Br J Ophthalmol [JOURNAL]
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200 papers
Sex-based differences in retinal detachment in a genotyped Stickler syndrome cohort: implications for preventive management.
Borella Y, Constant A, Rothschild PR … +6 more , Robert MP, Burin Des Roziers C, Valleix S, Brezin AP, Bremond Gignac D, Daruich A
Br J Ophthalmol · 2026 May · PMID 42082323 · Publisher ↗
AIMS: Stickler syndrome is a genetically inherited vitreoretinopathy that can lead to retinal detachment from early childhood. There is currently no consensus preventive treatment. We aimed at determining whether sex inf...
AIMS: Stickler syndrome is a genetically inherited vitreoretinopathy that can lead to retinal detachment from early childhood. There is currently no consensus preventive treatment. We aimed at determining whether sex influences the age of onset of rhegmatogenous retinal detachment (RRD) in and Stickler patients. METHODS: This is a retrospective study including genotyped Stickler patients from two tertiary centres with at least one RRD. We analysed differences in the age of occurrence of RRD according to sex and genetic mutation. A multivariate analysis was used to analyse risk factors for RRD including sex, presence of preventive treatment, congenital myopia or extra-ophthalmologic conditions. RESULTS: 58 patients with at least one RRD were included. In girls with variants (n=30), the average age of RRD onset was later (21.3 (±14.5) years; range: 5.4-66.0), and the age distribution was broader than in boys with variants (n=19, 10.07 (±5.7) years; range: 0.5-19.7; p<0.0001). Among patients, there was no significant difference in age of RRD between boys and girls. Preventive treatment (360° laser or scleral buckling) was the only independent protective factor for RRD (RR=-0.49 (±0.002); p<0.001). CONCLUSION: In -Stickler syndrome, males tend to experience RRD at an earlier age. In -Stickler patients, RRD occurs earlier in life but no sex difference was found. Based on these findings, if preventive treatment is considered, it should be performed before puberty, particularly earlier in boys with COL2A1-related Stickler syndrome and in both male and female patients with COL11A1 variants.
Impact of AI-enhanced three-dimensional OCT scans on disease activity assessment in patients with nAMD: the RAZORBILL study.
Kortuem KU, Zarranz-Ventura J, Bandello F … +9 more , Duval R, O'Toole L, De Zanet S, Blair JPM, Seaman J, Zvolanek M, Jaeger K, Gmeiner B, Holz FG
Br J Ophthalmol · 2026 May · PMID 42082322 · Publisher ↗
BACKGROUND: The standard of care for neovascular age-related macular degeneration (nAMD) is repeated intravitreal injection with anti-vascular endothelial growth factor agents. Real world evidence suggests that some pati...
BACKGROUND: The standard of care for neovascular age-related macular degeneration (nAMD) is repeated intravitreal injection with anti-vascular endothelial growth factor agents. Real world evidence suggests that some patients are undertreated, which might be linked with the retreatment decisions made by physicians. Therefore, this multicentre observational study aimed to investigate the extent to which enrichment of optical coherence tomography (OCT) images with segmentation information could influence and support disease activity assessment (DAA) in patients treated for nAMD. METHODS: Descriptive statistics were tabulated for the demographic and clinical characteristics and outcome variables. To assess the influence of automated OCT image enrichment with segmentation information on DAA, a generalised linear mixed model was employed. The degree of agreement in classification of disease activity across reviewers was assessed by Krippendorff's alpha. RESULTS: The odds estimate for DAA regarding enriched OCT images was 0.759 and for non-enriched OCT images 0.772. The OR for enriched versus non-enriched OCT images was 1.078 with a p value of 0.229. No difference in the odds of DAA between automated OCT image enrichment with segmentation and DAA was noted. Krippendorff's alpha coefficient was 0.416 for enriched and 0.402 for non-enriched OCT images. Thus, the inter-reviewer reliability/agreement was similarly low between enriched and non-enriched OCT images. CONCLUSIONS: OCT image enrichment did not appear to impact the likelihood of adequately detecting disease activity, nor did it have an impact on agreement between reviewers of images in this study. No new safety signals in products involved in the study were detected. TRIAL REGISTRATION NUMBER: NCT04662944.
Association between pre-mortem chemotherapy exposure and reduced endothelial cell density in donor corneas.
Abd-Elkader A, Lugassi Y, Matzliach G … +4 more , Avitan M, Nahum Y, Bahar I, Livny E
Br J Ophthalmol · 2026 Apr · PMID 42062045 · Publisher ↗
AIMS: To evaluate whether pre-mortem exposure to systemic chemotherapy is associated with reduced endothelial cell density (ECD) in post-mortem donor corneas. METHODS: This retrospective cohort study included 912 donor c...
AIMS: To evaluate whether pre-mortem exposure to systemic chemotherapy is associated with reduced endothelial cell density (ECD) in post-mortem donor corneas. METHODS: This retrospective cohort study included 912 donor corneas evaluated at a tertiary cornea bank between 2013 and 2024. Donors with a documented history of malignancy who received systemic chemotherapy, with or without head and neck radiation, within 10 years before death were compared with age-matched donors without malignancy. Endothelial parameters, including ECD, coefficient of variation and hexagonality, were assessed using ex vivo specular microscopy. Univariate analyses and multivariable linear regression models were used to identify independent predictors of ECD. RESULTS: Mean ECD was significantly lower in donors with chemotherapy exposure compared with controls (2272±547 vs 2432±475 cells/mm; p<0.001). Endothelial morphologic parameters did not differ between groups. Age-stratified analyses demonstrated that decreased ECD was most pronounced in donors aged 51 years and older, whereas differences in younger donors did not reach statistical significance. Head and neck radiation exposure was not associated with additional ECD reduction. In multivariable analysis, chemotherapy exposure remained an independent predictor of lower ECD (β = -108.05 cells/mm; p<0.001) after adjusting for age, sex, systemic comorbidities and lens status. CONCLUSION: Pre-mortem exposure to systemic chemotherapy was independently associated with reduced ECD in donor corneas. These findings identify systemic cancer treatment as an under-recognised determinant of donor endothelial health and may have implications for donor screening and graft allocation strategies.
Impact of visit schedule on estimated success rates in glaucoma surgical studies.
Rabiolo A, Khaliliyeh D, Jin SW … +7 more , Morales E, Rossetti L, Anand N, Montesano G, Oddone F, Caprioli J, De Cillà S
Br J Ophthalmol · 2026 Apr · PMID 42055787 · Publisher ↗
AIMS: To evaluate how different methods of managing multiple visits within predefined time windows affect intraocular pressure (IOP)-based success rates in glaucoma surgery studies. METHODS: We applied literature-based h...
AIMS: To evaluate how different methods of managing multiple visits within predefined time windows affect intraocular pressure (IOP)-based success rates in glaucoma surgery studies. METHODS: We applied literature-based high IOP failure criteria to two cohorts of 934 and 1760 eyes undergoing trabeculectomy and deep sclerectomy (DS) with median follow-up of 41.4 months and 45.4 months, respectively. Failure was defined by IOP thresholds, loss of light perception, hypotony requiring revision or additional IOP-lowering surgery. Visits were grouped into guideline-based windows and six visit-managing strategies were applied to all visits, mean, lowest, highest, median and closest IOP to the recommended time point. We calculated Kaplan-Meier success rates for each visit-managing strategy. Visual field (VF) analysis was conducted on patients in the trabeculectomy cohort with ≥4 VFs in ≥2 years post-surgery. RESULTS: For the 21 mm Hg threshold, 5-year success was highest with the lowest IOP (trabeculectomy: 54.8%; DS: 74.5%), followed by closest IOP (trabeculectomy: 46.7%; DS: 67.6%), the median (trabeculectomy: 46.9%; DS: 69.1%) and mean IOP (trabeculectomy: 46.3%; DS: 68.6%). Success rates were lower with peak IOP (trabeculectomy: 39.3%; DS: 60.4%) and all visits IOP (trabeculectomy: 38.8%; DS: 61.0%). In the VF subset, eyes classified as failures demonstrated significantly faster mean deviation (MD) progression than those classified as successes although substantial overlap in the distribution of MD rates persisted between groups under every strategy. CONCLUSIONS: Visit-managing strategies influence reported success rates. None of the evaluated approaches achieved a clear separation in VF progression rates, underscoring the inherent limitations of IOP-threshold-based classifications.
Non-arteritic anterior ischaemic optic neuropathy incidence in placebo-controlled clinical trials of liraglutide or semaglutide.
Vilsbøll T, Arun Kumar D, Aiello LP … +3 more , Rönnbäck C, Stellfeld M, Larsen LM
Br J Ophthalmol · 2026 Apr · PMID 42049287 · Publisher ↗
BACKGROUND: Risk of non-arteritic anterior ischaemic optic neuropathy (NAION) following exposure to glucagon-like peptide-1 receptor agonists (GLP-1RAs) in people with type 2 diabetes and/or obesity remains unclear. The...
BACKGROUND: Risk of non-arteritic anterior ischaemic optic neuropathy (NAION) following exposure to glucagon-like peptide-1 receptor agonists (GLP-1RAs) in people with type 2 diabetes and/or obesity remains unclear. The aim of this study was to investigate NAION incidence across randomised placebo-controlled trials evaluating the GLP-1RAs liraglutide and semaglutide. METHODS: Pooled safety evaluation of NAION incidence from completed phase II, III and IV randomised placebo-controlled trials that evaluated the six Novo Nordisk-manufactured GLP-1RA products (active ingredients: liraglutide and semaglutide) in people with type 2 diabetes and/or overweight/obesity. Potential NAION cases were identified and categorised based on the likelihood of NAION occurrence (definite, probable, unlikely or not assessable). Definite or probable NAION cases were considered confirmed. RESULTS: This pooled analysis included 96 829 participants (GLP-1RA-treated: n=64 917; placebo-treated: n=31 912) with 205 777 participant-years of observation (PYO) (GLP-1RA-treated: 119 393 PYO; placebo-treated: 86 384 PYO). Across all trials, three confirmed NAION cases were identified in three GLP-1RA-treated participants and five confirmed cases were identified in four placebo-treated participants. In GLP-1RA-treated participants, the incidence of confirmed NAION cases was approximately three cases per 100 000 PYO, while in placebo-treated participants, the incidence was approximately six cases per 100 000 PYO. All ophthalmologist-confirmed cases reported one or more associated risk factors (eg, age >50 years, obesity, smoking, dyslipidaemia, hypertension). CONCLUSION: Data from randomised placebo-controlled trials with semaglutide and liraglutide do not show an increased incidence of NAION in participants receiving GLP-1RA treatment versus those receiving placebo and, thus, do not suggest a relationship between GLP-1RA use and NAION. SUMMARY: Based on data from randomised placebo-controlled trials, exposure to the glucagon-like peptide-1 receptor agonists (GLP-1RA) semaglutide and liraglutide was not associated with an increased incidence of non-arteritic anterior ischaemic optic neuropathy (NAION) relative to placebo.
PROductivity Study of Presbyopia Elimination in gaRment workers (PROSPER II): a randomised trial on the productivity impact of providing near glasses to Indian garment factory workers.
Pant S, Bagwe S, Esther S … +16 more , MacKenzie G, Sigwadhi LN, Prakash WD, Chan VF, Gade S, Dhir S, Joshi S, Calderón S, Piyasena MP, Clarke M, Lohfeld L, Cooke M, Gudwin ER, Adhvaryu A, Nyshadham A, Congdon N
Br J Ophthalmol · 2026 Apr · PMID 42045075 · Publisher ↗
BACKGROUND: Correction for presbyopia, the world's most common cause of vision impairment, significantly improves productivity in agriculture and crafts. However, effects on productivity in manufacturing remain unstudied...
BACKGROUND: Correction for presbyopia, the world's most common cause of vision impairment, significantly improves productivity in agriculture and crafts. However, effects on productivity in manufacturing remain unstudied. METHODS: PROSPER II was an individually randomised, investigator-masked, controlled trial conducted in Karnataka, India. Eligible garment factory workers aged ≥35 years with presbyopia (better-eye near vision N6.3 or worse (Snellen 6/12), correctable to N4 (Snellen 6/7.5)) and not owning glasses were randomised (1:1) to intervention (immediate delivery of glasses suited to working distance) or control (identical glasses delivered at endline). The primary outcome was work productivity, defined as the hourly number of items completed, normalised to a factory target rate, over 12 weeks. Secondary outcomes included glasses wear adherence, visual function, and ROI. RESULTS: Among 4990 potentially eligible workers, 3648 (73.1%) underwent eye examinations, and 682 (18.7%, mean age 41.0 years, 99.0% female) were enrolled and randomised (intervention: n=344, 50.4%; control: n=338, 49.6%). All participants completed 12-week observation. In panel regression models for the pre-specified primary analysis, intervention group assignment (difference=0.0325, 95% CI 0.006 to 0.060, p=0.017) was significantly associated with greater productivity. Compared with workers in the highest skill grade (A), those in the lowest grade (C) had significantly lower productivity (difference=-0.049, 95% CI -0.087 to -0.011, p=0.011). Glasses increased productivity in the intervention group relative to controls by 5.70% (95% CI 1.04% to 10.4%). CONCLUSIONS: Free near glasses confer a significant productivity benefit in this factory setting, and are substantially less costly than other successful interventions such as management training. TRIAL REGISTRATION NUMBER: NCT04629820.
Prevalence and associations of intraretinal hyperreflective foci in age-related macular degeneration: the Beijing Eye Study.
Jonas JB, Panda-Jonas S, Pan Z … +3 more , Xu J, Jonas RA, Wang YX
Br J Ophthalmol · 2026 Apr · PMID 42031505 · Publisher ↗
BACKGROUND: To assess prevalence and associations of intraretinal hyperreflective foci (HRFs) in a general population. METHODS: Participants of the population-based Beijing Eye Study underwent optical coherence tomograph...
BACKGROUND: To assess prevalence and associations of intraretinal hyperreflective foci (HRFs) in a general population. METHODS: Participants of the population-based Beijing Eye Study underwent optical coherence tomography and macula photography. RESULTS: The study cohort included 1641 eyes (mean age: 62.8±9.1 years; range: 50-93 years). Prevalence of any HRF or HRFs located only above the ellipsoid zone (EZ) increased from 33/590 (5.6%; 95% CI 4.0 to 7.0) and 22/590 (3.7%; 95% CI 2.2 to 5.2), respectively, in normal eyes to 371/725 (51.2%; 95% CI 47.7 to 54.7) and 246/725 (33.9%; 95% CI 30.4 to 37.4), respectively, in eyes with early age-related macular degeneration (AMD), to 283/314 (90.1%; 95% CI 87.1 to 93.1) and 260/314 (82.8%; 95% CI 78.8 to 86.8), respectively, in eyes with intermediate AMD, and to 12/12 (100%) and 12/12 (100%), respectively, in late AMD. HRFs above the EZ were spatially associated with EZ defects in 298/540 (55.2%) eyes and external limiting membrane (ELM) defects in 203/540 (37.6%) eyes. 52 (96%) of 54 eyes with macular hyperpigmentations showed HRFs above the EZ, and 52 (9.6%) of 540 eyes with HRFs above the EZ had corresponding macular hyperpigmentations. Higher HRF prevalence was associated (multivariable analysis) with higher AMD stage (OR: 1.75; 95% CI 1.36 to 2.26; p<0.001), and higher prevalences of EZ defects (OR: 36.6; 95% CI 8.56 to 157; p<0.001), reticular pseudodrusen (OR: 1.91; 95% CI 1.29 to 2.82; p<0.001), retinal pigment epithelium (RPE) elevations (OR: 34.5; 95% CI 10.4 to 111; p<0.001) and interdigitation zone thinnings (OR: 4.22; 95% CI 1.90 to 9.35; p<0.001). CONCLUSIONS: The HRF prevalence was relatively high in early AMD and increased to late AMD. HRF location and shape suggested intraretinally migrated RPE cells as their equivalent. The majority of HRFs were not associated with an ophthalmoscopically detected macular hyperpigmentation. HRFs can also be found in locations with a localised interdigitation zone thinning with spatially corresponding EZ defects and ELM defects.
Cone structure and retinal sensitivity assessment in patients with red-green colour vision deficiency using multimodal imaging.
Liang J, Zou Z, Chen L … +13 more , Hei X, Diao Y, Feng L, Zhuang Y, Li W, Zheng H, Xiao P, Lin Q, Pan C, Zhang J, Chi W, Fang D, Zhang S
Br J Ophthalmol · 2026 Apr · PMID 42031504 · Publisher ↗
BACKGROUND/AIMS: To evaluate cone morphology, retinal sublayer thicknesses and vessel density (VD) and their associations with retinal sensitivity (RS) in red-green colour vision deficiency (CVD). METHODS: 36 patients wi...
BACKGROUND/AIMS: To evaluate cone morphology, retinal sublayer thicknesses and vessel density (VD) and their associations with retinal sensitivity (RS) in red-green colour vision deficiency (CVD). METHODS: 36 patients with red-green CVD and 38 age-matched controls were enrolled. Diagnosis was confirmed by pseudoisochromatic plates and the Farnsworth-Munsell 100-hue test. All participants underwent adaptive optics scanning laser ophthalmoscopy (AO-SLO), optical coherence tomography (OCT), OCT-angiography and microperimetry. RESULTS: Patients with red-green CVD exhibited significantly decreased cone density and regularity, increased cone dispersion and spacing at 3° eccentricity, and thinner myoid and ellipsoid zone (MEZ) and outer segment (OS) (all p<0.01). VDs, blue-yellow error score and axial length did not differ between groups. Patients with CVD had higher red-green error scores and lower RS (p<0.05). Temporal cone density was correlated with RS only in CVD (r=0.410, p=0.011). Mean cone density correlated with favourable cone parameters and MEZ thickness (r=-0.827 to 0.862, p<0.005) and predicted higher RS (r=0.463, p<0.001). CONCLUSION: Red-green CVD features reduced cone density, disorganised arrangement and MEZ and OS thinning, which are closely linked to RS. Cone structural integrity has clinical value for managing visual impairments in CVD.
Histopathological characteristics of secondary enucleation after iodide-125 plaque radiotherapy in Chinese patients with uveal melanoma.
Zhang H, Wang H, Liu Y … +4 more , Luo J, Yin S, Xu X, Wei W
Br J Ophthalmol · 2026 Apr · PMID 42019982 · Full text
PURPOSE: To explore the histopathological characteristics in eyes with uveal melanoma (UM) that had secondary enucleation after iodine-125 plaque radiotherapy (PRT). METHODS: This study included 243 patients with unilate...
PURPOSE: To explore the histopathological characteristics in eyes with uveal melanoma (UM) that had secondary enucleation after iodine-125 plaque radiotherapy (PRT). METHODS: This study included 243 patients with unilateral UM treated at Beijing Tongren Hospital from 2007 to 2020. Of these, 119 initially received PRT, followed by enucleation 2 months-9 years later. We retrospectively examined the histopathological features of enucleated ocular tissues to investigate microscopic differences based on treatment methods and reasons for secondary enucleation. RESULTS: Compared with 124 primary enucleations, eyes after PRT were more likely to show tumour diffuse distribution; had more tumour cell necrosis and more inflammation. In addition, eyes after PRT had a higher frequency of sclera invasion, optic nerve invasion by the tumour and neovascularisation of the iris. Histopathologically, 55 eyes (46%) were removed due to local control failure. Compared with eyes enucleated because of severe radiotherapy complications, eyes enucleated for local control failure had tumours invading the optic disc and ciliary body more frequently, pathological mitosis and the proportion of tumour diffuse distribution were higher. Eyes with radiotherapy complications had more tumour tissue necrosis and more neovascularisation of the iris. CONCLUSIONS: By observing the pathological features, we regrouped the patients who underwent secondary enucleation after PRT. These differences in histopathology may represent tissue effects of radiotherapy radiation or features related to tumour progression and growth. Tumour insensitivity and progression after PRT clearly increased the risk of metastasis-related death. Some pathological microscopic features may be important prognostic indicators of patients with UM.
Efficacy of lenadogene nolparvovec gene therapy versus idebenone in Leber hereditary optic neuropathy due to the m.11778G>A variant: two matching adjusted indirect comparisons.
Yu-Wai-Man P, Newman NJ, Carelli V … +5 more , Biousse V, Pierache A, Montestruc F, Taiel M, Sahel JA
Br J Ophthalmol · 2026 Apr · PMID 42019972 · Publisher ↗
BACKGROUND: Lenadogene nolparvovec is an intravitreal gene therapy for patients with Leber hereditary optic neuropathy (LHON) carrying the m.11778G>A variant. Idebenone, a synthetic coenzyme Q analogue, is the only appr...
BACKGROUND: Lenadogene nolparvovec is an intravitreal gene therapy for patients with Leber hereditary optic neuropathy (LHON) carrying the m.11778G>A variant. Idebenone, a synthetic coenzyme Q analogue, is the only approved treatment for LHON. To estimate the relative effects of both treatments, we performed two matching adjusted indirect comparisons (MAICs) between idebenone aggregated data from the LEROS study and expanded access programme (EAP), and lenadogene nolparvovec individual data from the REFLECT study (bilateral treatment). METHODS: Matching covariates included age at disease onset, sex, baseline best-corrected visual acuity (BCVA), and time from vision loss to treatment. The outcomes of interest were clinically relevant recovery (CRR) from nadir at 24 months, time to initial CRR and change from baseline BCVA at 24 months. RESULTS: For the MAIC LEROS versus REFLECT (effective sample size (ESS): 77), a statistically higher CRR at 24 months was observed with lenadogene nolparvovec compared with idebenone (60.4% vs 35.4%; OR=2.78, 95% CI 1.53 to 5.06; p=0.001). No statistically significant difference was observed for time to initial CRR and change from baseline BCVA at 24 months. For the MAIC EAP versus REFLECT, there was a low overlap between the two populations related to a difference in the time from vision loss to treatment. In a post hoc sensitivity analysis comparing EAP to RESCUE data (ESS: 33), CRR was 39.0% for idebenone versus 69.5% for lenadogene nolparvovec (OR=3.59, 95% CI 1.42 to 9.06; p=0.011). CONCLUSION: The two MAICs demonstrated a clinically meaningful higher visual recovery at 24 months with lenadogene nolparvovec than with idebenone in patients with LHON due to the m.11778G>A variant.
Epidemiological insights into epiretinal membranes using optical coherence tomography: the Singapore Epidemiology of Eye Diseases Study-2.
Chen Y, Soh ZD, Chee ML … +10 more , Xue CC, Thakur S, Peng Q, Cheung N, Hoang QV, Teo KY, Sabanayagam C, Tham YC, Zhang X, Cheng CY
Br J Ophthalmol · 2026 Apr · PMID 42014185 · Publisher ↗
BACKGROUND: To investigate prevalence and risk factors of epiretinal membrane (ERM), particularly those associated with ERM severity, in a multi-ethnic Asian cohort using optical coherence tomography (OCT). METHODS: A to...
BACKGROUND: To investigate prevalence and risk factors of epiretinal membrane (ERM), particularly those associated with ERM severity, in a multi-ethnic Asian cohort using optical coherence tomography (OCT). METHODS: A total of 6762 Malays, Indians and Chinese from the Singapore Epidemiology of Eye Diseases (SEED) Study cohort underwent a comprehensive evaluation. OCT macular scans were primarily used to assess the presence of ERM. ERM was classified into three stages based on structural characteristics on OCT images and as either primary or secondary. The data acquired were analysed using various multivariable logistic regression analyses to identify the potential risk factors. RESULTS: The age-standardised prevalence of any ERM was 14.5% in Malays, 13.6% in Indians and 16.3% in Chinese. Older age (OR 1.05 (95% CI 1.04 to 1.06)), female gender (OR 1.34 (95% CI 1.13 to 1.59)), Chinese ethnicity (OR 1.23 (95% CI 1.01 to 1.50) vs Malays; OR 1.71 (95% CI 1.39 to 2.10) vs Indians) and longer axial length (OR 1.19 (95% CI 1.13 to 1.26)) were risk factors for primary ERM. Significant risk factors for primary ERM severity were older age (OR 1.04 (95% CI 1.01 to 1.07)) and cardiovascular disease (CVD) (OR 2.17 (95% CI 1.03 to 4.57)), while for severe secondary cases were Chinese ethnicity (OR 2.07 (95% CI 1.18 to 3.63) vs Malays; OR 2.49 (95% CI 1.42 to 4.38) vs Indians) and higher glycated haemoglobin (HbA1c) level (OR 1.39 (95% CI 1.15 to 1.67)). CONCLUSIONS: ERM was more prevalent among Chinese adults in the SEED cohort. Older age and CVD were risk factors for primary ERM severity, while Chinese ethnicity and higher HbA1c were associated with severe secondary cases.
Structural and vascular correlates of visual field defects in branch retinal vein occlusion: a multimodal imaging study.
Choi KE, Yoon EG, Chung HW … +2 more , Choi M, Kim SW
Br J Ophthalmol · 2026 Apr · PMID 42014184 · Publisher ↗
BACKGROUND: To evaluate the association between visual field (VF) defects and retinal structural and perfusion biomarkers in eyes with branch retinal vein occlusion (BRVO), using optical coherence tomography (OCT) and OC...
BACKGROUND: To evaluate the association between visual field (VF) defects and retinal structural and perfusion biomarkers in eyes with branch retinal vein occlusion (BRVO), using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: This retrospective cross-sectional study included 85 patients with unilateral BRVO. The eyes were classified as having either major or macular BRVO. VFs were assessed using the Humphrey 24-2 VF testing. Structural parameters were obtained from spectral-domain OCT for each parafoveal and perifoveal sublayer thickness in the superior and inferior fields. Perfusion parameters from 3×3 mm macular OCTA included vessel density (VD) in the superficial and deep capillary plexuses (DCPs), foveal avascular zone area, central non-perfusion area (NPA) and parafoveal NPA. Eyes were stratified by VF mean deviation (MD): Group 1 (significant VF defect, MD ≤-6 dB) and Group 2 (mild VF defect, MD >-6 dB). Intergroup comparisons, correlations and multivariate regression analyses were performed. RESULTS: Group 1 (n=27) had a significantly higher prevalence of major BRVO (96.3 vs 65.5%) than Group 2 (n=58). Group 1 showed thinner parafoveal ganglion cell-inner plexiform layer (GCIPL) (76.8±14.7 vs. 87.9±11.9 µm; p<0.001) and outer plexiform layer (32.5±6.6 vs. 36.1±5.5 µm; p=0.024). Hemispheric VD in the DCP was lower in Group 1 (28.9±6.2% vs. 32.7±8.1%; p=0.031). In multivariate analysis, BRVO type and parafoveal GCIPL thickness were independent predictors of significant VF loss. CONCLUSIONS: VF impairment in BRVO was strongly associated with inner retinal thinning than with OCTA parameters. VF testing and structural OCT can be complemented by acuity-based assessments of BRVO.
Epiretinal membranes: prevalence and associations in relationship to posterior vitreous detachment - the Beijing Eye Study.
Jonas JB, Panda-Jonas S, Wang YX … +1 more , Jonas RA
Br J Ophthalmol · 2026 Apr · PMID 42014183 · Publisher ↗
PURPOSE: To assess prevalence and associations of epiretinal membranes (ERMs) in a general population. METHODS: In participants of the population-based Beijing Eye Study, we assessed macular volume optical coherence tomo...
PURPOSE: To assess prevalence and associations of epiretinal membranes (ERMs) in a general population. METHODS: In participants of the population-based Beijing Eye Study, we assessed macular volume optical coherence tomographic (OCT) scans for ERMs. RESULTS: The study included 1351 eyes (914 participants) (age: 64.7±9.8 years; range: 50-91 years). ERMs were detected in 80 eyes (5.9%; 95% CI 4.9% to 6.9%) of 60 participants (6.6%; 95% CI 5.1% to 8.1%), with ERMs without retinal surface wrinkling in 34 (2.5%) eyes, ERMs with retinal surface wrinkling and normal fovea contour in 16 (1.2%) eyes, ERMs with reduced foveal depth in 20 (1.5%) eyes, ERMs with complete foveal flattening in 6 (0.4%) eyes and ERMs with foveal elevation in 4 (0.2%) eyes. Hyper-reflective epiretinal dots (HEDs) were detected in 114 (8.4%) eyes. Higher ERM prevalence was associated (multivariable analysis) with higher stage of posterior vitreous detachment (PVD) (OR: 1.81; 95% CI 1.34 to 2.45; p<0.001), older age (OR: 1.05; 95% CI 1.01 to 1.09; p=0.002), higher prevalence of HEDs (OR: 9.18; 95% CI 4.85 to 17.4; p<0.001) and worse best corrected visual acuity (BCVA) (OR: 2.75; 95% CI 1.04 to 7.30; p=0.04), but not with axial length (p=0.69) or pseudophakia (p=0.98). Out of 746 eyes without PVD, 3 (0.4%) eyes had ERMs (without retinal surface wrinkling) and 9 (1.2%) eyes showed HEDs. Higher ERM stage increased with higher PVD stage (beta: 0.32; p<0.001), older age (beta: 0.11; p=0.006) and worse BCVA (beta: 0.07; p=0.04), but not with axial length (p=0.75) or pseudophakia (p=0.71). CONCLUSIONS: As measured by OCT, ERM prevalence was mainly associated with PVD and to a minor degree with older age and worse BCVA, while longer axial length, pseudophakia or ocular diseases such as age-related macular disease and glaucoma were not related to prevalence and stage of ERMs.
Real-world early outcomes of intravitreal faricimab 6-mg and aflibercept 2-mg injection in diabetic macular oedema.
Chalkiadaki E, Sim SY, Williams O … +6 more , Elder L, Addison PK, Hamilton RD, Nicholson L, Sivaprasad S, Heng LZ
Br J Ophthalmol · 2026 Apr · PMID 42014182 · Publisher ↗
BACKGROUND/AIMS: To evaluate real-world, short-term anatomical and functional outcomes of faricimab versus aflibercept 2 mg in diabetic macular oedema (DMO). METHODS: This retrospective, parallel-cohort comparative study...
BACKGROUND/AIMS: To evaluate real-world, short-term anatomical and functional outcomes of faricimab versus aflibercept 2 mg in diabetic macular oedema (DMO). METHODS: This retrospective, parallel-cohort comparative study included 300 consecutive patients with DMO from Moorfields Eye Hospital. Eligible eyes were treatment-naïve and treatment-experienced not receiving therapy for ≥6 months and subsequently initiated on loading phase of faricimab or aflibercept 2mg. Follow-up was 4 months. Data were collected from the Moorfields electronic medical records system. Changes in visual acuity (VA) and central subfield thickness (CST) from baseline to the fourth injection were analysed using multiple linear regression adjusted for baseline covariates (age, gender, ethnicity, diabetes type, baseline retinopathy status, baseline VA or CST and treatment interval). RESULTS: Of 300 eyes enrolled, 292 were ultimately analysed (191 aflibercept; 101 faricimab), with 246 eyes (84.2%) completing follow-up. Mean unadjusted VA gain was +3.9±10.4 letters with aflibercept and +5.2±11.8 letters with faricimab. Adjusted marginal mean VA gain was +4.2 letters for aflibercept and +4.7 letters for faricimab, with a non-significant difference of -0.5 letters (p=0.7). Baseline VA and treatment interval were significant predictors of functional response, with baseline VA exerting approximately 3.4 times the impact of treatment interval. Mean CST reduction was 87.3±106.1 µm with aflibercept and 113.1±136.7 µm with faricimab. Adjusted mean reductions were 95.4 µm and 99.8 µm, respectively (difference -4.4 µm, p=0.7). Baseline CST was the only independent predictor of anatomical response. CONCLUSION: Faricimab and aflibercept achieved comparable short-term anatomical and functional outcomes, with greater anatomical improvement associated with higher baseline CST and larger visual gains observed with lower baseline VA. Treatment interval influenced functional response, underscoring the importance of timely therapy. Baseline disease features and treatment adherence are key determinants of early outcomes, rather than drug selection.
Regional variations in type 1 retinopathy of prematurity: GHANAROP and SUNDROP.
Shah SV, Brant AR, Ahmed A … +4 more , Zhao C, Braimah IZ, Tabin GC, Moshfeghi DM
Br J Ophthalmol · 2026 Apr · PMID 42009518 · Publisher ↗
BACKGROUND/AIMS: To compare the incidence of Zone I Stage 3 retinopathy of prematurity (ROP) without Plus disease between diverse cohorts. METHODS: 1164 premature infants (716 from the Stanford University Network for Dia...
BACKGROUND/AIMS: To compare the incidence of Zone I Stage 3 retinopathy of prematurity (ROP) without Plus disease between diverse cohorts. METHODS: 1164 premature infants (716 from the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) in the USA and 448 from GHANAROP in Ghana) underwent telemedicine ROP screening from January 2023 to March 2025. Retinal images were prospectively graded by the same expert grader using International Classification of Retinopathy of Prematurity, third edition terminology. Treatment-warranted ROP (TW-ROP) was defined as type 1 ROP or aggressive ROP. The telemedicine ROP Severity Score (tROP-SS) was quantified for each examination. Incidence of Zone I Stage 3 without Plus disease, correlation between Plus disease and TW-ROP and correlation between Stage and Plus versus tROP-SS in Zone I disease were analysed. RESULTS: 40% of treated eyes in GHANAROP versus 7.5% in SUNDROP (p=0.002) were Zone I Stage 3 without Plus. Treatment rates were similar between cohorts (2.2%-2.8%), although GHANAROP patients were significantly older (gestational age: 31 years, 2/7 vs 28 years, 5/7; p<0.001) and heavier (1352 g vs 1161 g; p<0.001) at birth. Correlation between Plus disease and TW-ROP was stronger in SUNDROP (Kendall's Tau 0.73 vs 0.46, both p<0.001). In Zone I disease, Stage correlated poorly with Plus in both cohorts but strongly with tROP-SS (Kendall's Tau ≥0.90, p<0.001). CONCLUSIONS: Zone I Stage 3 ROP without Plus is more prevalent in the Ghanaian cohort, challenging the assumed centrality of Plus disease for intervention in certain populations. Integrated scoring systems incorporating Zone, Stage and Plus may be crucial for accurate ROP classification, especially in low- and middle-income countries with zone-dominated disease.
Socioeconomic status, cardiovascular health and joint associations with incident cataract: a prospective study from UK Biobank.
Peng Y, Zhang Y, Kam KW … +11 more , Ho M, Yim CL, Au SCL, Zhang XJ, Ng MP, Ip P, Young AL, Pang CP, Tham CC, Chen LJ, Yam JC
Br J Ophthalmol · 2026 Apr · PMID 41991254 · Publisher ↗
AIMS: To investigate the interaction and combined effects of cardiovascular health (CVH) and socioeconomic status (SES) on incident cataract risk. METHODS: This prospective cohort study included 236 248 UK Biobank partic...
AIMS: To investigate the interaction and combined effects of cardiovascular health (CVH) and socioeconomic status (SES) on incident cataract risk. METHODS: This prospective cohort study included 236 248 UK Biobank participants free of cataract at baseline and with complete data on SES and CVH. Incident cataract was ascertained through hospital inpatient and self-reported records. SES was derived from household income, employment and education using latent class analysis, while CVH was assessed via the Life's Essential 8 (LE8) score. Cataract risk was evaluated using multivariable Cox regression, with interaction and joint effects analyses performed to assess the interplay between SES and CVH. RESULTS: This analysis involved 236 248 participants with an average age of 55.5 years (range: 38-73); 51.6% were female and 95.6% were of white ethnicity. Over a median follow-up period of 11.7 years, 26 791 participants (11.3%) developed cataract. Compared with the high SES group, participants with low SES had a significantly higher risk of cataract (HR, 1.30; 95% CI 1.25 to 1.35). Significant additive and multiplicative interactions between SES and CVH on cataract risk were observed. Better CVH substantially mitigated the adverse association of low SES with cataract. Notably, individuals with low SES and poor CVH showed the highest cataract risk (HR, 1.74; 95% CI 1.57 to 1.93) in contrast to those with high SES and optimal CVH. CONCLUSIONS: Implementing interventions aimed at enhancing both SES and CVH may prove beneficial in preventing or delaying cataract onset. Adhering to the LE8 guidelines to maintain optimal CVH has the potential to alleviate a significant portion of the excess cataract risk associated with socioeconomic disadvantage.
Trends in incidence and survival for uveal melanoma in Norway, 1993-2021.
Leitzinger N, Falk RS, Jespersen H … +4 more , Eide NA, Green AC, Robsahm TE, Veierød MB
Br J Ophthalmol · 2026 Apr · PMID 41991253 · Publisher ↗
BACKGROUND/AIMS: Understanding uveal melanoma incidence and survival trends is crucial for improving patient outcomes and allocating healthcare resources. We aimed to investigate the incidence and survival for uveal mela...
BACKGROUND/AIMS: Understanding uveal melanoma incidence and survival trends is crucial for improving patient outcomes and allocating healthcare resources. We aimed to investigate the incidence and survival for uveal melanoma in Norway, 1993-2021, including information on tumour site, tumour (T) category and summary stage. METHODS: The Cancer Registry of Norway provided data on all patients diagnosed with a first primary uveal melanoma in Norway between 1 January 1993 and 31 December 2021. We calculated age-standardised incidence rates using the European standard population and estimated net survival and crude probability of death. Net survival estimates were obtained using the Pohar-Perme estimator, period approach and cohort approach. RESULTS: Altogether, 1497 patients (49.6% men) were diagnosed with a primary uveal melanoma in 1993-2021. The age-standardised incidence rate increased from 6.8 (95% CI 5.7 to 7.9) per million person-years in 1993-1997 to 9.8 (95% CI 8.8 to 11.0) per million person-years in 2017-2021, with an overall rate of 9.0 (95% CI 8.6 to 9.5). This increase was primarily driven by localised, T1 and T2 choroidal melanomas. Ten-year net survival for patients with uveal melanoma remained relatively stable between 57.2% (95% CI 36.2% to 73.5%) in 1993-1997 and 65.5% (95% CI 53.8% to 74.9%) in 2017-2021. Over the same periods, there was a notable net survival improvement in patients with choroidal melanoma from 53.4% (95% CI 27.9% to 73.4%) to 74.8% (95% CI 59.8% to 84.9%). CONCLUSION: The increased uveal melanoma incidence in Norway was mainly due to localised choroidal tumours. Improved detection of choroidal tumours is likely to have contributed to both the increased incidence and long-term net survival, highlighting the potential benefits of early detection strategies.
Prevention of endophthalmitis with cataract surgery
Kuo IC, O'Brien T
Br J Ophthalmol · 2026 Apr · PMID 41991252 · Publisher ↗
Acute postoperative endophthalmitis in cataract surgery, while rare, occurs despite efforts at prevention. Risk factors include host-related characteristics and technique-related aspects. The ocular surface plays a pivot...
Acute postoperative endophthalmitis in cataract surgery, while rare, occurs despite efforts at prevention. Risk factors include host-related characteristics and technique-related aspects. The ocular surface plays a pivotal role, with external microbial flora serving as a pervasive potential source of organisms for infection. Innate natural defence mechanisms are capable of protecting against infection, despite evidence of microbial contamination, with organisms recovered from aqueous humour even in uncomplicated cataract surgeries. With acute endophthalmitis after cataract surgery, coagulase-negative species are the most commonly recovered organisms, followed by other Gram-positive organisms and, less frequently, Gram-negative organisms. Strategies to prevent infection aim to limit organisms entering the eye by reducing organisms on the ocular surface, preventing intraoperative intraocular bacterial contamination and preventing postoperative bacterial contamination with watertight wound closure. Secondary strategies target the eradication of organisms that (despite all precautions) might have entered the eye, including intracameral antibiotic administration. Topical ophthalmic antisepsis with administration of povidone-iodine reduces the clinical occurrence of endophthalmitis with cataract procedures. Evidence demonstrates similar low rates of postoperative endophthalmitis after cataract surgery using standardised preoperative preparation alone, with or without intracameral antibiotic administration, in routine, uncomplicated cases. Stratification of risk guides possible adjunctive intracameral antibiotic administration in addition to standardised prevention practices, with individuals at higher risk, including those undergoing same-day bilateral surgery or with complicated and combined procedures.
Optic nerve intraneural pressure trend under intraocular-intracranial pressure effects.
Xie Y, Li Z, Wu J … +7 more , Zhang Y, Zhang K, Shao Y, Mao Y, Cheng Y, Wang X, Wang N
Br J Ophthalmol · 2026 Apr · PMID 41986093 · Publisher ↗
The imbalance between intraocular pressure (IOP) and intracranial pressure (ICP) is a recognised contributor to optic nerve (ON) injury. Clinically, the translaminar pressure difference is often simplistically interprete...
The imbalance between intraocular pressure (IOP) and intracranial pressure (ICP) is a recognised contributor to optic nerve (ON) injury. Clinically, the translaminar pressure difference is often simplistically interpreted as the direct subtraction of ON cerebrospinal fluid pressure (ON - CSFp) from IOP. While finite element analyses suggest that the transition between these two pressure compartments is neither abrupt nor uniform, instead forming a spatially graded finite transition zone, this concept remains unconfirmed from a fluid dynamics perspective. Given the inability to directly measure intraneural pressure in vivo, we modelled the ON as a continuous fluid medium. Using a mathematical approach, we visually illustrate how IOP and ON-CSFp interact to generate spatially varying intraneural hydrostatic pressure gradients. Our results show that these gradients assume a three-dimensional conical configuration. Elevation of IOP or reduction of ON-CSFp expands this conical gradient field, contributing to ON injury, whereas elevation of ICP produces an inverted conical gradient. The steepest gradients occur in the peripheral region posterior to the lamina cribrosa, rendering this area most vulnerable to damage. This study challenges the clinical oversimplification that pressure difference is equivalent to a mere subtraction of two values. It thereby improves clinicians' understanding of the biomechanical mechanisms underlying IOP and ICP imbalance-related ON injury. Importantly, it also highlights the often-overlooked phenomenon of intraneural pressure gradients, extending beyond the conventional focus on the translaminar pressure gradient alone.
Quantitative aqueous PCR viral load predicts poor visual outcome in acute retinal necrosis.
Tsubota K, Nonaka R, Asakage M … +2 more , Goto H, Usui Y
Br J Ophthalmol · 2026 Apr · PMID 41986092 · Publisher ↗
BACKGROUND/AIMS: Acute retinal necrosis (ARN) is a rare herpetic uveoretinitis that frequently results in severe vision loss. Evidence from large single-centre cohorts remains limited. We evaluated clinical characteristi...
BACKGROUND/AIMS: Acute retinal necrosis (ARN) is a rare herpetic uveoretinitis that frequently results in severe vision loss. Evidence from large single-centre cohorts remains limited. We evaluated clinical characteristics and prognostic factors in 148 ARN cases. METHODS: We retrospectively reviewed 148 consecutive patients with ARN treated at a tertiary referral centre (1985-2021). Causative virus and aqueous viral DNA copy number at presentation were determined by PCR. Associations of final best-corrected visual acuity (BCVA, logMAR) with aqueous viral load, timing of antiviral initiation and extent of retinal necrosis (quadrants involved) were analysed. Quantitative aqueous viral-load data were available in 73 of 148 patients. RESULTS: Varicella-zoster virus accounted for 125/148 (84.5%) cases; herpes simplex virus (HSV-1) for 16 (10.8%) and HSV-2 for 7 (4.7%). Mean age at onset was 50.8 years. Mean interval from symptom onset to antiviral initiation was 11.5±7.0 days; median interval from onset to vitrectomy was 22 days. Mean BCVA worsened from 0.71 logMAR at presentation to 1.20 logMAR at final visit (p<0.0001). Higher aqueous viral DNA copy number correlated with poorer final BCVA (p<0.001). Greater retinal involvement (more quadrants affected) was also associated with poorer final BCVA (p<0.0001). The interval from onset to antiviral initiation showed a weak, non-significant trend with final BCVA (p=0.055). CONCLUSIONS: In this large single-centre cohort of ARN, higher aqueous viral load and greater retinal involvement were associated with worse visual outcome. Quantitative viral load assessment at presentation may support risk stratification and timely selection of optimal interventions.
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