Surv Ophthalmol [JOURNAL]
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200 papers
Altered ocular surface microbiome in nasolacrimal duct obstruction: Clinical implications for intraocular surgery.
Eshraghi B, Babaei L, Aghajani A
Surv Ophthalmol · 2025 Sep · PMID 40992697 · Publisher ↗
Nasolacrimal duct obstruction (NLDO) significantly alters the ocular surface microbiome, increasing bacterial load, polymicrobial colonization, and the presence of drug-resistant organisms. This microbial shift poses a s...
Nasolacrimal duct obstruction (NLDO) significantly alters the ocular surface microbiome, increasing bacterial load, polymicrobial colonization, and the presence of drug-resistant organisms. This microbial shift poses a serious risk for postoperative endophthalmitis following intraocular surgery. Patients with NLDO have up to a 100 % conjunctival culture positivity rate, compared to 40 % in normal eyes, with increased prevalence of pathogenic species such as Pseudomonas aeruginosa and Streptococcus pneumoniae. Preoperative screening using the Regurgitation on Pressure over the Lacrimal Sac (ROPLAS) test is recommended for all patients undergoing intraocular surgery; however, its low sensitivity necessitates selective use of lacrimal irrigation in high-risk individuals. Definitive management with dacryocystorhinostomy (DCR) reduces microbial burden, with normalization of flora typically occurring around 4 weeks postoperatively. In cases where DCR cannot be performed, alternative strategies such as topical/systemic antibiotics or dacryocystectomy may help mitigate infection risk. Even after successful DCR, ocular surface microbiome may resemble nasal microbiota, requiring continued vigilance during the perioperative period. These findings highlight the importance of identifying and managing NLDO before intraocular procedures to reduce the risk of vision-threatening complications.
Advancements in ocular blood flow imaging: Clinical applications of laser speckle flowgraphy and optical coherence tomography angiography in retinal and choroidal vascular diseases.
Tseng YH, Wu PL, Kang EY … +8 more , Chen KJ, Yeh PH, Yeung L, Sun MH, Wang NK, Hwang YS, Lai CC, Wu WC
Surv Ophthalmol · 2026 · PMID 40987377 · Publisher ↗
Ocular blood flow imaging techniques have become indispensable in current clinical practice because retinal vascular disturbances have been implicated in the pathophysiology of numerous ocular diseases. In this review, w...
Ocular blood flow imaging techniques have become indispensable in current clinical practice because retinal vascular disturbances have been implicated in the pathophysiology of numerous ocular diseases. In this review, we explore the applications of laser Doppler flowmetry, laser speckle flowgraphy (LSFG), and optical coherence tomography angiography (OCTA), focusing on LSFG and OCTA. Each modality is discussed in detail, including its principles, key parameters, advantages, limitations, and common artifacts. We further evaluated their roles in several ocular diseases, including age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, pathologic myopia, glaucoma, non-arteritic anterior ischemic optic neuropathy, and retinopathy of prematurity. Finally, we discuss emerging advancements such as neonatal imaging devices, ultrawide-field OCTA, and artificial intelligence integration in vascular analysis.
Double layer sign in chorioretinal diseases: Clinical significance and implications from multimodal imaging.
Quarta A, Feo A, Corradetti G … +2 more , Popovic MM, Sadda SR
Surv Ophthalmol · 2026 · PMID 40983165 · Publisher ↗
The double-layer sign (DLS) is an emerging optical coherence tomography (OCT) biomarker of growing diagnostic and prognostic relevance in retinal and chorioretinal diseases, including age-related macular degeneration, pa...
The double-layer sign (DLS) is an emerging optical coherence tomography (OCT) biomarker of growing diagnostic and prognostic relevance in retinal and chorioretinal diseases, including age-related macular degeneration, pachychoroid spectrum disorders. Multimodal imaging, particularly OCT angiography (OCTA), has enhanced our ability to characterize DLS and its role in disease progression and treatment response. DLS is identified as a separation between the retinal pigment epithelium (RPE) and Bruch's membrane, with overlapping phenotypic presentations including flat irregular pigment epithelial detachment (FIPED) and shallow irregular retinal pigment epithelial elevation. These signs are often associated with vascularized lesions that demonstrate increased DLS thickness, irregular contours, and heterogeneous reflectivity. OCTA offers superior sensitivity and specificity for detecting subclinical macular neovascularization compared to dye-based angiography, which may underestimate nonexudative neovascularization. Additionally, indocyanine green angiography remains crucial for identifying branching vascular networks and polypoidal lesions, especially in polypoidal choroidal vasculopathy. In pachychoroid diseases, such as chronic central serous chorioretinopathy, the presence of FIPED/DLS can indicate underlying neovascularization, which may benefit from combination therapy with anti-vascular endothelial growth factor agents. We discuss the multimodal imaging characteristics, prognostic significance, and clinical relevance of DLS across various retinal and chorioretinal disorders.
Clinical trials and quasi-experimental studies in the treatment of noninfectious retinal vasculitis: A systematic review from the International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) - Report 4.
Saboya-Galindo P, Cifuentes-González C, Rojas-Carabali W … +18 more , Mejía-Salgado G, Le Tong Y, Putera I, Song XYR, Walter CFY, Shengjuan Z, Chan R, La Distia Nora R, Biswas J, Gangaputra S, Pulido JS, Kempen JH, Nguyen QD, de-la-Torre A, Gupta V, Rosenbaum JT, Agrawal R, REVISE-IUSG study group
Surv Ophthalmol · 2026 · PMID 40983164 · Publisher ↗
This systematic review evaluates clinical trials and quasi-experimental studies reporting diagnostic criteria, disease activity scoring systems (including Disease Activity Index (DAI), Total Inflammatory Activity Index (...
This systematic review evaluates clinical trials and quasi-experimental studies reporting diagnostic criteria, disease activity scoring systems (including Disease Activity Index (DAI), Total Inflammatory Activity Index (TIAI), and Total Adjusted Disease Activity Index (TADAI), and others), and therapeutic strategies used in noninfectious retinal vasculitis (RV), aiming to consolidate current evidence on treatment response and effectiveness measures. Of 5533 articles screened (PROSPERO: CRD42023489232), 15 studies met the inclusion criteria. Most were conducted in Asia (73.3 %) and focused on Behçet disease (60 %) or Eales disease (27 %). RV was diagnosed clinically in all studies, while half incorporated fluorescein angiography to confirm vascular inflammation through leakage, staining, or occlusion; however, definitions of RV were highly variable, often inferred rather than explicitly stated, and lacked standardization. This diagnostic inconsistency, combined with limited imaging data, undermines comparability across studies. Disease activity was assessed using outdated composite indices such as the DAI, TIAI, and TADAI, which lack external validation and fail to capture key clinical features such as macular ischemia or capillary non-perfusion. Best corrected visual acuity, although frequently reported, was confounded by unrelated factors such as cataracts or macular scarring. Therapeutic strategies included systemic corticosteroids, immunosuppressants (e.g., methotrexate, azathioprine), and biologics (e.g., infliximab, interferon-alpha). Treatment selection was heterogeneous, and several regimens-such as cyclophosphamide-azathioprine combinations-do not align with current standards of care. Due to variability in study design and outcome reporting, no pooled effect estimates, or statistical comparisons were conducted. Treatment outcomes were synthesized descriptively based on individual study findings. Current evidence in RV clinical trials is outdated and lacks diagnostic and therapeutic standardization. There is a particular need for RV-specific definitions, validated disease activity and response indices, and contemporary therapeutic trials to guide clinical management and improve outcome comparability.
Artificial intelligence in age-related macular degeneration: Advancing diagnosis, prognosis, and treatment.
Lee E, Hunt D, Cakir Y … +4 more , Kuo D, Zhou Z, Pajic M, Hadziahmetovic M
Surv Ophthalmol · 2026 · PMID 40975441 · Full text
Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in older adults. While anti-vascular endothelial growth factor (anti-VEGF) therapy and novel treatments for geographic atrophy have im...
Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in older adults. While anti-vascular endothelial growth factor (anti-VEGF) therapy and novel treatments for geographic atrophy have improved management, timely diagnosis and personalized intervention remain a challenge. Artificial intelligence (AI), such as machine learning and deep learning models, shows promise in AMD diagnosis, classification, and treatment planning. This review summarizes AI's recent advancements, highlights its clinical utility, and addresses key limitations for wider real-world implementation in AMD. We conducted systematic search of PubMed from its conception up to August 1, 2024. Studies utilizing AI-based algorithms for AMD management were identified and categorized into early detection/classification and prediction of disease progression/treatment response. Data extraction focused on AI model performance, imaging modalities, and clinical applicability. Of 193 records screened, 47 studies were included, in which 19 studies focused on early detection/classification and 28 on prediction of disease progression/treatment response. AI models demonstrated high accuracy in AMD classification and progression prediction, including in real-world settings. Prediction models for treatment response, particularly anti-VEGF therapy, could provide recommendations on optimizing injection timelines. Recent studies have also begun tackling previous challenges, such as algorithmic biases, limited generalizability, and AI's "black-box" nature. AI-based models offer significant potential to transform AMD care through timely detection and personalized treatment; however, clinical integration depends on improving model interpretability and validating tools across diverse populations. As AI continues to evolve, ongoing research is needed to refine AI models and support their translation into evidence-based, real-world applicability in AMD.
Unfolding the diagnostic pipeline of diabetic retinopathy with artificial intelligence: A systematic review.
Suganya Devi K, Vasireddi HK, Reddy GR … +1 more , Satti SK
Surv Ophthalmol · 2026 · PMID 40972797 · Publisher ↗
Diabetic retinopathy (DR) is a leading cause of vision impairment globally, necessitating early and accurate detection through effective screening methods. We focus on the integration of artificial intelligence (AI) tech...
Diabetic retinopathy (DR) is a leading cause of vision impairment globally, necessitating early and accurate detection through effective screening methods. We focus on the integration of artificial intelligence (AI) techniques in automating and enhancing DR diagnosis. Timely detection and classification of DR severity are critical for patient management and intervention. AI-driven DR classification frameworks typically consist of sequential stages: image preprocessing, optic disc (OD) localization and removal, blood vessel segmentation, feature extraction, and classification of DR severity. In the proposed and implemented model, each of these phases was systematically addressed to ensure improved performance. The implementation demonstrated superior accuracy, achieving 98.02 % on the widely used MESSIDOR dataset. The pipeline incorporated effective preprocessing to enhance image quality, accurate OD localization and exclusion to avoid false detections, followed by precise vessel segmentation. Extracted features were then used to train deep learning models for DR severity classification. Comparative analysis with existing methods executed on the same dataset revealed that proposed model outperformed other state-of-the-art techniques in terms of classification accuracy and robustness. Ww outline the recent progress in AI-based DR screening, highlighting the significance of each diagnostic phase and their role in improving overall performance. By evaluating multiple approaches and benchmarking them against established dataset, the study emphasizes the transformative role of AI in DR diagnosis. Despite current challenges, AI holds substantial promise in clinical application, offering scalable, accurate, and efficient DR screening solutions that may significantly reduce the risk of blindness in diabetic patients.
Work-up in patients with retinal vasculitis: A systematic review and meta-analysis: International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) Report 2.
Cifuentes-González C, Putera I, Walter CFY … +17 more , Mejía-Salgado G, Le Tong Y, Chan R, Rojas-Carabali W, Song XYR, Mobasserian A, Nora RD, Biswas J, Gangaputra S, Pulido JS, Kempen JH, Nguyen QD, de-la-Torre A, Gupta V, Rosenbaum JT, Agrawal R, REVISE-IUSG study group
Surv Ophthalmol · 2026 · PMID 40972796 · Publisher ↗
This systematic review and meta-analysis investigate global diagnostic approaches for retinal vasculitis (RV), with a focus on infectious and non-infectious causes. As in our prior report, systematic searches were conduc...
This systematic review and meta-analysis investigate global diagnostic approaches for retinal vasculitis (RV), with a focus on infectious and non-infectious causes. As in our prior report, systematic searches were conducted in 5 databases and registered in PROSPERO (CRD42023489232). Studies included articles on at least 10 patients with RV without publication date or language restrictions. RV was categorized as secondary RV if they were associated with systemic disease, syndromic if they were associated with a syndromic ocular disease without systemic disease, idiopathic RV without association to systemic or syndromic ocular diseases. This report includes 84 studies analyzing 3480 patients with RV. Among infectious causes, tuberculosis tests were frequently reported, with TST/IGRA positivity observed in 31.4 % (95 % CI: 17.2-50.2 %) of de novo RV cases, increasing to 64.7 % (95 % CI: 47.8-78.9 %) in confirmed tubercular RV and 65.7 % (95 % CI: 39.0-85.1 %) in Eales disease. Chest radiograph abnormalities were present in 21.8 % (95 % CI: 12.9-33.8 %) of tubercular RV cases. Non-infectious causes showed notable regional variability. HLA-B51 positivity was 1 % (95 % CI: 0.03-3.1 %) in de novo RV, but rose to 61.4 % (95 % CI: 23.1-89.4 %) in Behçet's RV. Sarcoidosis RV revealed noncaseating granulomas in 80.5 % (95 % CI: 9.7-99.4 %), with angiotensin-converting enzyme elevation in 4.6 % (95 % CI: 2.3-9.1 %). This study highlights significant geographic variability in RV etiologies. Tuberculosis remains a key infectious cause, while non-infectious causes vary regionally. Region-specific diagnostics and Bayesian testing protocols are critical to improving diagnostic accuracy and patient outcomes.
Angioid streaks-related choroidal neovascularization: Clinical features, multimodal imaging-based differential diagnosis, and optimized treatment strategies.
La Rosa A, Feo A, Bousquet E … +4 more , Cabral D, Fouad Y, Parravano M, Romano MR
Surv Ophthalmol · 2026 · PMID 40972795 · Publisher ↗
Angioid streaks-related choroidal neovascularization (AS-CNV) is a vision-threatening complication arising from breaks in a calcified Bruch membrane, commonly associated with systemic conditions such as pseudoxanthoma el...
Angioid streaks-related choroidal neovascularization (AS-CNV) is a vision-threatening complication arising from breaks in a calcified Bruch membrane, commonly associated with systemic conditions such as pseudoxanthoma elasticum (PXE). This review comprehensively addresses the clinical features of AS-CNV, emphasizing its distinct pathophysiology and systemic implications. We highlight the critical role of multimodal imaging-including color fundus photography, fundus autofluorescence, fluorescein and indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography-in accurately diagnosing and differentiating AS-CNV from other choroidal neovascular pathologies. The integration of imaging biomarkers and vascular pattern analysis facilitates early detection of subclinical and quiescent CNV, allowing for timely, individualized anti- vascular endothelial growth facgtor therapy. Additionally, the systemic management of PXE and its cardiovascular, renal, and gastrointestinal manifestations is underscored to optimize overall patient outcomes. We provide an up-to-date synthesis of diagnostic advances and treatment strategies aimed at improving visual prognosis in patients with AS-CNV.
Visual outcomes associated with optical coherence tomography biomarkers in diabetic macular edema: A systematic review.
Nanji K, Hatamnejad A, Grad J … +19 more , El-Sayes A, Mihalache A, Gemae M, Huang R, Phillips M, Zeraatkar D, Singh R, Munk MR, Sadda SR, Sarraf D, Kaiser P, Guymer R, Sivaprasad S, Fraser-Bell S, Tham YC, Garg SJ, Wong TY, Wykoff CC, Chaudhary V
Surv Ophthalmol · 2026 · PMID 40967513 · Publisher ↗
We evaluated the value of baseline structural optical coherence tomography (OCT) biomarkers in determining functional treatment response at 6,12-, and 24-months following treatment initiation in patients undergoing anti-...
We evaluated the value of baseline structural optical coherence tomography (OCT) biomarkers in determining functional treatment response at 6,12-, and 24-months following treatment initiation in patients undergoing anti-vascular endothelial growth factor, steroid, or laser treatment for diabetic macular edema (DME). Ovid MEDLINE, EMBASE, and Web of Science databases were searched from inception for studies evaluating the association between baseline OCT biomarkers and best-recorded central visual acuity (VA). A synthesis using vote counting based on the direction of effect in relation to a five-letter minimally important difference was used. GRADE guidelines informed the certainty of evidence. Ninety-six studies evaluating 29 biomarkers were included. No biomarker with at least 'Low' certainty was associated with improved VA. Greater baseline ellipsoid zone (EZ) disruption and hyperreflective foci were associated with decreased VA at 6 months with "Low" certainty of evidence. There was also "Low" certainty that increased baseline disorganization of the retinal inner layers, increased baseline disruption of the external limiting membrane or EZ were associated with decreased VA at 12 months. No biomarker was associated with a poor prognosis with at least 'Moderate' certainty. The certainty was downgraded due to inadequately controlling for confounders and a lack of standardization regarding how biomarkers were defined and outcomes were measured.
Effect of methotrexate in preventing retinal detachment after proliferative vitreoretinopathy surgery: A systematic review and meta-analysis.
Kocak I, Sayin N, Bayramoglu SE … +1 more , Thalib L
Surv Ophthalmol · 2026 · PMID 40967512 · Publisher ↗
Intravitreal methotrexate (MTX) is increasingly administered as an adjunctive therapy alongside surgical intervention in patients with proliferative vitreoretinopathy (PVR) or those at high risk of its development, with...
Intravitreal methotrexate (MTX) is increasingly administered as an adjunctive therapy alongside surgical intervention in patients with proliferative vitreoretinopathy (PVR) or those at high risk of its development, with the aim of preventing recurrent PVR and subsequent retinal detachment; however, its efficacy remains uncertain. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library from inception to December, 2024, for studies evaluating intravitreal MTX as an adjuvant therapy in PVR surgery. The primary analysis included randomized controlled trials (RCTs), while supplementary analyses incorporated non-randomized studies. All meta- analyses were conducted using random-effect models. Study quality was assessed using the Cochrane Risk of Bias (ROB2) tool, and the certainty of evidence was evaluated using the GRADE approach. Three RCTs with 145 eyes met the eligibility criteria. The meta-analysis showed a pooled RR estimate of 0.64 (95 % CI 0.30-1.38), indicating a 36 % reduction in the risk of recurrent RD in MTX-treated eyes, although this was not statistically significant. No significant differences were observed in visual acuity improvement (SMD = 0.04; 95 % CI -0.53-0.60). Additionally, our meta-analysis of 5 non-randomized studies involving 277 eyes found no evidence to suggest that MTX reduces the incidence of recurrent retinal detachment in eyes undergoing surgery for PVR (RR = 0.90; 95 % CI 0.49-1.64). The RCTs were rated as having moderate risk of bias, while most non-randomized studies were assessed as having high risk of bias. Funnel plots indicated potential publication bias, and the certainty of evidence was rated as moderate according to GRADE. Although MTX was associated with a clinically relevant 36 % reduction in recurrent RD risk, the effect was not statistically significant. Larger, high-quality RCTs with adequate power are needed to confirm these findings.
Impact of artificial intelligence in vision science: A systematic review of progress, emerging trends, data domain quantification, and critical gaps.
Lewallen CF, Ortolan D, Reichert D … +2 more , Sharma R, Bharti K
Surv Ophthalmol · 2026 · PMID 40967511 · Publisher ↗
The prominence of artificial intelligence (AI) is growing exponentially, yet its implementation across research domains is uneven. To quantify AI trends in vision science, we evaluated over 100,000 PubMed article metadat...
The prominence of artificial intelligence (AI) is growing exponentially, yet its implementation across research domains is uneven. To quantify AI trends in vision science, we evaluated over 100,000 PubMed article metadata spanning 35 years. Using Medical Subject Headings (MeSH) terms, we analyzed trends across four prominent ocular diseases: age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract. Most articles utilized research techniques from at least one of the following domains: biological models, molecular profiling, image-based analysis, and clinical outcomes. Our quantification reveals that AI prominence is disproportionally concentrated in the image-based analysis domain, and, additionally, among 4 diseases evaluated, AI prevalence in cataract research is lagging. Contributing factors towards these disparities include insufficient data standardization, complex data structures, limited data availability, unresolved ethical concerns, and not gaining meaningful improvements over human-based interpretations. By mapping where AI thrives and where it lags, we offer a quantitative reference for funding agencies, clinicians, and vision scientists. Connecting various research domains with multimodal and generative AI could improve diagnostic utility; enabling earlier diagnosis, personalized therapy, reduced healthcare costs, and accelerate innovation. Future work should move AI in vision science beyond image-centric pattern recognition toward integrative, mechanistic analyses that explain - rather than merely detect - disease.
A scoping review on clinical and genetic diagnostic approaches for cerebral visual impairment.
Albertos-Arranz H, Juvier-Riesgo T, Sainfort F … +4 more , Jayakar A, Alfonso EC, Jacko VA, Mendoza-Santiesteban CE
Surv Ophthalmol · 2026 · PMID 40967510 · Publisher ↗
In recent years, the prevalence of cerebral/cortical visual impairment (CVI) in pediatric population has risen in developed countries; however, the condition's heterogeneity complicates its assessment and the creation of...
In recent years, the prevalence of cerebral/cortical visual impairment (CVI) in pediatric population has risen in developed countries; however, the condition's heterogeneity complicates its assessment and the creation of standardized diagnostic and treatment protocols. We review current clinical and genetic approaches to the diagnosis of CVI. A PubMed search conducted in October, 2024, identified original articles on the genetic and clinical diagnosis of children or young adults with CVI or at risk. Articles differentiating CVI from other diagnoses or typically developing children, as well as those examining screening tools, were also included. Of 565 references, 10 focused on the genetic features of CVI and 56 on clinical characteristics using different protocols or tests. Up to 40 % of CVI patients showed chromosomal abnormalities, and 26.9 % had genetic pathogenic variants linked to seizures, global developmental delay, intellectual disabilities, or birth complications. Ten of 17 questionnaires or screening tools are validated. Diagnostic protocols for identifying or diagnosing CVI (n = 12) included medical history, parent reports, visual field testing, optic nerve and oculomotor examinations, and visual perceptual assessments. Individuals with CVI showed poor visual performance on eye tracking (n = 9). Different visual evoked potential tests can help detect CVI (n = 9), and some studies highlight magnetic resonance imaging abnormalities in the dorsal and ventral stream and the thalamus. Several tests and screening tools are used to diagnose CVI, but their limited validation and variability make it challenging to establish precise protocols. Genetic testing can provide essential diagnostic information given the numerous genes involved, particularly after the main possible causes have been excluded.
Interventions to improve patients' knowledge in ophthalmology: A systematic review and narrative synthesis.
Sumodhee D, Ioannidou E, Ramessur R … +5 more , Prashar J, Abbas M, Balaskas K, Pontikos N, Thomas P
Surv Ophthalmol · 2026 · PMID 40953804 · Publisher ↗
Low eye health knowledge is associated with suboptimal treatment adherence, self-care practice and follow-up rate leading to poorer outcomes. The aim of this review was to survey what interventions are effective at impro...
Low eye health knowledge is associated with suboptimal treatment adherence, self-care practice and follow-up rate leading to poorer outcomes. The aim of this review was to survey what interventions are effective at improving patients' knowledge of eye disease and treatments. Randomised controlled trials and cross-sectional studies delivering interventions to improve patients' knowledge about eye diseases were reviewed. Databases, grey literature, reference lists and journals were searched for relevant studies. Three authors reviewed and extracted the data and assessed quality. Seventeen publications were included examining different types of interventions. Thirteen studies showed significant improvements on patients' eye disease knowledge following intervention. These included all 5 verbal interventions, 5 out of 6 video interventions, 5 out of 8 written or image material interventions, and 1 out of 2 using other formats. Study quality varied, with 7 studies rated as having low risks of bias, 8 moderate, and 2 high. Intervention design varied considerably across studies, making comparisons challenging. Interventions to improve patients' knowledge of eye conditions show promising results in particular verbal and video interventions; however, higher quality studies, as well as standardisation of reporting and intervention formats, are required to strengthen the evidence base.
Radiological features of lacrimal gland masses.
Huang S, Tong JY, Juniat V … +3 more , Almater A, Mombaerts I, Selva D
Surv Ophthalmol · 2026 · PMID 40946753 · Publisher ↗
Computed tomography and magnetic resonance imaging play a pivotal role in the investigation of lacrimal gland masses. Different lacrimal gland masses will demonstrate specific imaging characteristics. Although a definiti...
Computed tomography and magnetic resonance imaging play a pivotal role in the investigation of lacrimal gland masses. Different lacrimal gland masses will demonstrate specific imaging characteristics. Although a definitive diagnosis cannot always be reached with imaging alone, it can be particularly useful in assisting with identifying benign and malignant features and therefore guiding appropriate further investigation and management. We perform a detailed literature review and describe the radiological features of various lacrimal gland pathologies.
Choroidal vascularity index as a marker of health and disease: systematic review and meta-analyses.
Loh NC, Rojas-Carabali W, Lim YH … +15 more , Bong JE, Villabona-Martinez V, Cifuentes-González C, Kumar M, Sadda S, Schmetterer L, Cheung CMG, Gupta V, Grewal DS, Fekrat S, de-la-Torre A, Lee B, Wei X, Nivison-Smith L, Agrawal R
Surv Ophthalmol · 2026 · PMID 40915427 · Publisher ↗
The Choroidal Vascularity Index (CVI), derived from optical coherence tomography (OCT), has emerged as a potential biomarker for detecting vascular changes. Understanding its variability across physiological states, ocul...
The Choroidal Vascularity Index (CVI), derived from optical coherence tomography (OCT), has emerged as a potential biomarker for detecting vascular changes. Understanding its variability across physiological states, ocular conditions, and systemic diseases is crucial for its integration into clinical practice. We evaluated variations in CVI across different physiological states (e.g., first-trimester pregnancy), ocular conditions (e.g., age-related macular degeneration[AMD]), and systemic diseases (e.g., diabetes mellitus) compared to healthy controls. From 1210 identified articles, 63 studies (7316 participants: 4000 controls and 3316 cases) met inclusion criteria. Data covered 12 distinct conditions and physiological states. Most studies were conducted in Europe and Asia, predominantly using spectral-domain OCT machines with a low risk of bias. Increased CVI was seen in some physiological states (e.g., Valsalva maneuver, first-trimester pregnancy) and some disorders (e.g. active panuveitis, inactive thyroid eye disease). Reduced CVI was found in diabetes mellitus (both with or without diabetic retinopathy), hyperopic amblyopia, and AMD. CVI demonstrates potential as a biomarker to differentiate between physiological states and pathological conditions compared to healthy controls. These findings underscore the choroid's adaptive response to systemic and ocular challenges, highlighting CVI's relevance in understanding disease mechanisms and monitoring health.
Current advances in dome-shaped macula and associated conditions.
Carlà MM, Philippakis E, Gaucher D … +2 more , Couturier A, Gaudric A
Surv Ophthalmol · 2026 · PMID 40915426 · Publisher ↗
Dome-shaped macula (DSM) is a distinctive anatomical entity characterized by an inward convexity of the macula, initially described in highly myopic eyes within posterior staphyloma, but is now recognized as occurring ac...
Dome-shaped macula (DSM) is a distinctive anatomical entity characterized by an inward convexity of the macula, initially described in highly myopic eyes within posterior staphyloma, but is now recognized as occurring across a broader spectrum of refractive conditions, including mild myopia and even emmetropia. Since its initial description in 2008, advances in imaging technologies and longitudinal studies have significantly improved our understanding of DSM. We analyzed the recent literature, focusing on publications from the last 10 years. DSM affects about 0.2 % of the general population, with a prevalence reaching 10-20 % in highly myopic eyes. Its pathophysiology involves complex mechanisms ranging from emmetropization processes in non-myopic eyes to differential scleral biomechanics and asymmetric posterior segment growth in high myopia. Polarization-sensitive optical coherence tomography provided new insights into scleral fiber architecture, showing horizontal interpapillomacular fibers corresponding to the typical horizontal DSM configuration. DSM plays a dual role in myopic complications, potentially protecting against foveal retinoschisis while predisposing to serous retinal detachment (SRD) and retinal pigment epithelium (RPE) atrophy when the dome height exceeds specific thresholds. SRD, the most common (8-50 % of cases), and RPE atrophy are the main complications directly related to DSM. There are numerous treatment approaches for SRD with variable success rates. Longitudinal studies have described DSM evolution over time and shown that an increased dome height correlated with the axial elongation. We provide updated information on the epidemiology, pathophysiology, clinical presentation and management of DSM to improve the diagnosis and treatment of this increasingly recognized condition.
Dissecting the clinical and pathophysiological complexity of fundus tessellation.
Venkatesh R, Hande P, Prabhu V … +9 more , Vidyasagar S, Tendulkar K, Roy R, Godani K, Sirsikar A, Biradar P, Gandhi P, Yadav NK, Chhablani J
Surv Ophthalmol · 2026 · PMID 40914444 · Publisher ↗
Fundus tessellation (FT)-also referred to as tigroid or mosaic fundus-is characterized by increased visibility of underlying choroidal vessels. While often a physiological finding, FT may also signal early pathology in c...
Fundus tessellation (FT)-also referred to as tigroid or mosaic fundus-is characterized by increased visibility of underlying choroidal vessels. While often a physiological finding, FT may also signal early pathology in conditions such as high myopia, choroidal atrophy, or pigmentary disorders. We synthesize current understanding of the anatomical, optical, and imaging factors influencing FT appearance, including the roles of axial elongation, melanin distribution, and media clarity. Advances in multimodal imaging-such as color fundus photography, optical coherence tomography, and fundus autofluorescence-have improved the ability to differentiate physiological FT from disease-associated changes. Furthermore, artificial intelligence-driven tools like the Fundus Tessellation Density Index (FTDI) provide quantitative support for clinical decision-making. We propose a structured framework combining clinical parameters, imaging features, and FTDI to guide diagnosis and risk assessment. We underscore the clinical relevance of accurately distinguishing physiological from pathological FT and highlights directions for future research, including the potential of FTDI as a prognostic biomarker.
Predicting treatment response in retinal vein occlusions using baseline optical coherence tomography biomarkers: A systematic review.
Hatamnejad A, Nanji K, Grad J … +17 more , El-Sayes A, Mihalache A, Gemae M, Huang R, Waheed NK, Sarraf D, Sadda SR, Wong TY, Zeraatkar D, Ma J, Garg SJ, Munk MR, Borrelli E, Steel DH, Sivaprasad S, Wykoff CC, Chaudhary V
Surv Ophthalmol · 2026 · PMID 40914443 · Publisher ↗
This systematic review examines the prognostic value of baseline optical coherence tomography (OCT) biomarkers in predicting visual acuity (VA) outcomes for eyes with macular edema secondary to retinal vein occlusions (R...
This systematic review examines the prognostic value of baseline optical coherence tomography (OCT) biomarkers in predicting visual acuity (VA) outcomes for eyes with macular edema secondary to retinal vein occlusions (RVO) treated with anti-VEGF therapies, steroids, laser photocoagulation, or combination treatments. VA predictions at 6, 12, and 24 months post-treatment were assessed using a narrative synthesis approach and vote counting based on effect direction relative to a minimal clinically important difference. Certainty of evidence was evaluated using GRADE guidelines. Confounding factors, biomarker variability, and inconsistent outcome measurements were critically analyzed. A total of 116 studies assessing 31 unique OCT biomarkers were included. 'Low' certainty evidence indicated that an intact external limiting membrane (ELM) at baseline predicted better VA at 6 months, while baseline ellipsoid zone (EZ) integrity predicted better VA at 12 months at 5-letter change, however, these associations were not observed at thresholds of 10 and 15 letters. Certainty of evidence was often downgraded due to confounding factors, variability in biomarker definitions, and inconsistent outcomes. These findings highlight OCT biomarkers' potential for prognostication in RVO patients, but underscore the need for standardized definitions and further research to address confounders, improving the reliability and clinical utility of OCT-based biomarkers.
The role of lipid metabolism disorder in the progression and treatment of ocular vascular diseases.
Song W, Chen W, Chi J … +2 more , Liu X, Zhu W
Surv Ophthalmol · 2026 · PMID 40914442 · Publisher ↗
Lipid metabolism plays a critical role in maintaining normal physiological functions and is strongly linked to the pathogenesis of ocular vascular diseases. We examine how disorders of lipid metabolism drive progression...
Lipid metabolism plays a critical role in maintaining normal physiological functions and is strongly linked to the pathogenesis of ocular vascular diseases. We examine how disorders of lipid metabolism drive progression in ocular vascular diseases, including diabetic retinopathy, age-related macular degeneration, retinal vascular occlusive diseases, and retinopathy of prematurity. These disorders are classified as a related group due to their common feature of impaired ocular vascularization. Glaucoma has also been increasingly recognized as a condition resulting from both retinal and choroidal blood flow abnormalities, with shared lipid metabolism disturbances contributing to its pathogenesis. Lipid components such as fatty acids may exacerbate retinal and choroidal damage by promoting neovascularization and inflammatory responses. Additionally, lipid metabolic dysregulation negatively influences the retinal and choroidal microenvironment by increasing oxidative stress and inhibiting autophagy. We also discuss emerging therapeutic strategies targeting lipid metabolism, highlighting their potential in preventing or mitigating ocular vascular diseases. These include lipid-modulating agents and their use in combination with established therapies. Understanding the influence of lipid metabolism on the pathophysiology of these diseases could pave the way for the development of novel treatment approaches. These advancements hold potential to improve visual prognosis in patients with ocular vascular diseases. Identifying the specific roles and molecular targets associated with lipid metabolism in ocular vascular diseases will offer valuable insights into disease mechanisms. This knowledge will lay the groundwork for personalized and more effective clinical interventions.
Detection and quantification of fluorescein angiography leakage: From manual grading to advances in machine learning.
Parmar UPS, Arora A, Agarwal A … +3 more , Gangaputra S, Agrawal R, Gupta V
Surv Ophthalmol · 2026 · PMID 40902824 · Publisher ↗
Fluorescein angiography (FA) has long been a cornerstone for evaluating retinal vascular leakage in diseases like uveitis, diabetic retinopathy, and macular degeneration, but its interpretation relies on subjective gradi...
Fluorescein angiography (FA) has long been a cornerstone for evaluating retinal vascular leakage in diseases like uveitis, diabetic retinopathy, and macular degeneration, but its interpretation relies on subjective grading that can vary between clinicians. With the emergence of artificial intelligence (AI), there is a push to transform this qualitative assessment into objective, quantifiable metrics. We conducted a comprehensive literature search using PubMed, Embase, and Scopus, combining keywords and MeSH terms related to fluorescein angiography leakage, artificial intelligence, and retinal vascular diseases. Studies were included if they assessed FA leakage using manual, semi-automated, or AI-based methods and were peer-reviewed, published in English, and focused on human subjects. Our review charts the evolution from manual grading to modern machine learning techniques that segment and measure leakage using various angiograms. These AI-based approaches enable standardized, reproducible leakage indices that correlate with disease severity, inform treatment decisions, stratify high-risk patients, and facilitate sensitive monitoring of therapeutic response. We also introduce the concept of "minimal residual disease" in this context. By moving from coarse, subjective estimations to precise digital biomarkers, AI-driven FA leakage quantification promises to improve clinical care and research endpoints in retinal disease.
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