Br J Ophthalmol [JOURNAL]
Sun
200 papers
Adult myopia progression in high myopes aged 18-25 years: evidence from a population-based cohort.
Wu H, Ni Z, Qi Z … +9 more , Cheng T, Qian T, Zhao L, Wang Y, Yang J, Wang J, Zhang B, Xu X, He X
Br J Ophthalmol · 2026 May · PMID 41249003 · Full text
AIMS: To investigate the prevalence and severity of adult myopia progression among highly myopic individuals aged 18-25 years, identify its associated factors and evaluate its association with pathologic myopia (PM). MET...
AIMS: To investigate the prevalence and severity of adult myopia progression among highly myopic individuals aged 18-25 years, identify its associated factors and evaluate its association with pathologic myopia (PM). METHODS: We retrospectively included participants aged 18-25 years with consecutive follow-ups from the Shanghai Child and Adolescent Large-scale Eye Study database. Annual changes of cycloplegic spherical equivalent (ΔSE) and axial length (ΔAL) were calculated. Adult myopia progression is defined as ΔSE ≤-0.50 D/year or ΔAL≥0.10 mm/year. PM was diagnosed based on META-Analysis for Pathologic Myopia criteria (category≥2) and optical coherence tomography (OCT) images. RESULTS: Among all included 345 eyes, the mean ΔSE was -0.28 D/year (95% CI -0.31 to -0.20; p<0.001) and 64 (18.6%) were classified as having adult myopia progression. The mean ΔAL was 0.09 mm/year (95% CI 0.09 to 0.10; p<0.001), with axial elongation observed in 138 (40.0%) eyes. Both age (ΔSE: β=0.045, p=0.005; ΔAL: β=-0.015, p<0.001) and baseline AL (ΔSE: β=-0.044, p=0.028; ΔAL: β=0.020, p<0.001) were identified as factors associated with ΔSE and ΔAL. No differences in ΔSE (95% CI -0.08 to 0.11; p=0.759) or ΔAL (95% CI -0.04 to 0.01; p=0.190) were found between PM and non-PM groups, and neither metric improved PM discrimination. CONCLUSIONS: Among high myopic individuals aged 18-25 years, 18.6% exhibited adult myopia progression and 40.0% showed axial elongation. Age and baseline AL were associated with adult myopia progression, but no clear link was found between adult myopia progression and the development of PM.
Synergistic effects of glaucoma, degeneration of macula and posterior pole, and diabetic ophthalmic complications on vision loss.
Choe S, Xi C, Park DY … +4 more , Kang KH, Ha A, Kim SH, Kim YK
Br J Ophthalmol · 2026 Jan · PMID 41249002 · Publisher ↗
BACKGROUND/AIMS: Major age-related ocular diseases (ARODs)-glaucoma, degeneration of macula and posterior pole (DMPP) and diabetes mellitus with ophthalmic complications (DOC)-often coexist in ageing populations, but the...
BACKGROUND/AIMS: Major age-related ocular diseases (ARODs)-glaucoma, degeneration of macula and posterior pole (DMPP) and diabetes mellitus with ophthalmic complications (DOC)-often coexist in ageing populations, but their combined impact on severe visual impairment (VI) remains unclear. This study aimed to determine the coincidence rate of ARODs and evaluate the association between concomitant ARODs and the risk of developing severe VI. METHODS: This nationwide, longitudinal cohort study used data from the Korea National Health Insurance System (KNHIS) National Health Screening Cohort from 2004 to 2019. Incident ARODs were identified by diagnostic codes combined with medication prescriptions. Severe VI was identified through KNHIS health check-up records and the National Disability Registration. Adjusted HRs (aHRs) and 95% CIs were estimated, adjusting for demographic, behavioural and comorbidities. RESULTS: Among 0.5 million participants followed over 7 495 390 person-years, 7296 (1.45%) developed glaucoma, 1051 (0.21%) DMPP and 3062 (0.61%) DOC. Compared with those without AROD, the aHRs for severe VI were 4.78 (95% CI 4.00 to 5.72) for glaucoma, 8.27 (95% CI 5.95 to 11.51) for DMPP and 3.23 (95% CI 2.38 to 4.37) for DOC. A total of 595 individuals (0.12%) developed two or more ARODs. For patients with one AROD, the risk of severe VI (aHR 4.96; 95% CI 4.33 to 5.68) increased 1.93-fold with a second AROD (aHR 9.54; 95% CI 6.37 to 14.30) and 2.54-fold with a third AROD (aHR 12.59; 95% CI 2.32 to 68.44). CONCLUSION: The presence of multiple ARODs significantly elevates the risk of severe VI. These findings emphasise the need for integrated eye care, including prevention of developing additional ARODs.
Reduced macular pigment in vitamin A deficiency retinopathy.
Karakosta C, Birtel J, Thiele S … +2 more , Charbel Issa P, De Silva SR
Br J Ophthalmol · 2026 May · PMID 41233160 · Publisher ↗
Vitamin A deficiency (VAD) can lead to rod then cone dysfunction. We evaluated fundus autofluorescence (FAF) and optical coherence tomography (OCT) images in patients with confirmed VAD. Five patients (10 eyes) were incl...
Vitamin A deficiency (VAD) can lead to rod then cone dysfunction. We evaluated fundus autofluorescence (FAF) and optical coherence tomography (OCT) images in patients with confirmed VAD. Five patients (10 eyes) were included, with VAD related to Crohn's disease (n=4) and deficiency of fat soluble vitamins of unknown cause (n=1). After vitamin A supplementation, mean visual acuity improved from 0.2 to 0.1 logMAR, and the initially observed ellipsoid and interdigitation zone abnormalities on OCT imaging improved, supporting previous reports. In contrast, we describe a lack of normal foveal hypoautofluorescence on FAF imaging, which persisted post-treatment and could also be a useful diagnostic sign.
Global, regional and national burden of major blindness-associated ophthalmologic conditions, 1990-2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021.
Yeo D, Hwang SH, Lee S … +10 more , Jeong J, Kong J, Lee H, Smith L, Cho J, Yim Y, Lee J, Kang J, Yang JM, Yon DK
Br J Ophthalmol · 2026 May · PMID 41224521 · Publisher ↗
BACKGROUND: The global burden of blindness and vision loss continues to increase, yet comprehensive analyses of underlying causes remain limited. This study estimated the global and regional burden of blindness-related d...
BACKGROUND: The global burden of blindness and vision loss continues to increase, yet comprehensive analyses of underlying causes remain limited. This study estimated the global and regional burden of blindness-related diseases from 1990 to 2021 and projected trends to 2050 to inform public health strategies. METHODS: We analysed data from the Global Burden of Disease Study (GBD) 2021 to estimate the prevalence and disability-adjusted life years (DALYs) rates of blindness and vision loss, focusing on six major causes, including glaucoma, cataract, age-related macular degeneration, refraction disorders, near vision loss and other vision loss. We quantified the contribution of risk factors, and future trends were projected to 2050 using GBD's forecast framework. RESULTS: In 2021, the global age-standardised prevalence and DALY rates of blindness were 15 784.3 (95% uncertainty interval (UI), 12 761.4-19 502.3) and 342.8 (224.2-503.6) per 100 000. Although global age-standardised DALY rates remained statistically stable between 1990 and 2021, regional trends varied numerically. Southern sub-Saharan Africa recorded the highest age-standardised prevalence rate in 2021 at 16 741.4 (13 187.8-21 129.5), whereas the highest DALY rate was observed in South Asia at 497.1 (345.3-691.6). While the overall burden of blindness did not differ significantly by sex, glaucoma showed a higher burden in males. From 1990 to 2021, cataract DALY rates attributable to household air pollution decreased by 38.4%, with projections showing stable age-standardised rates through 2050. CONCLUSIONS: As populations age, the global burden of vision loss is projected to grow, with particularly high impact in lower-sociodemographic index regions such as Southern Sub-Saharan Africa and South Asia.
Triglycerides as a predictor of activity and severity in thyroid eye disease: a multicentre study.
Park J, Yoon JS, Choung H … +3 more , Lew H, Korean Society of Ophthalmic Plastic and Reconstructive Surg group, KSOPRS group
Br J Ophthalmol · 2026 May · PMID 41224520 · Full text
BACKGROUND: This study investigated the association between dyslipidaemia and thyroid eye disease (TED) activity and severity using a multicentre dataset from South Korea. METHODS: A retrospective, multicentre study incl...
BACKGROUND: This study investigated the association between dyslipidaemia and thyroid eye disease (TED) activity and severity using a multicentre dataset from South Korea. METHODS: A retrospective, multicentre study included adult patients (aged ≥19 years) with TED and elevated thyroid autoantibody levels, including thyroid-stimulating immunoglobulin >140% and thyroid-stimulating hormone-binding inhibitory immunoglobulin >1.5 IU/L. Patients previously treated with systemic steroids were excluded. TED activity was defined by a Clinical Activity Score, and severity was categorised as mild or marked based on the NOSPECS classification. Logistic regression analyses identified associations between lipid profiles and TED activity/severity. Subgroup analysis excluded statin users. Receiver operating characteristic curves determined optimal triglyceride (TG) cut-off values. RESULTS: Of 330 patients (71.2% women; mean age, 45.7±13.2 years), elevated TG levels were independently associated with TED activity (OR=1.005, 95% CI 1.001 to 1.008, p=0.011) and severity (OR=1.004, 95% CI 1.001 to 1.007, p=0.014). Optimal TG cut-off values were 104 mg/dL for active TED and 108 mg/dL for marked severity. These associations remained consistent in non-statin users with similar cut-off values. Elevated intraocular pressure and smoking were significantly associated with increased disease severity. Subgroup analysis excluding statin users revealed significant associations of total cholesterol and low-density lipoprotein cholesterol with TED activity. CONCLUSIONS: Elevated TG levels are significantly associated with TED activity and severity, highlighting the potential clinical value of measuring TG for risk stratification and disease management. Further studies should explore whether TG-lowering interventions improve TED outcomes.
Clinical characteristics and visual recovery in lost-to-follow-up myopic choroidal neovascularization treated with antivascular endothelial growth factor therapy.
Xu Y, Shen Y, Li S … +25 more , Zhou C, Li X, Yang X, Wang X, Li Y, Sun D, Zhang W, Li S, Zhang H, Lv H, Ma X, Yu H, Song Z, Zhang T, Yu X, Liu Y, Niu T, Yuan R, You Z, Liu Q, Song Y, Sun X, Zheng Z, Xu X, Liu K
Br J Ophthalmol · 2026 Apr · PMID 41218832 · Publisher ↗
BACKGROUND/AIMS: To identify sociodemographic and clinical factors associated with best-corrected visual acuity (BCVA) restoration at the visit after lost to follow-up (LTFU) in patients with myopic choroidal neovascular...
BACKGROUND/AIMS: To identify sociodemographic and clinical factors associated with best-corrected visual acuity (BCVA) restoration at the visit after lost to follow-up (LTFU) in patients with myopic choroidal neovascularization (mCNV) treated with antivascular endothelial growth factor intravitreal injections (IVI). METHODS: A multicentre, retrospective cohort study was conducted in China of mCNV patients receiving injections who were LTFU >6 months. Data were collected from baseline visit, pre-LTFU, initial post-LTFU visit and 6 months post-LTFU, and the final visit. Logistic regression analyses assessed associations between sociodemographic/clinical factors and BCVA restoration. RESULTS: The study included 1155 LTFU patients with mCNV (mean (SD) age: 54 (16) years; 61.6% female), with 66.6% achieving BCVA restoration at the initial post-LTFU visit after LTFU (mean(SD) duration: 315 (154) days. Patients with BCVA restoration were younger (p=0.004), more often from eastern China (p=0.022), and had shorter LTFU duration (p=0.013). Stratification by pre-LTFU BCVA showed that patients with BCVA ≥20/40 had lower restoration odds (OR 0.65, 95% CI 0.44 to 0.96; p=0.032) compared with those with BCVA <20/200. BCVA decline was associated with increased central subfield thickness(CST) (OR 1.52, 95% CI 1.15 to 2.01; p=0.004). Among 223 patients with ≥6 months post-LTFU, those with initial post-LTFU CST >280 µm had higher BCVA restoration odds (OR 1.98, 95% CI 1.02 to 3.92; p=0.046). CONCLUSIONS: Better pre-LTFU BCVA (≥20/40) increased post-LTFU deterioration risk (associated with progressive CST thickening), while elevated post-LTFU CST (>280 µm) predicted higher BCVA restoration odds in patients with sustained follow-up, supporting CST-guided monitoring and early intervention for high-risk groups.
Choroidal thickness and associated factors in children: the Ufa Children Eye Study.
Bikbov MM, Kazakbaeva GM, Iakupova EM … +8 more , Bikbova G, Gilemzianova LI, Nizamutdinova AM, Panda-Jonas S, Insapova AV, Timerbulatova DA, Lilia R, Jonas JB
Br J Ophthalmol · 2026 Apr · PMID 41207699 · Publisher ↗
BACKGROUND: To assess subfoveal choroidal thickness (SFCT) and its associations in school children in a Russian population. METHODS: The Ural Children Eye Study (UCES), a school-based case-control study, was performed in...
BACKGROUND: To assess subfoveal choroidal thickness (SFCT) and its associations in school children in a Russian population. METHODS: The Ural Children Eye Study (UCES), a school-based case-control study, was performed in Ufa/Bashkortostan/Russia from 2019 to 2022 and included 4933 children (mean age: 9.7±2.6 years; range: 6.2-18.8 years). The children underwent a series of ophthalmological and systemic examinations. Optical coherence tomographic (OCT) images of the macula were obtained in a randomly selected subgroup. RESULTS: Out of 4933 children primarily participating in the UCES, a randomly selected group of 1462 (29.6%) children underwent OCT. Thicker SFCT (mean: 322±82 µm; median: 317 µm; range: 105-691 µm) was associated (multivariable analysis) with the systemic parameters of older age (beta: 0.15; B: 3.99; 95% CI 0.91, 7.08; p=0.01), taller body height (beta: 0.17; B: 0.78; 95% CI 0.27, 1.29; p=0.003), earlier school start in the morning (beta: -0.07; B: -5.60; 95% CI -9.42, -1.88; p=0.004), lower prevalence of actively resting during studying (beta: -0.06; B: -8.80; 95% CI -15.6, -1.98; p=0.01) and earlier time of going to bed in the evening (beta: -0.07; B: -0.68; 95% CI -1.20, -0.15; p=0.01), and the ocular parameters of shorter axial length (beta: -0.59; B: -46.8; 95% CI -53.0, -40.5; p<0.001), lower corneal refractive power (beta: -0.18; B: -10.3; 95% CI -23.9, -6.81; p<0.001) and deeper anterior chamber depth (beta: 0.12; B: 36.4; 95% CI 17.7, 55.2; p<0.001). It was not significantly associated with sex (p=0.87), body Mass Index (p=0.88) and best-corrected visual acuity (p=0.18). Mean inter-eye SFCT difference (39.3±35.5 µm; median: 30 µm; range: 0.00-259 µm) was related with inter-eye difference in axial length (beta: -0.29; B: -57.1; 95% CI -66.9, -47.4; p<0.001). CONCLUSIONS: In this ethnically mixed school children population from Russia, in contrast to studies on adult individuals, SFCT increased with older age. As in adults, however, at a more marked degree compared with adults, it decreased with longer axial length, by approximately 47 µm for each mm of longer axial length in multivariable analysis.
Comparison of microRNA expression in pseudoexfoliation syndrome with and without glaucoma.
Lee SM, Kwon S, Lee MJ … +4 more , Cho BJ, Park MS, Kim J, Baek SU
Br J Ophthalmol · 2026 Apr · PMID 41203265 · Publisher ↗
BACKGROUND/AIMS: Pseudoexfoliation syndrome (PXS) is associated with increased risk of glaucoma, but the underlying molecular mechanisms remain unclear. This study aimed to compare microRNA (miRNA) expression profiles be...
BACKGROUND/AIMS: Pseudoexfoliation syndrome (PXS) is associated with increased risk of glaucoma, but the underlying molecular mechanisms remain unclear. This study aimed to compare microRNA (miRNA) expression profiles between PXS with glaucoma (PXSG) and PXS without glaucoma (PXSWG). METHODS: We enrolled 24 PXS patients undergoing cataract surgery, dividing them into PXSG (n=16) and PXSWG (n=8) groups. miRNA expression in anterior lens capsule tissue was analysed using NanoString nCounter technology. Differentially expressed miRNAs were identified, and functional pathway analysis was conducted using the Kyoto Encyclopedia of Genes and Genomes (KEGG). The correlations between miRNA expression and clinical variables, including glaucoma severity, endothelial cell counts (ECCs) and systemic factors identified in serum blood tests, were also examined. RESULTS: Using a panel of 827 miRNAs, 23 upregulated miRNAs in PXSG were identified, miRNA-(miR-)887-3 p and miR-933 exhibiting the highest differential expression. The KEGG highlighted enrichment in pathways related to ageing and signal transduction. Elevated levels of several miRNAs, miR-933 and miR-302a-3p, were linked to worse visual field (VF) and thinner peripapillary retinal nerve fibre layer thickness (pRNFLT). Multivariate regression analysis identified associations of miR-302a-3p with lower ECC, miR-302f with thinner pRNFLT and miR-614 with higher triglyceride levels. CONCLUSION: This study indicates potential differences in miRNA expression between PXSG and PXSWG, with several showing suggestive associations with key clinical parameters. These preliminary findings may provide valuable insights into processes relevant to PXS and glaucoma but require validation in larger, independent cohorts to clarify their biomarker potential.
Multimodal artificial intelligence for retinal detachment diagnosis using fundus imaging and patient questionnaires.
Yonemaru N, Tabuchi H, Deguchi H … +5 more , Omi Y, Tanabe M, Ishitobi N, Maruyama H, Ayatsuka Y
Br J Ophthalmol · 2026 Apr · PMID 41203264 · Publisher ↗
BACKGROUND/AIMS: This study aimed to develop a multimodal artificial intelligence (AI) system that integrates fundus imaging and patient questionnaire data to achieve clinician-level diagnostic accuracy for diagnosing re...
BACKGROUND/AIMS: This study aimed to develop a multimodal artificial intelligence (AI) system that integrates fundus imaging and patient questionnaire data to achieve clinician-level diagnostic accuracy for diagnosing retinal detachment (RD). METHODS: Ultra-widefield fundus images and comprehensive patient questionnaires were collected from patients with RD and healthy controls at Tsukazaki Hospital. A multimodal model was developed using the Contrastive Language-Image Pretraining framework to classify RD cases, alongside separate image-only and questionnaire-only models for comparison. Per-image and per-subject analyses were conducted to assess model performance. RESULTS: The multimodal model outperformed single-modal models in per-image and per-subject assessments. It achieved accuracy, recall and F1 scores of 0.899±0.054, 0.902±0.043 and 0.902±0.048 in the per-image analysis and 0.893±0.071, 0.949±0.044 and 0.873±0.074 in the per-subject analysis, respectively. The AI model's overall diagnostic accuracy was slightly lower than that of human clinicians; however, it exhibited a higher recall rate, indicating improved detection of true RD cases. CONCLUSION: Integrating fundus imaging with patient questionnaire data significantly improves AI-based RD diagnosis. Future research needs to focus on expanding the dataset and refining the questionnaire design to further improve model performance.
Monitoring tear monocyte chemoattractant protein-1 levels after endonasal versus external dacryocystorhinostomy: a prospective, longitudinal study.
Karabulut S, Saruhan E, Karabulut M … +1 more , Akmaz O
Br J Ophthalmol · 2026 Mar · PMID 41198168 · Publisher ↗
BACKGROUND: We aimed to monitor changes in tear monocyte chemotactic protein-1 (MCP-1) levels following endonasal dacryocystorhinostomy (endo-DCR) and external dacryocystorhinostomy (ext-DCR). METHODS AND ANALYSIS: This...
BACKGROUND: We aimed to monitor changes in tear monocyte chemotactic protein-1 (MCP-1) levels following endonasal dacryocystorhinostomy (endo-DCR) and external dacryocystorhinostomy (ext-DCR). METHODS AND ANALYSIS: This study was designed as a prospective, longitudinal study and included 42 eyes in the endo-DCR group and 48 eyes in the ext-DCR group. We monitored changes in tear MCP-1 levels. Tear samples were collected on the day before surgery, the first week, and the first and sixth months after surgery to compare changes in tear MCP-1 levels between and within groups. Surgery time and success rates were also compared. RESULTS: The mean MCP-1 levels at baseline, first and sixth months were similar between the groups (p=0.722, p=0.661, p=0.676, respectively). In the first week, it was significantly higher in the ext-DCR group than in the endo-DCR group (p<0.001). In the endo-DCR group, it showed a significant and continuous decrease until the first month (p<0.001), and the decrease stabilised in the sixth month. In the ext-DCR group, the mean MCP-1 level displayed a significant peak increase during the first week, followed by a steady decline until the sixth month (p<0.001). The surgery time was longer in the ext-DCR group (p<0.001) and showed a significant correlation with MCP-1 levels in the first week (Spearman's rho=0.857, p <0.001). The groups' subjective and anatomical success rates were similar (p=0.642, p=0.549, respectively). CONCLUSION: Both surgeries demonstrated comparable success rates and decreased tear MCP-1 levels during follow-up. In the first week, the mean MCP-1 level exhibited a significant peak increase in the ext-DCR group. Extended surgical duration is a recognised factor affecting the wound-healing process.
Retinal nerve fibre layer optical texture analysis: retinal nerve fibre bundle defect patterns and the extent of macular involvement across different stages of glaucoma.
Kamalipour A, Moghimi S, Khosravi P … +11 more , Tansuebchueasai N, Camp AS, Vasile C, Adelpour M, Gunasegaran G, Kashaf MS, Nishida T, Zangwill LM, Lam AKN, Leung CK, Weinreb RN
Br J Ophthalmol · 2026 Apr · PMID 41192945 · Full text
BACKGROUND/AIMS: To apply retinal nerve fibre layer (RNFL) optical texture analysis (ROTA) to investigate (1) the patterns of RNFL bundle defects, and (2) the frequency of papillomacular and papillofoveal bundle involvem...
BACKGROUND/AIMS: To apply retinal nerve fibre layer (RNFL) optical texture analysis (ROTA) to investigate (1) the patterns of RNFL bundle defects, and (2) the frequency of papillomacular and papillofoveal bundle involvement across early, moderate and advanced glaucoma. METHODS: All eyes underwent 24-2 visual field (VF) testing and optical coherence tomography (OCT) for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate, papillomacular and papillofoveal bundles was determined for each eye. 24-2 VF stimulus projections were mapped onto the corresponding topographic areas of ROTA images. Multilevel logistic regression analysis was applied to evaluate the structure-function association. RESULTS: Papillomacular bundle defects were highly prevalent in glaucoma, increasing from 87.7% in early to 95.35% in moderate and 100% in advanced glaucoma. Papillofoveal bundle defects were also common, increasing from 29.7% in early to 36.05% in moderate and 60.98% in advanced glaucoma. Central four 24-2 test locations that projected onto the trajectories of papillomacular or papillofoveal RNFL bundle defects demonstrated significantly increased likelihood of VF sensitivity abnormality (ORs of 22.42 at PDP<5% and 20.26 at TDP<5%, respectively, p<0.001 for both). CONCLUSION: ROTA uncovers a wide spectrum of RNFL bundle defects spanning the entire glaucoma continuum. It also provides visualisation of the preserved RNFL bundles in advanced glaucoma. Papillomacular and papillofoveal RNFL bundle defects are present in a considerable proportion of eyes with early, moderate and advanced glaucoma, and, when detected, they significantly increase the likelihood of abnormality in the corresponding central 24-2 test locations.
3D integrated approach to structural and functional monitoring in glaucoma.
Lee K, Morales E, de Gainza A … +1 more , Caprioli J
Br J Ophthalmol · 2026 Apr · PMID 41192944 · Publisher ↗
AIMS: To introduce a three-dimensional (3D) trajectory model that integrates structural and functional changes over time to improve assessment and prediction of glaucoma progression. METHODS: This retrospective longitudi...
AIMS: To introduce a three-dimensional (3D) trajectory model that integrates structural and functional changes over time to improve assessment and prediction of glaucoma progression. METHODS: This retrospective longitudinal study included 1742 eyes from 996 glaucoma patients with ≥4 years of follow-up. Structural data from various devices were converted into a Structural Metascore (SMS), and the Visual Field Index (VFI) was used as the functional parameter. Robust linear regression was applied to each eye's SMS and VFI over time. Eyes were categorised by baseline mean deviation (MD) into preperimetric (MD ≥0 dB), mild (-6 < MD < 0 dB), moderate (-12 ≤ MD ≤ -6 dB) or severe (MD <-12 dB). Progression was defined as a slope <-1% per year for SMS or VFI. RESULTS: Mean SMS slopes ranged from -0.1±0.8%/year (preperimetric) to -0.8±0.7%/year (severe) and VFI slopes ranged from -0.2±0.5%/year to -0.9±1.4%/year (p<0.001). Structural and functional slopes were more correlated in earlier stages. Progression classifications were: both structural and functional (6%), structural-only (13%), functional-only (11%) and stable (70%). Functional-only progression was more common in moderate and severe glaucoma, while structural-only progression predominated in earlier stages. The SMS approach achieved 8.9% prediction error compared with 34.1% for single-device methods. CONCLUSION: The 3D trajectory model visualises distinct progression patterns, with structural changes preceding functional decline in earlier stages and functional-only progression dominating in advanced stages. This integrated model enhances visualisation and quantification of disease dynamics, supporting personalised glaucoma management.
But doctor, will I be able to drive? Car mirror placement design and viewing angles required for safe binocular vision for drivers.
Richkind H, Jody N, Robbins SL … +2 more , Rudell JC, Granet DB
Br J Ophthalmol · 2026 Mar · PMID 41184086 · Publisher ↗
BACKGROUND/AIMS: To examine the angle between the driver's eye and the three mirrors (side and rear-view) across different vehicle models, in order to understand head and gaze adjustments that may be necessary for post-s...
BACKGROUND/AIMS: To examine the angle between the driver's eye and the three mirrors (side and rear-view) across different vehicle models, in order to understand head and gaze adjustments that may be necessary for post-strabismus surgery patients to reduce diplopia while driving. METHODS: The driver's eye angle (DEA) was defined as the horizontal angle between the driver's line of sight when looking straight ahead and the direction of their gaze required to view the centre of a given mirror. Angles were measured using a digital protractor from a single 69 inch (1.75 m) tall driver's eye position to the centre of the three mirrors (left side, right side and rear-view) in each vehicle. Measurements considered seat height and proximity to the steering wheel. RESULTS: DEAs were calculated for the seat position deemed most comfortable (CP) by the model driver. For the rear-view mirror, the average CP DEA was 43.5° (range: 35.0°-48.4°). The left side mirror averaged 45.8° (range: 39.3°-52.1°) and the right side mirror 68.9° (range: 63.1°-80.3°). Generally, DEAs were highest with the seat in a forward-high position and lowest when seated further back and lower. CONCLUSIONS: Patients with strabismus or postsurgical limitations may experience diplopia when using mirrors that require extreme gaze angles. Clinicians should incorporate driving-related visual demands into postoperative counselling. Encouraging rearward-lowered seating and recommending vehicles with narrower mirror angles may reduce symptoms. In some cases, adaptive devices (wide-angle mirrors, blind spot monitoring) may be necessary for safe and comfortable driving.
Effects of nicotinamide supplementation in normal-tension glaucoma: a crossover placebo-controlled randomised clinical trial.
Ha A, Kim YK, Lee CK … +6 more , Williams PA, Morgan JE, Shin YI, Kim E, Kim M, Rho S
Br J Ophthalmol · 2026 Mar · PMID 41167798 · Full text
BACKGROUND/AIMS: The neuroprotective effect of nicotinamide (NAM) supplementation has been demonstrated in both animal models and clinical trials. We conducted a trial to assess whether oral NAM improves retinal function...
BACKGROUND/AIMS: The neuroprotective effect of nicotinamide (NAM) supplementation has been demonstrated in both animal models and clinical trials. We conducted a trial to assess whether oral NAM improves retinal function in normal-tension glaucoma (NTG) participants receiving intraocular pressure (IOP)-lowering therapy. METHODS: Fifty-three NTG participants (untreated IOP ≤18 mm Hg) were enrolled in a double-masked, placebo-controlled crossover randomised clinical trial. Participants were randomly assigned to receive either oral placebo or NAM, followed by crossover without a washout period. Each treatment was administered for 12 weeks (NAM/placebo 1 g/day for 6 weeks, then 2 g/day for the subsequent 6 weeks). Retinal function was evaluated using full-field electroretinography and visual field testing. RESULTS: After 12 weeks, the amplitude changes of the photopic negative response in peak-to-trough (PhNRPT) and the B-wave were significantly greater in the NAM group (3.121±3.968 and 2.112±3.220 μV, respectively) compared with the placebo group (0.996±4.190 and 0.305±3.279 μV, respectively; p=0.045 and p=0.032). PhNRPT improved beyond twice the 95% coefficient of variation in 29.0% of the NAM group and 19.3% of the placebo group. No significant intergroup differences were observed in changes in mean deviation, pattern SD or visual field index after 12 weeks. CONCLUSION: Oral NAM supplementation in NTG participants induced functional improvement, as measured by PhNRPT and B-wave amplitude. Given that NTG is characterised by lower IOP, which may show a weaker correlation with electrophysiological activity and a slower progression rate compared with high-tension glaucoma, further long-term studies are needed to clarify the effects of NAM in this population. TRIAL REGISTRATION NUMBER: NCT06078605.
Choroidal changes correlate with type 1 neovascular activity in neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.
Huang X, Chen J, Li J … +5 more , Zhang G, Zhu X, Zhou M, Bo Q, Sun X
Br J Ophthalmol · 2026 Apr · PMID 41167797 · Full text
PURPOSE: To investigate the association among choroidal factors and lesion activity of polypoidal choroidal vasculopathy (PCV) and type I neovascular age-related macular degeneration (nAMD) using swept-source optical coh...
PURPOSE: To investigate the association among choroidal factors and lesion activity of polypoidal choroidal vasculopathy (PCV) and type I neovascular age-related macular degeneration (nAMD) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: 69 eyes with PCV or type I nAMD were retrospectively included. All eyes had either ≥2 consecutive non-exudative visits without treatment or no exudation/treatment within 6-month SS-OCTA follow-up. Lesions were categorised into active and inactive based on progression, defined as exudation, branching vascular network (BVN)/macular neovascularisation enlargement or recurrence/new/growth of polypoidal lesions. Choroidal parameters, including mean choroidal thickness (MCT), choroidal vascularity index (CVI) and choroidal volume (CV), were evaluated before and after lesion progression. The association between CVI variation and lesion area growth in PCV was also analysed. RESULTS: No baseline differences in MCT or CVI were found between PCV and nAMD. However, significant differences in CVI and MCT variation were observed between active and inactive lesions (p<0.05). In PCV, lesion activity was characterised by decreased CVI and increased MCT, while in nAMD, only MCT and CV increased. Notably, combined CVI decrease and MCT increase served as a sensitive marker for active PCV (p<0.05), but not for nAMD. CVI reduction also correlated with BVN growth in PCV (R=-0.722, p<0.01). CONCLUSION: Choroidal parameters varied significantly during lesion progression. Combined CVI decrease and MCT increase sensitively reflected active PCV lesions and were correlated with lesion location, size and progression, highlighting the differences in the choroidal microenvironment in the activities of PCV and nAMD.
Ethnic and dose-dependent differences in atropine efficacy for myopia control: a systematic review and meta-analysis.
Biswas S, Lanca C, Kynman-Sprinks D … +1 more , Grzybowski A
Br J Ophthalmol · 2026 Apr · PMID 41167796 · Publisher ↗
BACKGROUND/AIM: Clinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic rev...
BACKGROUND/AIM: Clinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic review and meta-analysis evaluated the efficacy of different concentrations of atropine for myopia control, comparing outcomes among East Asian, South Asian and white European children. METHODS: Five databases were searched for randomised controlled trials (RCTs) including children ≤16 years with myopia who received atropine treatment. Thirty-four RCTs with ≥12 months of follow-up were included. Weighted mean differences (WMD) in spherical equivalent refraction (SER) progression and axial length (AL) elongation were pooled by atropine concentration and ethnicity. RESULTS: Compared with controls, atropine significantly reduced myopia progression across all concentrations: <0.1% (WMD in SER: 0.44 (95% CI 0.35 to 0.52) dioptres (D)/year; AL: -0.20 (95% CI -0.24 to -0.16) mm/year), 0.1% to <0.5% (0.81 (95% CI 0.50 to 1.13) D/year) and ≥0.5% (1.06 (95% CI 0.88 to 1.24) D/year; -0.36 (95% CI -0.40 to -0.33) mm/year). The pooled effect on SER and AL progression across all concentrations was greater in East Asians (0.63 (95% CI 0.50 to 0.76) D/year; -0.26 (95% CI -0.31 to -0.20) mm/year) than in South Asians (0.40 (95% CI 0.11 to 0.70) D/year; -0.13 (95% CI -0.21 to -0.05) mm/year) or white Europeans (0.18 (95% CI 0.11 to 0.25) D/year; -0.11 (95% CI -0.16 to -0.05) mm/year). CONCLUSION: Atropine slows myopia progression in a dose-dependent manner in studies with 1-5 years of follow-up. Efficacy appears greater in Asian children, particularly East Asians, who also exhibit greater photopic pupil dilation. These findings support the role of atropine in myopia control and highlight the importance of ethnicity-specific considerations when prescribing and tailoring treatment strategies. PROSPERO REGISTRATION NUMBER: CRD42023454104.
Incidental ocular surface squamous neoplasia in pterygia: a systematic review and meta-analysis.
Mihalache A, Huang RS, Balas M … +5 more , Bert B, Godiwalla Do RY, Hsu H, Popovic M, Chan CC
Br J Ophthalmol · 2026 Apr · PMID 41167795 · Publisher ↗
AIMS: Differentiating pterygium from ocular surface squamous neoplasia (OSSN) is important for guiding management. This meta-analysis evaluates the prevalence and risk factors for incidental OSSN in clinically diagnosed...
AIMS: Differentiating pterygium from ocular surface squamous neoplasia (OSSN) is important for guiding management. This meta-analysis evaluates the prevalence and risk factors for incidental OSSN in clinically diagnosed pterygia. METHODS: Ovid Embase, MEDLINE, Cochrane Library and Web of Science were systematically searched from January 2000 to February 2025. Included studies analysed ≥100 clinically diagnosed pterygia via histopathology. Random-effects meta-analysis assessed the prevalence of incidental OSSN among pterygia. Risk factors were evaluated using the Mantel-Haenszel and inverse variance methods, and meta-regression analysed the influence of publication year, geographic proximity to the equator, and country-level ultraviolet (UV) radiation exposure. RESULTS: 12 studies, comprising 8688 specimens, identified 202 cases of incidental OSSN (pooled prevalence=1.32%, 95% CI 0.41% to 4.21%, I=95.3%). Meta-regression revealed that lower OSSN prevalence was associated with greater distance from the equator (OR 0.49, 95% CI 0.28 to 0.83, p<0.01), while higher prevalence was associated with greater UV exposure (OR 2.20, 95% CI 1.17 to 4.14, p=0.01). Publication year had no effect (p=0.98). Age (p=0.18), sex (p=0.45) and lesion location (p=0.60-0.82) did not differ between incidental OSSN cases and benign pterygia. Incidental OSSN prevalence also did not differ between primary and recurrent pterygia (p=0.23). Regional analyses revealed variation in prevalence: Europe (0.29%), Asia (0.76%), North America (1.03%), Oceania (8.57%) and South America (14.97%). CONCLUSIONS: This meta-analysis, based on low- to very low-certainty evidence, identified a 1.32% pooled prevalence of incidental OSSN in clinically diagnosed pterygia, highlighting the potential influence of UV exposure and equatorial proximity. The overlap in demographic and lesion characteristics between benign pterygia and OSSN underscores diagnostic challenges.
Lamellar hole-associated epiretinal proliferation: pathophysiology, clinical role and treatment strategies.
Carlà MM, Oreste G, Cusato M … +3 more , Mottola F, Campaniello G, Rizzo S
Br J Ophthalmol · 2026 Feb · PMID 41151779 · Publisher ↗
Lamellar hole-associated epiretinal proliferation (LHEP) is a distinctive clinical entity characterised by a homogeneous, medium-reflective material on optical coherence tomography that is commonly associated with lamell...
Lamellar hole-associated epiretinal proliferation (LHEP) is a distinctive clinical entity characterised by a homogeneous, medium-reflective material on optical coherence tomography that is commonly associated with lamellar macular holes (LMH). Since its initial description, significant advances have been made in understanding its histopathological origins, natural progression and clinical implications. Histological studies suggest LHEP likely originates from Müller cells, with immunohistochemical studies consistently demonstrating positivity for glial fibrillary acidic protein and glutamine synthetase. Unlike conventional epiretinal membranes, LHEP does not exhibit tractional properties and is often associated with deeper retinal defects and ellipsoid zone disruption. While early studies yielded conflicting results regarding the impact of LHEP on visual outcomes, recent evidence suggests that LMH with LHEP may represent a distinct clinical entity with potentially different management implications. Surgical approaches have evolved from conventional peeling techniques to LHEP-sparing and LHEP-embedding procedures, with recent innovations including autologous platelet-rich plasma therapy showing promising results. Emerging data suggest improved outcomes with these newer approaches, including the 'no-retina-touch' technique that minimises iatrogenic trauma while achieving high efficacy in foveal defect closure. This review synthesises the current understanding of LHEP, its clinical significance and evolving treatment strategies.
Genetic associations of high myopia.
Mao B, Dong XX, Gong SY … +3 more , Li DL, Fan Q, Pan CW
Br J Ophthalmol · 2026 Mar · PMID 41151778 · Publisher ↗
AIMS: The impact of genetic variants on high myopia (HM) remains unclear. This study aims to systematically evaluate the relationship between genetic polymorphisms and HM. METHODS: Eligible studies were retrieved from fi...
AIMS: The impact of genetic variants on high myopia (HM) remains unclear. This study aims to systematically evaluate the relationship between genetic polymorphisms and HM. METHODS: Eligible studies were retrieved from five databases (PubMed, Web of Science, Cochrane, Embase and Scopus) up to 18 January 2025. We included all case-control studies that examined the association of single nucleotide polymorphisms (SNPs) with HM susceptibility. Fixed or random effects models were used to evaluate pooled ORs and CIs for each SNP in HM. Sensitivity analyses were conducted to assess the reliability and stability of the results. RESULTS: Seventy-six studies (89 separate cohorts) were eligible for the meta-analysis of HM, involving 77 SNPs in 34 genes. Twenty-two SNPs in 13 genes (rs1516794 in gene; rs2269336 in gene; rs2071861 and rs2009066 in gene; rs339501 in gene; rs698047 in gene; rs3741834, rs2300588, rs3759223 and rs7135740 in gene; rs9318086 in gene; rs243845 and rs1861320 in gene; rs662702 and rs644242 in gene; rs8027411 and rs17175798 in gene; rs7839488, rs4395927 and rs6469937 in gene; rs1800470 in gene; and rs7829127 in gene) showed significant associations with HM. CONCLUSION: This study identified 22 SNPs in 13 genes (, , , , , , , , , , , and ) as potential genetic biomarkers for HM. Future research should conduct large-scale genome-wide association studies across diverse populations to yield more robust evidence.
Structural MRI alterations in children with form-deprivation amblyopia: a propensity score-matched case-control study - a commentary.
Reynolds MM, Culican SM, Girault JB
Br J Ophthalmol · 2026 Feb · PMID 41136325 · Publisher ↗
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