeks. Results: Patients from both groups significantly reduced their body weight and WC and the values of the following indices: BMI, WHtR, ABSI, LAP and BRI. A significant increase in LDL cholesterol and triglyceride values was observed in both groups and a significant decrease in glucose level only in the group with tirzepatide combined with dietary modification. Energy value, energy density of food and nutrient intake did not differ between groups, while the intensity of beneficial nutritional features (pHDI-10) was low. Significant differences in patients' QoL were observed, especially in the domain related to mental health (higher in trizepatide + diet group). Conclusions: Support in primary care by a physician was successful from a long-term perspective in the group using tirzepatide in combination with diet modification as well as in the group based on dietary modification only. The data do not indicate a significant advantage of any one approach for patients, prioritizing an individualized approach to treatment.
To evaluate the effect of congenital lower eyelid entropion surgery on refractive status and corneal astigmatism in children, and to explore surgical timing and visual rehabilitation. A total of 43 pediatric patients (43 eyes) aged 3-12 years who underwent entropion correction between June 2022 and June 2023 were included. Best-corrected visual acuity (BCVA), cycloplegic refraction and corneal topography were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Statistical analyses included Spearman correlation, repeated-measures ANOVA, and nonlinear fitting. Preoperative entropion severity correlated significantly with cylinder power (r = -0.583) and corneal astigmatism (r = 0.476). Cylinder power decreased progressively from -1.34 ± 0.84 D preoperatively to -1.04 ± 0.69 D at 6 months (p < 0.001). Steep corneal curvature (Ks) reduced from 44.41 ± 1.49 D to 43.85 ± 1.45 D at 6 months (p < 0.001), and further to 43.91 ± 1.28 D at 12 months (p < 0.001), while corneal astigmatism decreased from 1.82 ± 0.88 D to 1.42 ± 0.68 D at 6 months (p < 0.001) and remained stable at 1.42 ± 0.74 D at 12 months (p < 0.05). No significant change was observed in flat curvature (Kf). Refractive parameters stabilized by 3 months postoperatively, with the stabilization point identified at 3.06 months. Best corrected visual acuity (BCVA) improved from 0.85 ± 0.19 preoperatively to 0.95 ± 0.09 at 12 months (p < 0.001), and the proportion of amblyopic eyes decreased from 20.9% (9/43) preoperatively to 7.0% (3/43) at 1 year postoperatively. Surgical correction of congenital lower eyelid entropion significantly reduces astigmatism and improves visual acuity in children. Refractive status stabilizes by 3 months postoperatively, supporting early intervention to reduce amblyopia risk.
To examine the association between serum Klotho levels and the prevalence of glaucoma, cataract, and retinal disease, and to explore the potential causal relationship between Klotho and glaucoma. Data from the 2007-2008 National Health and Nutrition Examination Survey were used, including participants aged 40 years and older. Serum Klotho levels were analyzed both as a continuous variable and by quartiles. Logistic regression analysis was performed to assess the associations between serum Klotho levels and ocular disorders. Bidirectional two-sample Mendelian randomization (MR) was used to assess a causal relationship between serum Klotho and glaucoma. A total of 2952 participants were included in the glaucoma analysis. Higher serum Klotho levels were positively associated with glaucoma risk (odds ratio [OR] = 1.05 per 100 pg/mL increase; 95% confidence interval [CI], 1.01-1.09; P = 0.006). Individuals in the highest Klotho quartile had significantly greater glaucoma risk (OR = 1.47; 95% CI, 1.07-2.03; P = 0.02). MR analyses found no evidence of a causal relationship between Klotho and glaucoma in either direction. No significant associations were observed between serum Klotho and cataract (n = 2950) or retinal disease (n = 2637). Higher circulating Klotho levels are associated with an increased prevalence of glaucoma, suggesting a more complex relationship than the previously presumed protective role of Klotho in glaucoma. The lack of genetic evidence for causality suggests this systemic-level association is unlikely to be causal, highlighting the need to investigate whether circulating Klotho reflects distinct processes from those involving its local expression within ocular tissues. These findings highlight the potential of circulating Klotho as a systemic biomarker for glaucoma risk assessment, while emphasizing that its role in ocular pathophysiology requires separate investigation of local expression and function.
Training medical vision-language models (VLMs) typically demands millions of image-text pairs to achieve versatility and reasoning, posing significant challenges in data acquisition. We propose ConceptVLM, a novel data-efficient fine-tuning paradigm that transforms general-domain VLMs into specialized medical ones with minimal labeled data, integrating medical knowledge without disrupting the model's existing general capabilities. Central to our approach is a key concept-aware training strategy, building a structured medical concept dictionary and employing masked attention to guide the model's focus toward essential clinical concepts. This focused fine-tuning enhances domain-specific comprehension while preserving the model's reasoning abilities and response diversity. Experiments across multimodal medical benchmarks show ConceptVLM achieves state-of-the-art results using only 1% of the original training data, outperforming traditional methods reliant on large-scale QA datasets. These findings challenge the prevailing reliance on extensive annotated corpora, demonstrating key concept-guided tuning as a viable path to developing cognitively capable medical VLMs.
To develop a machine learning (ML)-driven polygenic risk score (PRS) for DR and evaluate the extent to which lifestyle may mitigate genetic risk. This multicenter, multiethnic cohort study included 91,691 participants with DR-free prediabetes/diabetes from the UK Biobank (UKB); and 1,119 participants with DR-free diabetes from the Guangzhou Diabetic Eye Study (GDES) for independent validation. A systematic literature review was conducted to identify candidate DR loci in PubMed, EMBASE, Web of Science, and WHO databases until 1 May 2025. An ML-driven PRS for DR was constructed by integrating 182 literature-derived single nucleotide polymorphisms, which was subsequently applied to two multiethnic, prospective cohorts. Lifestyle adherence was determined using a scoring system based on four behavioral factors (no smoking, optimal weight control, regular physical activity, and healthy sleep) and were categorized as favorable (3-4 factors), intermediate (2 factors) and unfavorable (0-1 factor). Participants at high genetic risk had a 37% higher risk of developing incident DR than those at low genetic risk, regardless of lifestyle (HR = 1.37, 95% CI: 1.18 to 1.60; P < 0.001). An unfavorable lifestyle was associated with a 49% higher risk than a favorable lifestyle, regardless of genetic risk (HR = 1.49, 95% CI: 1.34 to 1.65; P < 0.001). High genetic risk combined with an unfavorable lifestyle more than doubled the DR risk (HR = 2.09, 95% CI: 1.67 to 2.60; P < 0.001). Among participants at high genetic risk, a favorable lifestyle was associated with a 44% lower DR risk (HR = 0.56, 95% CI: 0.42 to 0.75; P < 0.001), corresponding to a reduction in the standardized DR rates from 7.5% (95% CI: 7.4% to 7.6%) to 4.6% (95% CI: 4.5% to 4.7%). The gene-lifestyle synergistic associations were confirmed by replication in the GDES. Both genetic risk and modifiable lifestyles demonstrated independent and joint impacts on DR risk. While risk reduction was greatest among those with high genetic risk, our findings support universal behavioral interventions for DR prevention, regardless of genetic background.
Background: The metamorphopsia questionnaire (MeMoQ) is an established patient-reported outcome measure (PROM) in the context of macular disease. However, its performance has not been proved in those being treated for various macular conditions with intravitreal anti-vascular endothelial growth factor (Anti-VEGF). The objective was to eliminate misfitting items, enhance measurement precision, and ensure optimal response categorisation. Methods: Rasch analysis was performed iteratively on 2286 responses from patients with macular diseases being treated with Anti-VEGF to optimise the MeMoQ. Fit statistics, reliability indices, person and item separation measures, and principal component analysis (PCA) of residuals were assessed to determine the optimal model. This study was conducted in an outpatient clinic specialising in retinal diseases in Hywel Dda University Health Board. Results: Misfitting items were removed in successive iterations, leading to optimised category probability curves and stable fit statistics for the MeMoQ. The resulting model for all responses included two final items, with person separation remaining inadequate reducing from 1.23 to 1.12 and reliability from 0.60 to 0.56. Category probability curves demonstrated good ordering of response variables with Andrich thresholds separated by >1.2 logits. In the subgroups of neovascular age-related macular degeneration and diabetic macular oedema person separation remained below two and reliability remained low. Conclusions: Rasch analysis demonstrated that the MeMoQ was not a valid or reliable PROM in this patient population. Therefore, the MeMoQ may not provide a reliable index of patient's perception and visual experience when undergoing Anti-VEGF treatment.
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Vision impairment is increasingly recognised as a complex condition shaped not only by ocular pathology but also by cognitive, psychological, social and environmental factors that influence participation and quality of life. In line with the United Nations Convention on the Rights of Persons with Disabilities and the International Classification of Functioning, Disability and Health, contemporary vision rehabilitation frameworks adopt a biopsychosocial perspective that extends beyond treatment of the eye condition alone toward holistic support to improve the lives of individuals with vision loss. An overview of the effectiveness and future directions of multidisciplinary vision rehabilitation in clinical practice is presented, and a summary of the findings concerning the international standards of vision rehabilitation, focusing on adults. Furthermore, some examples of achievements in emerging fields are presented, such as neuroplasticity and visual system recovery, technological interventions and psychosocial support, including their future directions. Multidisciplinary models are widely supported but remain difficult to implement because of limited resources, workforce constraints and differences in culture and health policy. Overcoming these barriers is critical to expanding and strengthening multidisciplinary vision rehabilitation. The evidence highlights the need for implementation-focused research, closer collaboration across disciplines and core outcome measures that capture participation, mental health and quality of life, not just impairment. The overview also points to the importance of structured models that integrate neurorehabilitation (artificial intelligence-based) technology and mental healthcare while adapting to regional and cultural contexts. Embedding multidisciplinary vision rehabilitation within health systems is both a clinical necessity and a prerequisite for advancing global commitments to inclusion and equity for people with vision impairment. As population ageing and global demographic change are expected to increase the absolute numbers of adults with vision loss, strengthening collaboration between research, clinical practice and service delivery will be essential to further improve the quality of life of individuals with vision loss.
To validate a custom smartphone application for at-home visual acuity (VA) measurement in children. A total of 452 children aged 3-17.5 years participated. Certified examiners measured in-office test-retest VA (logMAR) using gold-standard Amblyopia Treatment Study HOTV (3-to-6-year-olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7-to-17.5-year-olds, older cohort) protocols at 3-4.5 m and app-based VA at 1.5 m. Caregivers measured at-home app-based VA at 1.5 m. Comparing at-home app-based with gold-standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.04; 95% limits-of-agreement half-width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in-office app-based VA with gold-standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold-standard test-retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15). Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.
Currently, myopia affects approximately 1,406 million individuals, representing 22.9% of the global population. Emerging technologies are transforming eye care by providing innovative approaches to address the global challenge of myopia progression. Despite advancements in myopia control strategies, a comprehensive evaluation of the global landscape of emerging technologies remains an urgent priority. The article search was conducted across PubMed, Scopus, PsycInfo, Web of science and Google Scholar databases. Titles, abstracts, and full texts were screened for inclusion independently by all authors, with discrepancies resolved through discussion. The findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for Scoping Reviews checklist. A total of 28 articles were included in this scoping review. The majority of the included were randomized clinical trials (n = 10, 35.7%), with most conducted in China (n = 10, 35.7%). The study populations predominantly consisted of individuals less than 17 years of age. Several studies reported that Defocus Incorporated Multiple Segments (DIMS) spectacle lenses demonstrated outshining efficacy in controlling axial length growth and reducing myopia progression compared to alternative interventions. This scoping review identifies emerging technologies show potential in managing myopia progression, further research is needed to determine their long-term safety profiles, optimize treatment protocols, and address regional disparities in access to these options.
To investigate whether intravitreal vasoactive intestinal peptide (VIP) attenuates form-deprivation myopia (FDM) in a dose-dependent manner in guinea pigs and to determine whether this effect is mediated through regulation of the scleral Wnt/β-catenin signaling pathway. A customized latex-balloon facemask was used to induce monocular FDM by covering the right eye, with the left eye remaining uncovered and serving as an internal self-control (SC). Fifty-four 3-week-old guinea pigs were randomly assigned to FDM without injection, FDM with intravitreal VIP (six subgroups receiving 0.1-10000pmol VIP), or FDM with intravitreal saline. Refraction and axial length were measured at baseline and at weeks 2 and 4 to establish dose-response relationships and identify the optimal VIP concentration. Using the same FDM protocol, 45 additional 3-week-old guinea pigs were allocated to three groups: FDM, FDM + intravitreal VIP (100pmol), and FDM + saline. Ocular biometric measurements were obtained at baseline and at weeks 2 and 4 during follow-up. Eyes were then enucleated for hematoxylin-eosin histological analysis of the retina, choroid, and sclera, as well as immunohistochemical assessment of β-catenin expression. Primary scleral fibroblasts were isolated to evaluate VIP-induced changes in Wnt3 and β-catenin expression using immunofluorescence and qRT-PCR. Both refractive error and axial length demonstrated a clear VIP dose-dependent response. Form deprivation induced aberrant activation of the scleral Wnt/β-catenin signaling pathway, which was significantly suppressed by VIP treatment. Moreover, VIP administration partially restored the disrupted collagen fibril organization characteristic of myopic sclera. VIP effectively slows the progression of FDM by downregulating aberrant Wnt/β-catenin signaling.