Br J Ophthalmol [JOURNAL]
Sun
200 papers
Applicability of ChatGPT to generate multiple-choice questions for ophthalmology resident exam.
Feizi S, Hatami F, Khosravi Mirzaei S … +4 more , Shahriari MH, Dolikhani MR, Shirzadeh-Barough S, Esfandiari H
Br J Ophthalmol · 2026 Jun · PMID 41407519 · Publisher ↗
BACKGROUND/AIMS: Developing high-quality multiple-choice questions (MCQs) for medical education is a challenging and time-consuming task. This study aimed to assess the applicability of Chat Generative Pre-trained Transf...
BACKGROUND/AIMS: Developing high-quality multiple-choice questions (MCQs) for medical education is a challenging and time-consuming task. This study aimed to assess the applicability of Chat Generative Pre-trained Transformer (ChatGPT) in generating MCQs for ophthalmology residents. METHODS: ChatGPT 4 was used to generate 100 MCQs, while an additional 100 MCQs were authored by university faculty. Item-writing flaws in both sets of questions were evaluated by a single reviewer. A quality assessment panel, consisting of board-certified ophthalmology subspecialists, compared the quality of two sets. Ophthalmology residents then answered all MCQs in a randomised order. The item difficulty and discrimination indices were calculated and compared between the two sets of questions. RESULTS: Item-writing flaws were more frequent in ChatGPT-generated MCQs (56%) compared with human-authored MCQs (27%, p<0.001). While ChatGPT-generated questions were comparable to human-written ones in most quality parameters, the distractor quality was significantly higher in human-generated MCQs (p=0.006). The mean resident scores were 46.5±9.5 for the ChatGPT-generated MCQs and 49.0±10.9 for the human-written MCQs (p=0.051). The difficulty index was 0.47±0.21 and 0.51±0.19, respectively (p=0.12). The discrimination index was significantly lower in the ChatGPT questions (0.20±0.19 vs 0.28±0.16, p<0.001). CONCLUSIONS: While ChatGPT can efficiently generate MCQs for ophthalmology residents, it has notable limitations, including higher rates of item-writing flaws and lower-quality distractors. Additionally, ChatGPT-generated MCQs are less effective at distinguishing high-performing from low-performing examinees. Integrating ChatGPT with human expertise is essential to enhance the quality and reliability of artificial intelligence-generated MCQs.
Efficacy of perceptual learning among patients with infantile nystagmus: a prospective single-blind randomised controlled trial.
Hecht I, Yahalom C, Abaev O … +4 more , Einan-Lifshitz A, Pras E, Erdinest N, Zmujack-Yehiam S
Br J Ophthalmol · 2026 Jun · PMID 41402029 · Publisher ↗
BACKGROUND: There are limited treatment options to improve vision in patients with infantile nystagmus. We aimed to examine the use of repeated visual stimulation with Gabor patches to improve vision. METHODS: A prospect...
BACKGROUND: There are limited treatment options to improve vision in patients with infantile nystagmus. We aimed to examine the use of repeated visual stimulation with Gabor patches to improve vision. METHODS: A prospective randomised (3:1) controlled single-blind study. Included were patients aged 9-55 years with infantile nystagmus, treated in one tertiary referral centre in central Israel. The treatment group underwent visual stimulation for 4 months, which consisted of treatment sessions of approximately 30 min, 3-4 times a week, using web-based dedicated software. Controls were followed without treatment. RESULTS: 26 patients were treated, and 10 served as controls. Mean age was 22.47±12 years. 12/26 (46%) of treated subjects achieved driving licence best corrected visual acuity (BCVA) (20/40) versus 1/10 (10%) of controls. Distance BCVA improved by 0.11±0.07 logMAR (one line) in treated patients compared with 0.013±0.06 logMAR in controls (p<0.001). Near BCVA improved by 0.20±0.18 logMAR (2 lines) in treated patients compared with 0.06±0.06 logMAR in controls (p=0.040). 88% (8/9) of study patients who had no stereopsis prior to treatment achieved stereopsis (mean 630') as opposed to 25% (1/4) of controls (p=0.10). Mean stereoacuity and contrast sensitivity improved by 802±730' and 292±391% in the study group as opposed to 246±376' and 152±67% in controls, respectively (p=0.031; p=0.157). CONCLUSIONS: Visual perceptual learning using Gabor patches resulted in a significant improvement in near and distance visual acuity, as well as stereopsis. This modality may represent a promising non-invasive treatment option for improving visual function in patients with infantile nystagmus.
Development and validation of predictive models based on the first-month axial length change for the long-term efficacy of orthokeratology in myopic children.
Ruan Z, Jiang J, Xu S … +6 more , Lu M, Hao W, Xiang C, Li Z, Yang X, Hu Y
Br J Ophthalmol · 2026 Jun · PMID 41402028 · Publisher ↗
AIMS: To identify simple and practical predictors and develop predictive models for the long-term efficacy of orthokeratology (ortho-k) treatment in myopic children. METHODS: The training and external validation cohorts...
AIMS: To identify simple and practical predictors and develop predictive models for the long-term efficacy of orthokeratology (ortho-k) treatment in myopic children. METHODS: The training and external validation cohorts were composed of children with myopia who received ortho-k treatment from two separate prospective studies conducted at Zhongshan Ophthalmic Centre, respectively. Baseline variables and the first-month change in axial length (AL) were entered into logistic regression to develop predictive models to assess the 1-year efficacy of ortho-k treatment on retarding AL elongation. Nomograms and an online calculator were used to present the final models, and receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were used to assess model performance in both the training and external validation cohorts. RESULTS: The training and external validation cohorts comprised 150 and 88 children with myopia, respectively. Age and the first-month AL change were included in the final predictive model for excessive myopia progression with area under the ROC curves (AUC) above 0.84. Only the first-month AL change was included in the final predictive model for rapid myopia progression with AUC above 0.85. All the discrimination, calibration and clinical net benefit performed excellently in the training and external validation cohorts. The models were integrated into an open-source online risk calculator. CONCLUSIONS: The first-month AL change and age are simple and practical predictors for the long-term efficacy of ortho-k treatment in children with myopia. Predicting long-term ortho-k efficacy after the first month will provide eye care practitioners with guidance to evaluate subsequent outcomes and adjust follow-up plans.
Choroid thickness: a potential biomarker for pseudophakic cystoid macular oedema.
He W, Guo D, Zhou J … +7 more , Hu X, Cheng K, Qi J, Du Y, Meng J, Lu Y, Zhu X
Br J Ophthalmol · 2026 Jun · PMID 41390159 · Publisher ↗
AIMS: To determine whether choroidal thickness influences the risk of clinically significant pseudophakic cystoid macular oedema (CME). METHODS: We performed a retrospective case-control study of non-diabetic adults who...
AIMS: To determine whether choroidal thickness influences the risk of clinically significant pseudophakic cystoid macular oedema (CME). METHODS: We performed a retrospective case-control study of non-diabetic adults who underwent uncomplicated cataract surgery at the Eye & ENT Hospital of Fudan University between June 2023 and December 2024. Electronic records were reviewed to estimate pseudophakic CME incidence. For each CME case diagnosed, age-matched and sex-matched patients without CME within 3 months postoperatively were randomly selected as controls. Potential ocular risk factors, including axial length (AL), central retinal thickness, subfoveal choroidal thickness (SFCT), posterior vitreous detachment (PVD) and others, were assessed with multivariable logistic regression. Treatment methods and prognosis of CME cases were also evaluated. RESULTS: Among 9793 eyes, CME occurred in 65 (0.66%). After age adjustment, eyes with AL <26 mm (age-related cataract, ARC) had higher CME risk than those with AL ≥26 mm (highly myopic catar, HMC) (OR=1.94, p=0.046). Compared with matched controls, CME cases had shorter AL, less PVD and thicker SFCT (all p<0.001). In multivariable analysis, only thicker SFCT remained associated with CME (OR=1.012, p<0.001). SFCT predicted CME with areas under the curve of 0.805 in HMC and 0.792 in ARC. Mean recovery time was 38.7±9.6 days with periocular steroid injection plus topical steroid and non-steroidal anti-inflammatory drugs versus 42.4±12.3 days with topical therapy alone. Cox regression confirmed faster recovery with the combined regimen. CONCLUSIONS: Thinner choroidal thickness, which is common in high myopia, acts as a protective factor against pseudophakic CME.
Impact of artificial intelligence on the availability, accessibility, acceptability and quality of ophthalmic disease screening services: a scoping review.
Lin S, Zhang J, Jan C … +8 more , Li L, Peng Y, Qian D, Yin Y, Zhang M, Feng J, He M, Zou H
Br J Ophthalmol · 2026 May · PMID 41390158 · Full text
This scoping review examines the existing literature on the application of artificial intelligence (AI) in screening for eye diseases, with a focus on evaluating whether AI-assisted diagnostic technologies enhance the av...
This scoping review examines the existing literature on the application of artificial intelligence (AI) in screening for eye diseases, with a focus on evaluating whether AI-assisted diagnostic technologies enhance the availability, accessibility, acceptability and quality of screening services. 42 original studies were selected for in-depth analysis, including those employing health economic evaluations. Methodological quality was assessed using the Mixed Methods Appraisal Tool, with the majority of studies demonstrating high quality-24 scored 5/5, 15 scored 4/5 and the rest scored 3/5. Among the included studies, 34 compared manual screening with either AI-assisted or fully AI-driven approaches. Availability was the most frequently studied aspect (28 studies), followed by acceptability (12 studies), whereas accessibility and service quality were less commonly addressed. Overall, AI shows significant potential to improve the cost-effectiveness of eye care services and enhance patient access, particularly in remote or underserved regions. It was also well-accepted by patients, with high satisfaction and improved referral compliance. The findings suggest that AI holds promise for advancing eye disease screening, although large-scale, long-term trials are needed to effectively integrate AI into the reconstruction of screening processes and the reshaping of eye health service systems.
Prospective randomised controlled trial to compare tissue reactions and scarring with polypropylene versus polyglactin 910 sutures in periocular skin.
Fayers T, Vekinis JS, Ah-Kye L … +5 more , Parham D, Anketell P, Weir J, A'Hern R, Parkin B
Br J Ophthalmol · 2026 Jun · PMID 41386795 · Full text
BACKGROUND/AIMS: The aim of this study was to compare tissue reactions and scarring produced by polypropylene (Prolene) versus polyglactin 910 (Vicryl) sutures in eyelid skin. METHODS: 47 patients with entropion were ran...
BACKGROUND/AIMS: The aim of this study was to compare tissue reactions and scarring produced by polypropylene (Prolene) versus polyglactin 910 (Vicryl) sutures in eyelid skin. METHODS: 47 patients with entropion were randomised to 6-0 Prolene or 6-0 Vicryl. Patients underwent everting sutures 1 month prior to definitive surgery involving wedge excision and retractor plication. Only the randomised suture type was used in both procedures. The study suture within the wedge was analysed histologically. Patients were assessed clinically 2 weeks and 6 months following definitive surgery.The primary outcome was histological inflammatory reaction diameter around the suture assessed by a masked histopathologist. Secondary outcomes were clinical scarring assessed using a validated scar grading questionnaire completed by patients and masked assessors and clinical photographs assessed by two masked oculoplastic surgeons. RESULTS: Mean inflammatory reaction diameter was 0.39 mm for Prolene and 0.56 mm for Vicryl. Median histological grade sum was 32 (IQR 22-37) for Prolene and 40 (IQR 27-46) for Vicryl. The median number of foreign body giant cells around the suture was 1 (IQR 0-3) for Prolene and 4 (IQR 3-8) for Vicryl. Only this last result was statistically significant; the lack of significance for other results may be due to the small sample size. One patient developed a clinical granuloma following surgery with Vicryl. There was no significant difference between suture scarring assessed by questionnaire responses or clinical photography. CONCLUSION: Prolene may cause less histological inflammation than Vicryl in eyelid skin but clinical scarring is similar. TRIAL REGISTRATION NUMBER: NCT04724512.
Visual outcomes in patients with bilateral early to moderate primary open-angle glaucoma following wavefront-shaping partial-range of field-extend intraocular lens implantation.
Guarro M, Goñi Guarro I, López E … +5 more , Ruiz S, Vázquez M, Sararols L, Ní Dhubhghaill S, Biarnés M
Br J Ophthalmol · 2026 May · PMID 41381123 · Full text
BACKGROUND/AIMS: To assess binocular visual performance, visual acuity at different contrast levels and visual disturbances in patients with primary open-angle glaucoma (POAG) undergoing bilateral cataract surgery with t...
BACKGROUND/AIMS: To assess binocular visual performance, visual acuity at different contrast levels and visual disturbances in patients with primary open-angle glaucoma (POAG) undergoing bilateral cataract surgery with the placement of wavefront-shaping partial-range of field-extend (PROF-Ex) intraocular lens (IOL). DESIGN: Prospective, descriptive, single-arm study with 3 months of follow-up. METHODS: Patients diagnosed with bilateral early-to-moderate POAG were included and underwent cataract surgery with implantation of a PROF-Ex IOL (AcrySof IQ Vivity, Alcon Healthcare) bilaterally. Postoperative outcomes were measured in binocular conditions for visual acuity (uncorrected and corrected at varying distances and contrast levels), contrast sensitivity and visual disturbances assessed through light distortion analysis in terms of the light distortion index (LDI) and best-fit circle radius. RESULTS: 27 patients were included, with a mean age of 74.2±8.1 years. Three months after surgery, binocular corrected visual acuities at 100% contrast were -0.01±0.06, 0.11±0.08 and 0.26±0.13 LogMAR for far, intermediate and near distance vision, respectively. Those at 25% contrast were 0.57±0.11 and 0.65±0.12 LogMAR for intermediate and near distance vision, respectively. The mean binocular contrast sensitivity was 1.63±0.11, and the mean LDI was 13.28±7.06. No significant adverse events were recorded. CONCLUSIONS: The wavefront-shaping PROF-Ex IOL technology shows positive outcomes in terms of visual acuity, contrast sensitivity and visual disturbances for patients with bilateral early-to-moderate POAG. Thus, wavefront-shaping PROF-Ex technology lenses can be a viable and effective option for patients with POAG seeking spectacle independence.
Optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty: a randomised controlled clinical trial.
Madsen MBM, Ivarsen A, Hjortdal J
Br J Ophthalmol · 2026 May · PMID 41381122 · Publisher ↗
AIMS: To investigate corneal higher order aberrations (HOAs), densitometry and whole-eye optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), Descemet's membrane endothelial...
AIMS: To investigate corneal higher order aberrations (HOAs), densitometry and whole-eye optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), Descemet's membrane endothelial keratoplasty (DMEK) and cataract surgery and the association with visual function. METHODS: This predefined secondary analysis of a randomised trial included 72 patients with Fuchs' endothelial dystrophy (FED) and cataract for UT-DSAEK or DMEK combined with cataract surgery. Thirty-seven patients with cataract and healthy corneas served as controls and underwent cataract surgery alone. RESULTS: Total posterior HOAs were significantly higher 12 months after UT-DSAEK than DMEK (p<0.001) and higher after DMEK than in the control group (p<0.01).Total densitometry for the central (0-2 mm) and peripheral (2-6 mm) annular corneal zones was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01 for both comparisons).Objective scatter index (OSI) was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01) and higher after DMEK than in the control group (p<0.001). For patients treated with endothelial keratoplasty, visual acuity and OSI were significantly correlated (r=0.55, p<0.001), as were contrast sensitivity and OSI (r=0.37, p<0.001). CONCLUSIONS: Total posterior HOAs and OSI were higher 12 months after UT-DSAEK than after DMEK and higher after DMEK than after cataract surgery alone. Visual acuity and contrast sensitivity were correlated with OSI. Although DMEK surgery for FED provides excellent visual rehabilitation, the corneal optical quality remains suboptimal. TRIAL REGISTRATION NUMBER: NCT04417959.
Efficacy of natamycin monotherapy versus combination therapy with voriconazole for fungal keratitis: a randomised clinical trial.
Di Zazzo A, Surico PL, Parmar UPS … +5 more , Tarini S, De Luca A, Madduri B, Mohan N, Fernandes M
Br J Ophthalmol · 2025 Dec · PMID 41365527 · Publisher ↗
BACKGROUND: To assess whether adjunctive topical voriconazole 1% offers additional benefit over natamycin 5% monotherapy in fungal keratitis, focusing on ulcer resolution, visual outcomes and safety. METHODS: This prospe...
BACKGROUND: To assess whether adjunctive topical voriconazole 1% offers additional benefit over natamycin 5% monotherapy in fungal keratitis, focusing on ulcer resolution, visual outcomes and safety. METHODS: This prospective, double-masked, randomised clinical trial was conducted at L.V. Prasad Eye Institute, India. A total of 108 adults with smear- or culture-positive fungal keratitis were randomised 1:1 to receive either natamycin 5% plus voriconazole 1% (combination therapy) or natamycin 5% plus placebo (monotherapy). Drops were instilled hourly for 72 hours, then tapered over 2 weeks. All patients also received oral ketoconazole and cycloplegics. The primary outcome was complete ulcer resolution with medical therapy alone, defined as epithelial closure with scarring without therapeutic penetrating keratoplasty. Secondary outcomes included time to epithelial healing, best-corrected visual acuity (BCVA) and adverse events. RESULTS: Of 94 eyes completing follow-up (mean (SD) age, 50.4 (12.4) years; 66 (70%) male), complete healing occurred in 38 of 48 eyes (79.2%) in the combination group and 35 of 46 eyes (76.1%) in the monotherapy group (absolute difference, 3.1%; 95% CI -13.2% to 19.4%; p=0.70). Median time to epithelial healing was 38 days (IQR, 20-60) for combination therapy and 39 days (IQR, 21-61) for monotherapy (p=0.86). Final mean BCVA was 0.43 logMAR (logarithm of the minimum angle of resolution) versus 0.58 logMAR, respectively (p=0.07). In non- cases, natamycin monotherapy yielded better visual outcomes (p=0.048). CONCLUSIONS: Adjunctive topical voriconazole did not significantly improve clinical outcomes compared with natamycin monotherapy. Natamycin 5% remains an effective first-line treatment, particularly in non- keratitis. Further studies are warranted to explore targeted roles for combination therapy. TRIAL REGISTRATION NUMBER: NCT03230058.
Assessment of dry eye questionnaires in patients with and without glaucoma.
Coco G, Piccotti G, Rossi L … +2 more , Fucci P, Manni G
Br J Ophthalmol · 2026 May · PMID 41365526 · Publisher ↗
AIM: To compare the results of the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment Questionnaire iN Dry Eye (SANDE) in patients without glaucoma and with glaucoma at diffe...
AIM: To compare the results of the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment Questionnaire iN Dry Eye (SANDE) in patients without glaucoma and with glaucoma at different stages of severity. METHODS: Cross-sectional study including patients who underwent visual field (VF) testing, completed three dry eye disease (DED) questionnaires and had ocular surface examination. Glaucoma severity was staged by averaging the severity grade of both eyes using mean deviation (MD) thresholds as mild (MD≥-6 dB), moderate (-6>MD≥-12 dB) and advanced (MD<-12 dB). Questionnaire results, pairwise correlations and predictors for each questionnaire result were assessed. RESULTS: 147 patients with a mean age of 65.8±12.5 years were included. OSDI showed moderate-to-high correlations with DEQ-5 and SANDE in patients without glaucoma (n=43) and with mild-to-moderate (n=32 and n=56) VF damage (always ρ≥0.55; p<0.01 with DEQ-5 and ρ≥0.5; p<0.01 with SANDE); while correlations became low and non-significant in advanced glaucoma (n=16) (ρ:0.38; p=0.60 and ρ:0.41; p=0.464 with DEQ-5 and SANDE, respectively). Conversely, DEQ-5 and SANDE always showed significant correlations (ρ≥0.66; p<0.01). Linear regression showed the OSDI to be the only questionnaire affected by mean MD (p=0.002). Additionally, glaucoma patients were more frequently defined as symptomatic for DED using the OSDI compared with the DEQ-5 (65.4% vs 51.9%; p=0.0082). CONCLUSION: DED questionnaires showed different behaviours in patients with glaucoma. The OSDI failed to maintain its correlation with both the DEQ-5 and SANDE in advanced glaucoma stages and was the only questionnaire influenced by VF damage. Questionnaire choice may influence how DED symptoms are captured in glaucoma patients, particularly in advanced stages.
Cardiovascular risk following transient vision loss.
Miller T, Xie JS, Rahat Qureshi A … +2 more , Tao BK, Margolin E
Br J Ophthalmol · 2026 May · PMID 41365525 · Publisher ↗
BACKGROUND/AIMS: To evaluate short- and long-term cardiovascular risk following a first diagnosis of transient vision loss (TVL) compared with matched controls using the TriNetX research network. METHODS: Patients with a...
BACKGROUND/AIMS: To evaluate short- and long-term cardiovascular risk following a first diagnosis of transient vision loss (TVL) compared with matched controls using the TriNetX research network. METHODS: Patients with an incident diagnosis of TVL were retrospectively identified and 1:1 propensity score matched to controls with dry eye syndrome. Primary outcomes included major adverse cardiovascular events (MACE), stroke, myocardial infarction (MI), ventricular arrhythmias, venous thromboembolism (VTE), hospitalisation and all-cause mortality. Cox proportional hazards models estimated hazard ratios (HRs) from 14 days to 10 years. Subgroup analyses evaluated patients free of events at 90 days and 1 year. RESULTS: After matching, 37 750 patients were included in each cohort. Mean (SD) age was 56.8 (16.8) years in the TVL cohort (59.7% female) and 56.6 (16.3) years in the control cohort (58.9% female). Within 14 days, stroke risk increased over 21-fold (HR 21.7; 95% CI 13.4 to 37.4), MACE nearly 10-fold (HR 9.80; 95% CI 7.19 to 13.34), arrhythmia over fourfold (HR 4.01; 95% CI 2.72 to 5.90), MI fivefold (HR 5.00; 95% CI 1.92 to 12.06) and hospitalisation nearly fourfold (HR 3.83; 95% CI, 3.52 to 4.17) compared with controls. VTE risk was modest and transient, with no elevation beyond 5 years and all-cause mortality was not elevated at any time point. Among patients' event-free at 90 days or 1 year, elevated long-term risk persisted up to 10 years for MACE, stroke, arrhythmiaand hospitalisation. CONCLUSIONS: TVL is associated with increased short- and long-term risks of MACE, stroke, MI, arrhythmia and hospitalisation, warranting prompt systemic evaluation and long-term monitoring.
Development of a core outcome set for patients with epiretinal membranes: a Delphi consensus study.
Sandinha T, Mehta J, Doungsong K … +4 more , Edwards RT, Steel DHW, Lane DA, FINESSE study Group
Br J Ophthalmol · 2026 May · PMID 41365524 · Publisher ↗
BACKGROUND/AIMS: Idiopathic epiretinal membrane (iERM) can affect vision in complex ways, requiring assessment beyond visual acuity. We developed a core outcome set (COS) for patients undergoing surgery for macular pucke...
BACKGROUND/AIMS: Idiopathic epiretinal membrane (iERM) can affect vision in complex ways, requiring assessment beyond visual acuity. We developed a core outcome set (COS) for patients undergoing surgery for macular pucker secondary to iERMs for use in both clinical practice and clinical trials. METHODS: An online modified Delphi technique was used, incorporating literature review, stakeholder workshops and two-round Delphi survey, each followed by a hybrid consensus meeting. Stakeholders, including health professionals and patients rated the importance of each outcome on a 9-point Likert scale (1-3, not important; 4-6, important; 7-9, very important). Outcomes scored as 'very important' by ≥80% of stakeholders were included in the COS. RESULTS: Sixty-two outcomes were initially included. Only one outcome reached consensus after the first vote, a further 10 after the second vote and five in the final vote. After discussion and considering clinical relevance and patient importance, the initial list of 17 outcomes was reduced to 13 core outcomes, grouped into six overarching domains: measured visual function, symptoms, adverse events, functional ability, quality of life and other, including objective measurements of anatomical findings. CONCLUSION: A minimum COS for iERMS comprising 13 outcomes covering six domains was generated by the modified Delphi process. The COS is not yet ready for use as the methods of assessment and the time points remain to be determined before it can be used in practice. Future research will test the implementation of the COS in clinical practice and its' potential incorporation into future trials.
Analysis of gene mutation spectrum for early-onset high myopia based on whole-exome sequencing.
Wang L, Cao J, Yang D … +7 more , Yu Y, Wang Z, Xing S, Wang M, Yu X, Zhou X, Zhao J
Br J Ophthalmol · 2026 May · PMID 41344850 · Full text
AIM: This study aimed to identify the loci of gene mutations associated with high myopia, analyse the genetic mutation spectrum characteristics for early onset high myopia (eo-HM) and explore the application of polygenic...
AIM: This study aimed to identify the loci of gene mutations associated with high myopia, analyse the genetic mutation spectrum characteristics for early onset high myopia (eo-HM) and explore the application of polygenic risk scores (PRSs) in predicting eo-HM. METHODS: Whole-exome sequencing (WES) and ophthalmic measurements were performed on participants with high myopia, and the mutation results were further verified by copy number variation sequencing, long range PCR and Sanger sequencing. Participants were classified into eo-HM (onset age<7 years and binocular spherical equivalent refraction <-6.0 dioptres (D)) and late-onset high myopia (lo-HM). PRS was calculated and assessed for eo-HM prediction accuracy through receiver operating characteristic (ROC) curve metrics. RESULTS: The participants comprised 100 patients with high myopia. WES identified 36 variants across 35 of 100 patients (35.00%), with the eo-HM group exhibiting a significantly higher detection rate (56.52%) than the lo-HM group (16.67%) (p<0.001). c.1221+1G>A, c.41T>C, c.1006G>A, c.1672C>T and c.466A>G were recognised as de novo mutation loci in eo-HM. and the promoter mutation of were identified as novel potential pathogenic mutations for high myopia (HM). Genetic mutations related to retinal diseases were more frequently observed in the eo-HM group than in the lo-HM group (p<0.01). ROC curve analysis signified that PRS had acceptable predicting ability for eo-HM (area under the curve=0.70). CONCLUSION: This study expands the eo-HM mutational spectrum and proposes novel HM pathogenic genes. PRS demonstrates a certain ability to predict eo-HM.
Impact of epiretinal membrane surgery on glaucoma progression: influence of glaucoma severity and internal limiting membrane peeling.
Kim H, Jang H, Bae HW … +2 more , Kim CY, Choi W
Br J Ophthalmol · 2026 May · PMID 41338942 · Publisher ↗
BACKGROUND: This retrospective, comparative study evaluated the long-term impact of pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal on glaucoma progression, focusing on the influence of glaucoma severit...
BACKGROUND: This retrospective, comparative study evaluated the long-term impact of pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal on glaucoma progression, focusing on the influence of glaucoma severity and adjunctive internal limiting membrane (ILM) peeling. METHODS: A total of 231 eyes from patients diagnosed with primary open-angle glaucoma and coexisting ERM were included. Participants were divided into two groups: 114 eyes underwent PPV for ERM removal (PPV group) and 117 eyes did not undergo surgery (non-PPV group). The PPV group was further subdivided based on glaucoma severity and ILM peeling. Functional and structural parameters were assessed over 4 years using visual field testing, intraocular pressure (IOP) measurement, and optical coherence tomography. Linear mixed models were used for statistical analysis. RESULTS: The PPV group demonstrated a significant deterioration in mean deviation and visual field index, compared with the non-PPV group, over 4 years (p<0.001). However, the rate of progression did not differ significantly based on glaucoma severity. Patients with severe glaucoma experienced a relatively greater functional burden. Adjunctive ILM peeling did not worsen functional or structural outcomes. IOP and medication use remained stable throughout the study period. CONCLUSIONS: While associated with long-term visual field decline, PPV for symptomatic ERM demonstrates a consistent impact on glaucoma progression, irrespective of baseline disease severity. ILM peeling does not confer additional risk. These findings support individualised surgical decision-making based on patient symptoms rather than glaucoma stage alone.
Incidence and factors associated with incident cataract surgery in a rural population in the Indian state of Andhra Pradesh: findings from the Andhra Pradesh Eye Disease Study III.
Padhy D, Khanna RC, Marmamula S … +6 more , Mettla AL, Giridhar P, Banerjee S, Shekhar K, Chakrabarti S, Rao GN
Br J Ophthalmol · 2026 May · PMID 41338941 · Publisher ↗
PURPOSE: The Andhra Pradesh Eye Disease Study III (APEDS III) is a 15-year follow-up of participants examined in APEDS I. The aim of the study was to report the 15-year incidence of cataract surgery and its associated fa...
PURPOSE: The Andhra Pradesh Eye Disease Study III (APEDS III) is a 15-year follow-up of participants examined in APEDS I. The aim of the study was to report the 15-year incidence of cataract surgery and its associated factors among rural populations. METHODS: This population-based longitudinal cohort study was conducted in three rural regions of the Indian state of Andhra Pradesh. Data on demographics, ocular and systemic history and risk factors were collected at both baseline and follow-up. Cataracts were classified into pure forms (nuclear, cortical, posterior subcapsular cataract (PSC)) and mixed cataract. Cataract types were defined using baseline assessment. Incidence of cataract surgery was defined as cataract surgery performed in either eye during the 15-year follow-up period among participants who did not have cataract surgery at baseline. RESULTS: In total, 2576 (47.7%) of 5395 participants aged 30 years and above at baseline were included, with a mean age of 42.9 years (SD±9.9) and 45% were men. The 15-year crude incidence risk of cataract surgery was 17.5% (95% CI 16.0% to 19.0%) and rate was 17.7 per 100 person-years (95% CI 17.3 to 18.1). In multivariable logistic regression, the incidence of cataract surgery was significantly higher among older adults (OR 11.09; 95% CI 6.92 to 17.78 in 60 years and above), participants with diabetes mellitus (OR 3.27; 95% CI 1.18 to 9.08), those with pure nuclear cataract (OR 2.27; 95% CI 1.56 to 3.30), pure cortical cataract (OR 3.22; 95% CI 1.79 to 5.79), pure PSC (OR 14.70; 95% CI 6.25 to 34.54) and mixed cataract (OR 6.60; 95% CI 4.13 to 10.55). CONCLUSIONS: Our study found a significantly higher incidence rate of cataract surgery in rural south India. Targeted interventions are needed to enhance eye care services further and improve access to surgical care.
Association of polymorphisms in 17 loci with primary open-angle glaucoma in Chinese and Japanese.
Chen SY, Ling A, Chan PP … +13 more , Huang C, Kawashima R, Usui S, Matsushita K, Tam PO, Young AL, Yam JC, Nishida K, Tsujikawa M, Zhang M, Pang CP, Tham CC, Chen LJ
Br J Ophthalmol · 2026 May · PMID 41338940 · Publisher ↗
PURPOSE: To evaluate the associations of single-nucleotide polymorphisms (SNPs) in 17 loci with primary open-angle glaucoma (POAG) and subtypes in Chinese and Japanese. METHODS: 17 SNPs in 17 genes, selected from a recen...
PURPOSE: To evaluate the associations of single-nucleotide polymorphisms (SNPs) in 17 loci with primary open-angle glaucoma (POAG) and subtypes in Chinese and Japanese. METHODS: 17 SNPs in 17 genes, selected from a recent genome-wide association study, were genotyped in a Hong Kong Chinese cohort of 1093 POAG patients, including 557 high-tension glaucoma (HTG) and 536 normal-tension glaucoma (NTG) patients, and 584 controls. Seven SNPs showing association in the Hong Kong cohort were genotyped in a Shantou Chinese cohort of 155 POAG patients and 380 controls and an Osaka Japanese cohort of 254 POAG patients and 207 controls. The SNP-disease association of individual and pooled cohorts was analysed. RESULTS: In combined Chinese and Japanese subjects, three SNPs were significantly associated with POAG: rs938604 ( =6.40×10, OR=0.70), rs62283813 ( =0.0050, OR=1.24) and rs9913911 ( =0.0060, OR=1.19). In subgroup analysis, these three SNPs showed stronger association with HTG: rs938604 ( =8.00×10, OR=0.59), rs62283813 ( =6.00×10, OR=1.55) and rs9913911 ( =0.0040, OR=1.24). In addition, rs4414666 ( =8.00×10, OR=1.29) was also significantly associated with HTG. No SNP showed a significant association with NTG. CONCLUSIONS: This study confirms rs938604, rs62283813, rs9913911 and rs4414666 as HTG-specific loci in Chinese and Japanese populations. These findings provide new insights into the genetic architecture of POAG, highlighting distinct molecular mechanisms between HTG and NTG subtypes.
Use of patient-reported outcome measures in everyday clinical practice in ophthalmology: results of a European multicountry survey.
Ernst SK, Jones PR, Somfai GM … +2 more , Becker MD, Terheyden JH
Br J Ophthalmol · 2026 Apr · PMID 41320232 · Full text
Patient-reported outcome measures (PROMs) reflect patients' abilities, difficulties and perceptions, but their use in ophthalmic care in Europe is unclear. We conducted a cross-sectional electronic survey among ophthalmo...
Patient-reported outcome measures (PROMs) reflect patients' abilities, difficulties and perceptions, but their use in ophthalmic care in Europe is unclear. We conducted a cross-sectional electronic survey among ophthalmologists in the UK, Germany and Switzerland to assess PROM use in routine care, their perceived value and implementation barriers. Only 31% of 112 respondents reported using PROMs, mostly in cataract care, with no differences across countries or clinical settings. Strikingly, perceived usefulness did not predict adoption. Reported barriers included staff and patient burden and uncertainty about instrument choice. To promote routine use of PROMs in ophthalmology, system-level integration and support are needed.
Incidence of glaucoma in patients with systemic lupus erythematosus: a nationwide cohort study in South Korea.
Kim JH, Kim Y, Oraha KM … +6 more , Park HM, Kim YJ, Lim HW, Sung YK, Welsbie DS, Lee WJ
Br J Ophthalmol · 2026 May · PMID 41276280 · Publisher ↗
BACKGROUND/AIMS: To assess the incidence of glaucoma in patients with systemic lupus erythematosus (SLE) and to identify associated risk factors using a nationwide population-based cohort. METHODS: This retrospective coh...
BACKGROUND/AIMS: To assess the incidence of glaucoma in patients with systemic lupus erythematosus (SLE) and to identify associated risk factors using a nationwide population-based cohort. METHODS: This retrospective cohort study analysed data from the Korean National Health Insurance Service (2008-2022). A total of 9682 patients with SLE were identified using ICD-10 code M32 and rare intractable disease code V136 and matched 1:1 to non-SLE controls by age and sex. The incidence of glaucoma (ICD-10 codes H40 and H42) and glaucoma suspect (H40.0) was assessed. Multivariate logistic regression was used to identify risk factors for glaucoma, including long-term corticosteroid use (≥180 days). RESULTS: The incidence of glaucoma was significantly higher in the SLE group than in controls (11.34% vs 3.74%; p<0.0001), with a greater prevalence in younger patients (<40 years) and females. Glaucoma suspect cases were also more common in the SLE group (35.56% vs 30.25%; p<0.0001). SLE was independently associated with glaucoma (adjusted OR: 2.00, 95% CI 1.69 to 2.38), and prolonged corticosteroid use further increased the risk (OR: 1.75, 95% CI 1.51 to 2.02). Annual incidence trends showed a rising pattern over time, especially among SLE patients. CONCLUSIONS: SLE is associated with an increased risk of glaucoma, particularly among younger individuals and females. Prolonged corticosteroid therapy significantly contributes to this risk. These findings support the need for regular ophthalmic screening and judicious corticosteroid management in patients with SLE.
Gender disparities in the burden of vision impairment and regional environmental susceptibility among Chinese children and adolescents.
Tong H, Cao C, Shi S … +6 more , Liu X, Li T, Xu S, Wu X, Tao S, Tao FB
Br J Ophthalmol · 2026 May · PMID 41276279 · Full text
BACKGROUND: Gender disparities in vision impairment (VI) among Chinese children and adolescents persist over time. Assessment and prediction of secular trends and the disease burden associated with this disparity can opt...
BACKGROUND: Gender disparities in vision impairment (VI) among Chinese children and adolescents persist over time. Assessment and prediction of secular trends and the disease burden associated with this disparity can optimise vision health practices. METHODS: We analysed data from the 2005, 2010, 2014 and 2019 Chinese National Surveys on Students Constitution and Health (CNSSCH), which included 874 640 students aged 7-18 years. Regional environmental factors comprised the Price Constant Index (PCI), health worker density, greenery coverage, intensity of light at night, annual patent grants of three kinds, population density, climate and air quality. Trends in VI burden were assessed and predicted using Chinese standard population and WHO population estimates. Mixed-effects models were employed to evaluate sex-based disparities in regional environmental factors and VI prevalence. RESULTS: Male VI patients have surpassed females, with the gender disparity increasing from -8797.9 thousand in 2005 to 5941.9 thousand in 2030. The PCI (=0, p=0), greenery coverage (=0, p=0), intensity of light at night (=0, p=0) and annual patent grants of three kinds (=0, p<0) were positively associated with VI prevalence. Stronger associations were observed between VI in male and both PCI (male: =0, p=0.; female: =0, p=0) and annual patent grants of three kinds (male: =0, p<0; female: =0, p<0). CONCLUSIONS: In China, VI is more prevalent in females, yet the absolute number of patients is larger in males, with this disparity progressively increasing. Males demonstrate heightened susceptibility to regional environmental factors. These findings support incorporating sex-specific prevention measures into current vision protection policies.
Repeated low-level red-light therapy combined with orthokeratology for myopia control in Spain: a randomised controlled study.
Fernández Fidalgo MJ, Ferigo Ferrel VD, Wu Y … +5 more , Qi Z, Yin-Moe Aung Y, Chen Y, Zhu Z, Fernández-Velázquez FJ
Br J Ophthalmol · 2026 Jun · PMID 41266129 · Publisher ↗
AIM: To evaluate the 12-month efficacy and safety of repeated low-level red-light (RLRL) therapy combined with orthokeratology (ortho-k) (RCO) for controlling myopia in Spanish children. METHODS: In this single-site, ran...
AIM: To evaluate the 12-month efficacy and safety of repeated low-level red-light (RLRL) therapy combined with orthokeratology (ortho-k) (RCO) for controlling myopia in Spanish children. METHODS: In this single-site, randomised, parallel-group, non-blinded clinical trial (NCT06899139), eligible myopic children aged 10-13 years were recruited and assigned randomly either to the RCO group or the ortho-k group. Follow-up assessments were conducted at 6, 9 and 12 months after baseline. The primary outcome and secondary outcome were the axial length (AL) and macular thickness (MT) changes at 12 months estimated by longitudinal mixed model. RESULTS: All participants (n=26; 11 in the RCO group and 15 in the ortho-k group) were included in the analysis. After 12 months, the adjusted mean AL change was -0.124 mm (95% CI -0.164 to -0.084) in the RCO group, whereas the ortho-k group continued to exhibit a modest axial elongation of 0.102 mm (95% CI 0.068 to 0.136). The adjusted mean difference in AL change was -0.226 mm (95% CI -0.279 to -0.174) between the groups (p<0.001). Additionally, the adjusted mean change in MT showed no significant difference between groups at 12 months. In the RCO group, 80% of children achieved AL shortening >-0.05 mm, whereas no children in the ortho-k group showed AL shortening. No severe adverse events were reported during the study. CONCLUSIONS: Combining RLRL therapy with ortho-k is an effective and safe myopia control strategy in Caucasian Spanish children, supporting the potential generalisability of the synergistic effect across diverse ethnic groups.
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