Observational learning benefits are reported after watching "learning" models. Reasons for benefits are mostly speculative and the reliability of effects compared to watching correct models is relatively poor. Variation in what an observer sees when watching a learner is one proposed condition for a beneficial effect. Another is related to seeing errors, which engage error detection and correction processes. To date, variable versus errorful conditions have not been distinguished. In a pre-registered design, three groups (n = 34/group) practiced putting a golf ball to the centre of a grid and returned the next day to test for retention and transfer. Practice involved alternating blocks of watching putting videos (8 blocks of 20 trials), with physical practice, without and with outcome feedback (8 blocks, 10 trials each). Self-predictions were captured in no-feedback trials. Two "variable" groups watched a model putt to different corners of the grid, with instructions conveying intended "hits" (variable-correct) or unintentional "misses" (variable-error). A third group watched constant correct putts. Watching variable demonstrations caused more putting variability in practice and accuracy benefits in transfer, compared to constant. However, there were no group differences in retention, nor any error-group related differences. Although watching errors did not impact directional biases or facilitate putting accuracy as expected, it improved self-estimations of outcomes (i.e., error detection related to prediction of sensory effects). These data suggest that variability and errors in demonstrations have small, yet different effects on motor learning, with variability improving generalizability and errors contributing to improved feedforward predictions.
Primary tumors of the central nervous system are extremely aggressive and often incurable. While tumor cells are known to interact with their microenvironment, the complexity and temporal dynamics of this interplay and its impacts on tumor progression remains to be fully understood. We addressed this question in a Drosophila model of cancer stem cell-driven tumor which originates during development and grows extensively within a network of cortex glia cells through adulthood. We revealed a biphasic interplay between tumor and cortex glia cells, characterized by morphological, molecular, and functional changes. In early stages, glial cells infiltrate the tumor, display a distinct transcriptional signature, and resist its growth, supported by the intrinsic neuroprotective activity of the c-Jun N-terminal kinase (JNK) signaling pathway. However, cancer stem cell-driven competition takes place, eliminating cortex glia by apoptosis and ultimately unleashing tumor growth. This second phase sees the breakdown of the glial meshwork and adhesions to neurons, along with the downregulation of the JNK pathway and a decline in essential cellular functions. Ultimately, the host tissue collapses, in turn curbing tumor growth. This study uncovers a dynamic and complex interplay between host tissue resistance and tumor-driven competition, which shapes tumor progression.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(4):25f04104. Author affiliations are listed at the end of this article.
Cerebrovascular surgery has shifted a lot from the microsurgical aspects to the endovascular surgeries in nearly most of the cases. However, there are still some major controversies when one sees the long-term follow-up of microsurgical and endovascular procedures.MC aneurysms, PICA VA junction and PICA aneurysms, IC aneurysms with good cross flow (trapping), revascularisation surgery, dural AVF (coagulation or coiling), ICH evacuation timing, and recent changes in mechanical thrombectomy timing are a few of these examples. This chapter will comprehensively aim to provide an outlook on the best possible modality in these controversial aspects of cerebrovascular surgery.
The author offers a creative reading of Winnicott's "Playing: A theoretical statement," a paper in which Winnicott makes his most fully developed statement of his understanding of the phenomenon of playing. Winnicott is less interested in the symbolic content of play than in the experience of playing. Interpretation may at times supplement the psychic work the child and analyst achieve in playing together, but the principal agent of psychic change is the experience of playing. In the course of this paper, the author (1) views Winnicott's concept of transitional objects and phenomena as a significant step in the expansion of contemporary object relations theory; (2) understands Winnicott's view of playing as inherently self-therapeutic as an extension of Freud's conception of dreaming; (3) points out Winnicott's struggles with the limits of language to communicate what is conveyed in the medium of paradox;(4) offers his own experience of playing with children outside of a clinical setting to illustrate ideas introduced by Winnicott; and (5) notes that if the child does not know her baby is not a real baby, she is psychotic; if she sees the doll as only a doll, she is unable to play. Play rests on the simultaneity of the make-believe and the real.
To estimate DR prevalence, risk factors, and undiagnosed disease in the Thessaloniki Eye Study. Cross-sectional, population-based study. Community examinations and home visits in Thessaloniki, Greece. Adults aged 60 years or older; 2468 with gradable fundus data or fundus examination were analysed. Self-reported diabetes mellitus (DM), demographics, ocular/systemic history, and lifestyle factors. DR prevalence/severity graded from fundus photographs using a modified Airlie House system; clinically significant macular oedema (CSMO), vision-threatening retinopathy (VTR), and DR risk factors. Among 2468 participants, DR prevalence was 6.9% (170/2468; 95% CI, 6.0%-8.0%). Among 352 participants with self-reported diabetes, 31.0% (109/352; 95% CI, 26.4%-36.0%) had DR; mild, moderate, severe non-proliferative DR, and proliferative DR were observed in 13.6%, 7.1%, 7.4%, and 2.8%, respectively. CSMO and VTR were present in 6.5% and 11.9%, respectively. Increased DR risk was associated with male gender (OR = 2.64), insulin therapy (OR = 4.87), and longer antihyperglycaemic treatment duration (OR = 1.05/year). Lower DR risk was associated with older age (OR = 0.87/year), regular alcohol intake (OR = 0.39), and migraines with aura (OR = 0.11). Among participants with DR, 73.9% were unaware of their diagnosis. DR affected nearly one-third of participants with diabetes, and most DR cases were undiagnosed. These findings support improved DR screening and education in older Greek adults.
Cavernous hemangioma, currently classified as a cavernous venous malformation (CVM) according to the International Society for the Study of Vascular Anomalies classification, is the most common benign vascular malformation of the adult orbit. It typically arises within the intraconal compartment. Extraconal orbital CVMs are uncommon and are usually reported as isolated case reports or small case series. A 48-year-old female presented with a gradual diminution of near vision without pain, diplopia, or proptosis. Ocular examination was notable for presbyopia; however, an incidental, painless swelling of the right lower eyelid was also observed. Contrast-enhanced orbital computed tomography demonstrated a well-circumscribed extraconal lesion in the inferolateral orbit with homogeneous enhancement. Complete surgical excision was performed via anterior orbitotomy. Histopathological examination confirmed CVM. This case highlights an uncommon extraconal location with incidental clinical detection, emphasizing the importance of careful periocular examination even in patients presenting with unrelated visual complaints, and thus adds to the small pool of such case presentations. RésuméL’hémangiome caverneux, actuellement classé comme malformation veineuse caverneuse (MVC) selon la classification de l’International Society for the Study of Vascular Anomalies, est la malformation vasculaire bénigne la plus fréquente de l’orbite chez l’adulte. Il siège habituellement dans le compartiment intraconal. Les MVC orbitaires extraconales sont rares et généralement rapportées sous forme de cas isolés ou de petites séries de cas. Une femme de 48 ans s’est présentée avec une diminution progressive de la vision de près sans douleur, diplopie ni exophtalmie. L’examen ophtalmologique a montré une presbytie ; cependant, une tuméfaction indolore et fortuite de la paupière inférieure droite a également été observée. La tomodensitométrie orbitaire avec contraste a montré une lésion extraconale bien circonscrite dans l’orbite inférolatérale avec un rehaussement homogène. Une exérèse chirurgicale complète a été réalisée par orbitotomie antérieure. L’examen histopathologique a confirmé une MVC. Ce cas met en évidence une localisation extraconale inhabituelle avec découverte clinique fortuite et souligne l’importance d’un examen périoculaire attentif, même chez les patients présentant des plaintes visuelles non liées.
Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder characterized by capillary malformations, venous and/or lymphatic malformations, and asymmetric limb overgrowth. It results from somatic activating mutations in the PIK3CA gene, leading to dysregulated vascular development. While primarily affecting the skin and musculoskeletal system, ocular manifestations are uncommon. Central serous chorioretinopathy (CSC), a condition involving choroidal vascular hyperpermeability and retinal pigment epithelium dysfunction, has not been previously associated with KTS. A 52-year-old Iranian male presented with a 6-month history of bilateral vision loss. Ophthalmologic examination revealed best-corrected visual acuity of 20/30 in the right eye and 20/25 in the left eye. Optical coherence tomography (OCT) and fluorescein angiography (FA) confirmed bilateral chronic CSC. The patient exhibited an extensive capillary malformation on the right upper limb and trunk with mild limb hypertrophy. Magnetic resonance angiography (MRA) revealed venous malformations, supporting a diagnosis of previously unrecognized KTS. Laboratory tests excluded secondary causes of CSC. Bilateral photodynamic therapy (PDT) was performed. This novel case suggests a potential association between KTS-related venous malformations and CSC, possibly mediated by venous overload choroidopathy. Although follow-up was limited, routine ophthalmic screening in KTS patients may be warranted.
Thyroid eye disease (TED) is a potentially sight-threatening autoimmune condition affecting up to half of patients with Graves' disease. It presents with variable ocular symptoms such as lid retraction, proptosis, diplopia and discomfort, which can significantly impair vision and quality of life. Early detection is crucial, as prompt management can prevent progression and visual loss. This article provides general practitioners (GPs) with a framework to recognise, assess and initiate management of TED, and it outlines appropriate referral pathways to specialist care. GPs play an essential part in screening patients with thyroid disease for TED and identifying early warning signs. Initial measures include smoking cessation, restoration of euthyroid status and use of lubricants. Urgent referral is warranted for sight-threatening or rapidly progressive disease, while coordinated multidisciplinary management with endocrinologists and ophthalmologists supports optimal outcomes. Early recognition and referral by GPs can significantly improve visual and quality-of-life outcomes.
Diabetic retinopathy (DR) can lead to vision-threatening complications, and tools that capture microvascular damage beyond standard clinical grading of disease severity may improve risk prediction. Optical coherence tomography angiography (OCTA) quantifies retinal perfusion, but its prognostic value in referable DR is not fully established. We aimed to validate baseline deep capillary plexus (DCP) OCTA metrics for predicting one-year complications in eyes with referable DR. In this prospective longitudinal study in 137 eyes of 96 participants, we assessed baseline predictors of DR complications, defined as best-corrected visual acuity (BCVA) loss (≥ 10 letters on the ETDRS chart), center-involving diabetic macular edema, anti-VEGF injections, pan-retinal photocoagulation, or vitreous hemorrhage. Baseline variables included BCVA, low-luminance visual acuity (LLVA), ocular parameters, demographic characteristics, systemic variables, and OCTA metrics (foveal avascular zone area, vessel density [VD] and geometric perfusion deficit in the superficial capillary plexuses [SCP] and [DCP]). Logistic regression prioritized variables with pathophysiologic relevance while minimizing risk of collinearity. Receiver operating characteristic (ROC) curves assessed whether DCP OCTA metrics improved discrimination beyond a clinical model with traditional risk factors. Over one year, 34 eyes (24.8%) experienced one or more complications. Multivariate analysis including DR severity, DCP VD, and LLVA identified higher baseline DR severity (OR, 5.77; 95% CI: 1.93 to 17.27; P = 0.002) and lower DCP VD (OR, 0.59; 95% CI: 0.36 to 0.95; P = 0.031) as significant predictors. Adding DCP VD to the clinical model significantly improved discrimination. These findings support DCP OCTA metrics as capillary-level biomarkers for risk stratification in referable DR and highlight the need for larger longitudinal studies to confirm clinical utility.
This systematic review aimed to characterize pathological retinal changes following ocular alkali burns (OAB), evaluate potential therapeutic interventions to preserve retinal structure and function, and summarize reported human cases with retinal involvement. A systematic search of PubMed, Embase, SCOPUS, and Web of Science, supplemented by manual reference screening, was independently performed by two reviewers in accordance with PRISMA 2020. Eligible studies, human or animal, investigated retinal damage directly attributable to OAB and/or interventions targeting retinal pathology. Screening and selection were performed, with disagreements resolved by consensus. Quality assessment used SYRCLE's Risk of Bias tool for animal studies and a modified NHLBI tool for case reports. The protocol was registered with PROSPERO (CRD42024598186). A total of 14 studies were included: 12 animal studies and 2 human case reports. Across animal models, seven therapeutic interventions were studied: anti-TNFα, mesenchymal stem cells (MSCs), N-acetylcysteine, tamoxifen, endoplasmic reticulum (ER) stress inhibitors, Solcoseryl gel, and anti-VEGF agents. Infliximab consistently improved retinal ganglion cell (RGC) survival and reduced apoptosis. MSCs, NAC, and TUDCA demonstrated strong anti-inflammatory effects, suppressing cellular infiltration and cytokine expression. ER stress inhibitors and tamoxifen preserved retinal architecture, while Solcoseryl gel offered structural protection but limited anti-inflammatory benefit. Anti-TNFα and anti-VEGF, either alone or in combination, reduced retinal inflammation and RGC loss, whereas anti-VEGF alone showed limited evidence. Among three human case reports, no posterior segment-directed therapies were administered, and visual outcomes ranged from full recovery to persistent vision loss. Retinal injury is a significant but under-recognized consequence of severe OAB. Preclinical studies demonstrate that treatments which offer neuroprotective and anti-inflammatory properties mitigate retinal damage in OAB models. However, clinical evidence remains limited. These findings underscore the importance of early retinal evaluation in OAB and highlight the need for future clinical studies to validate and implement effective treatment strategies.
Belantamab mafodotin-blmf (bela-maf) is a first-in-class antibody-drug conjugate (ADC) that targets B-cell maturation antigen (BCMA) for the treatment of multiple myeloma. Its unique structure allows it to induce plasma cell apoptosis through microtubule inhibition, antibody-dependent cellular cytotoxicity (ADCC), and antibody-dependent cellular phagocytosis (ADCP). While bela-maf failed to show efficacy as monotherapy for relapsed/refractory myeloma in its initial phase 3 trial, it subsequently showed significant improvement in progression-free survival in combination with either bortezomib/dexamethasone (BVd, DREAMM-7) or pomalidomide/dexamethasone (BPd, DREAMM-8) resulting in updated regulatory approval. Bela-maf is an "off-the-shelf" BCMA-directed therapy with decreased risk of severe infections compared to other T cell redirection strategies, but it results in high incidence of ocular toxicity including keratopathy, blurred vision, and dry eye due to target-independent uptake of the monomethyl auristatin F (MMAF) payload in the corneal epithelium. Bela-maf-induced ocular toxicity requires close ophthalmology monitoring and may be partially mitigated by reducing the dose or frequency of bela-maf, and further data are needed to optimize dosing strategies. Herein, we review the pharmacology, clinical efficacy, and unique safety precautions related to belantamab mafodotin, as well as highlight ongoing studies of its use in earlier lines of therapy and in combination with other anti-myeloma agents.
Bacterial keratitis (bacterial corneal infection) is a serious, vision-threatening disease caused by a wide range of bacterial species. The gram-positive bacterium Nocardia spp. is increasingly recognized in keratitis, yet is particularly challenging to treat due to delayed diagnosis and limited efficacy of current ophthalmic therapeutics. Antimicrobial resistance among clinical Nocardia isolates is also rising, further complicating patient outcomes. Herein, we report a case of Nocardia amikacinitolerans keratitis, resistant to amikacin, ciprofloxacin, moxifloxacin, clarithromycin, and ceftriaxone, resulting in a complicated therapeutic course. A 53-year-old female presented with bacterial keratitis of the right eye, which over the course of 32 months progressed to scleritis (infection of the sclera) and a progressive, significant decrease in visual acuity to hand motion despite exhaustive topical and systemic antimicrobial therapies. While there is a general lack of efficacy of systemic therapies for bacterial keratitis, oral amoxicillin-clavulanate ultimately proved successful in resolving the infection. As Nocardia spp. ocular infections become more prevalent, this report underscores the highly virulent nature of this pathogen and provides insights into potential therapeutic modalities in the setting of multidrug resistance.
Systemic lupus erythematosus (SLE) is a chronic autoimmune condition characterized by immune dysregulation and use of immunosuppressive therapy, predisposing patients to opportunistic infections. Although infections are a major cause of morbidity and mortality in SLE, ocular toxoplasmosis is rarely reported in these patients and may pose a diagnostic challenge due to its ability to mimic other inflammatory or infectious ocular conditions. Early recognition is essential for timely management and improved visual outcomes. Here we report the case of a 21-year-old woman, a known case of SLE on maintenance immunomodulatory therapy, who presented with a blurring of vision in the right eye since 15 days. Ocular examination revealed vitritis with an active focus of necrotizing retinochoroiditis. Multimodal imaging, including ultrawide field fundus photography, fundus autofluorescence, and spectral domain optical coherence tomography, supported the clinical diagnosis of ocular toxoplasmosis. Serological evaluation showed positive immunoglobulin G (IgG) for Toxoplasma gondii, with negative IgM. The patient was treated with oral trimethoprim-sulfamethoxazole and corticosteroids, resulting in a progressive clinical improvement and resolution of the lesion with scarring. During follow-up, the patient also developed an SLE flare and herpes zoster infection, highlighting the complexity of persistent immune dysregulation in such patients, despite apparent clinical stability. Although uncommon, ocular toxoplasmosis should be considered in the differential diagnosis of posterior uveitis in SLE patients. Clinical examination supported by multimodal imaging remains crucial for diagnosis, particularly when serological tests are inconclusive. Prompt diagnosis and appropriate therapy can lead to favourable visual outcomes and prevent potentially life-threatening systemic complications.
Age-related macular degeneration (AMD) in the aging population frequently leads to vision impairment. Treatment for neovascular AMD (nAMD) focuses on the tortuous leaky vessels that typify choroidal neovascularization (CNV). Subretinal fibrosis in nAMD patients is more challenging to treat, as few effective options exist. This fibrosis notably impairs vision and typically develops in patients who do not fully respond to current treatments. To gain a better understanding of pathways that could be utilized to subvert subretinal fibrosis, we examined the role Bim, a pro-apoptotic mediator in the intrinsic cell death pathway, and thrombospondin-1 (TSP1), a key regulator of ocular angioinflammatory processes, have in moderating fibrosis. Here we show caffeine treatment significantly reduced subretinal fibrosis in the mouse laser photocoagulation model consistent with its known ability to enhance mononuclear phagocyte (MP) clearance and reduce CNV. Since the TSP1-Bim axis facilitates MP clearance, suppresses inflammation, prevents subretinal fibrosis and CNV, we assessed its necessity for the mitigation of fibrosis by caffeine. We show that caffeine did not prevent subretinal fibrosis or CNV in mice lacking Bim or TSP1. Thus, caffeine utilizes the intrinsic death pathway though TSP1-Bim axis to subvert subretinal fibrosis, likely by suppressing inflammation during CNV.
Purpose To report a case of severe refractory surgically induced scleral necrosis (SISN) with pan-uveitis and retinal detachment following pterygium excision, highlighting the challenges in differentiating infectious versus autoimmune mechanisms and demonstrating successful restoration of ocular structure with combined surgical and immunosuppressive therapy in a patient with poor initial prognosis. Observation: An 80-year-old man presented one year after pterygium surgery with severe pain, redness, and vision loss in the right eye. Examination revealed nasal necrotizing scleritis with purulent discharge, extensive scleral thinning and uveal exposure, pan-uveitis, serous retinal detachment, and choroidal folds. Co-infection was suspected, and systemic autoimmune predisposition was suggested by p-ANCA positivity and history of cutaneous lupus. The patient underwent urgent scleral debridement and biopsy, along with topical and systemic antibiotics, followed by weekly rituximab infusions and mycophenolate mofetil under steroid taper. After eight cycles of active treatment, scleral inflammation improved significantly, scleral thickness restored, and retinal detachment and subretinal fluid completely resolved. At last follow-up, visual acuity improved from counting fingers to 20/100 with restoration of ocular structural integrity. Conclusion The index case highlights the challenge of distinguishing infection from autoimmunity in SISN. Early debridement, prompt antimicrobial treatment, and immunosuppressive therapy are crucial in the management of SISN. Rituximab infusion is safe and effective for rapidly controlling severe scleral inflammation once infection is ruled out or is under control.
Sensory fusion and stereopsis are two crucial components of binocular depth perception. Current clinical tests do not provide a quantitative measure of sensory fusion and assess limited aspects of stereopsis. More importantly, patients who show no binocular fusion in standard clinical tests can demonstrate binocular integration and perceive depth from binocular disparity and motion cues, suggesting that current tests are insufficient to examine all aspects of binocularity. A battery of eight tests is presented here to provide a comprehensive assessment of binocular vision. These tests are designed to refine and extend existing assessments by targeting different components of binocular processing. Specifically, letter ocular dominance and plaid motion integration provide quantitative measures of sensory fusion. Binocular integration in peripheral vision is evaluated using fine- and coarse-peripheral stereopsis tests, dynamic local stereopsis, and motion parallax. Motion-in-depth is assessed by dynamic local stereopsis, the Pulfrich task, and motion parallax. An additional da Vinci stereopsis test provides qualitative insight into binocular integration by measuring the occlusion difference between the two eyes. Exemplary results are shown from a participant with normal vision. Modifications to the current protocol can be made to accommodate specific needs and to support applications in broader populations.
The École National Vétérinaire de Toulouse (ENVT) holds the Neumann's collection of parasites. The depository, created by Louis Georges Neumann at the end of the 19th century, contains a large number of ixodid specimens and primary types, all listed in an accession book by Neumann himself. In an effort to enhance the visibility and accessibility of this collection for the scientific community, the curatorial personnel of the collection recently transferred all accession data to an electronic database and began inventorying the specimens that are still available. This offered us with an opportunity to examine all remaining primary types of Ixodidae in the collection and write this catalogue.
Variants in pre-messenger RNA (mRNA) processing genes account for ∼15% to 20% of autosomal dominant retinitis pigmentosa, causing severe vision loss. We provide an in-depth characterization of pre-mRNA-processing variants in the population, with a focus on genotype-phenotype correlations. Participants underwent next-generation sequencing, variant filtering and interpretation. Impact(s) on protein structure/function were predicted through AlphaFold, ColabFold, among others. Clinical information was collated and segregation analysis undertaken. Variants were classified according to American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines. A total of 635 patients with retinitis pigmentosa (RP) were screened. Notably, 36 different variants were identified in PRPF31, PRPF8, SNRNP200, PRPF3, RP9, and PRPF 6; 19 were classified as likely pathogenic/pathogenic. Thirteen of 36 variants were absent from PubMed, gnomAD, LOVD, and ClinVar, with an additional 10 not previously associated with retinal degeneration. Genotype-phenotypes correlations were illuminated; variants in PRPF genes caused more severe retinal degeneration than SNRNP200 variants. We provide a detailed overview of the genetic landscape of variants in pre-mRNA-processing factor genes in Ireland, accounting for 14% of genetically solved autosomal dominant retinitis pigmentosa cases. Results highlight significant genetic diversity between populations, mutational diversity inherent in inherited retinal degenerations and the role of variants in mRNA-processing genes as causative of devastating ocular disorders.
To study the effects of a lipid-containing artificial tear (AT) and a non-lipid-containing AT on tear film dynamics over a 3-month period. Subjects with low lipid layer thickness were randomized to lipid-containing or non-lipid-containing ATs for 3 months. At each visit Ocular Surface Disease Index (OSDI), LipiView, non-invasive and fluorescein tear breakup times, tear lipid layer and aqueous film recordings with EasyTear View+, and corneal staining assessment were performed. Lipid layer thickness and tear thinning rate were calculated using custom LabView programs. Mixed effects models were used to analyze relationships among variables. Thirty nine subjects completed the study. Mean EasyTear View+ lipid layer thickness with non-lipid-containing AT decreased from baseline (65.1 [61.0, 69.2] nm) to 3 months (58.0 [53.4, 62.7] nm, p = 0.012), whereas mean lipid layer thickness with the lipid-containing AT remained stable (baseline = 59.0 [53.6, 64.4] nm, 3 months = 62.4 [56.1, 68.7] nm, p = 0.30). There was a significant difference in lipid layer thickness change from baseline to 3 months between the lipid-containing (3.4 nm) and non-lipid-containing ATs (-7.1 nm, p = 0.014). Tear thinning rate with the non-lipid-containing AT was faster at 3 months (baseline = 3.01 [2.21, 3.81]%/sec, 3 months = 4.78 [3.62, 5.94]%/sec, p = 0.008), but remained stable with the lipid-containing AT (baseline = 2.84 [1.93, 3.76]%/sec, 3 months = 2.93 [2.15, 3.70]%/sec, p = 0.84). The increase in tear thinning rate from baseline was greater with the non-lipid-containing (1.77%/sec) than the lipid-containing AT (0.09%/sec, p = 0.019). Fluorescein tear breakup time with the non-lipid-containing AT remained stable at 3 months (4.70 [4.14, 5.25] sec) versus baseline (4.23 [3.48, 4.99] sec, p = 0.26), whereas fluorescein tear breakup time with the lipid-containing AT was longer at 3 months (6.33 [4.85, 7.82] sec) versus baseline (4.44 [3.66, 5.22] sec, p = 0.029). There were no significant changes in OSDI score, LipiView lipid layer thickness, non-invasive tear breakup time or corneal staining grade over the 3-month period. Patients with lipid deficiency may benefit from lipid-containing AT over the non-lipid-containing AT to stabilize tear lipid thickness and minimize tear thinning while increasing tear breakup time. This study was registered at ClinicalTrials.gov (#NCT05705518) on the date of January 20, 2023.