Kolli A, Chen E, Xu X
… +17 more, Lu J, Takla P, Liang J, Huh M, Zhao Y, Lee J, Nguyen K, Liang E, Yu Y, McLeod SD, Stein JD, Gedde SJ, Aung T, Li F, Ramulu P, Ying GS, Han Y
Am J Ophthalmol
· 2026 May · PMID 42134617
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OBJECTIVE: To query current practice for glaucoma follow-up intervals by studying the association between delayed follow-up (DFU) and glaucoma progression. DESIGN: Retrospective cohort and matched case-control study. SUB...OBJECTIVE: To query current practice for glaucoma follow-up intervals by studying the association between delayed follow-up (DFU) and glaucoma progression. DESIGN: Retrospective cohort and matched case-control study. SUBJECTS: Glaucoma patients and suspects at a tertiary care center. METHODS: Electronic health record and Humphrey Visual Field (HVF) data were collected for patients with at ≥5 HVF tests between 2014 and 2023. DFU was defined as exceeding provider-recommended intervals and quantified for each participant as the percentage of visits with DFU, mean days of DFU, and maximum days of DFU. Associations between DFU metrics and HVF progression were analyzed using covariate adjusted multivariable logistic regression models. Subgroup analyses by baseline mean deviation (MD) and a sensitivity analysis of patients with 2 or more HVF tests with case-control matching (age, follow-up duration, number of HVF tests, and baseline MD) were performed. MAIN OUTCOME MEASURES: HVF progression: MD linear regression slope ≤-0.5 dB/year across all tests. RESULTS: A total of 1121 eyes from 600 patients were included (mean follow-up: 7.3 years; mean baseline age: 73.7 years; 50.2% female). HVF progression occurred in 19.8% of eyes with baseline MD >-6 dB and 32.8% with baseline MD ≤-6 dB. Any DFU occurred in 53.4% of all visits. In multivariable analyses, percentage of visits with DFU, mean days of DFU, and maximum days of DFU were not associated with HVF progression, including in subgroup analyses. Older age, larger cup to disc ratio, shorter follow-up duration, higher number of HVF tests, and unmet social needs were associated with higher odds of HVF progression (all P < .05). In the matched case-control analysis, a mean DFU of >60 days was significantly associated with higher odds of HVF progression (aOR: 1.95; 95% CI: 1.03-3.68, compared to ≤30 days), and a maximum DFU of >365 days showed a borderline association (aOR: 1.77; 95% CI: 0.97-3.23, compared to ≤120 days) among patients with baseline MD <-6 dB. CONCLUSION: These findings suggest that longer follow-up intervals than those currently prescribed may not be associated with VF progression for most glaucoma patients.
Am J Ophthalmol
· 2026 May · PMID 42134616
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PURPOSE: To provide an update on the published associations between cardiovascular disease (CVD) and age-related macular degeneration (AMD). DESIGN: Evidence-based perspective. METHODS: Review of literature and experienc...PURPOSE: To provide an update on the published associations between cardiovascular disease (CVD) and age-related macular degeneration (AMD). DESIGN: Evidence-based perspective. METHODS: Review of literature and experience of authors. RESULTS: CVD is the leading cause of death worldwide, and AMD is the leading cause of irreversible blindness among the elderly. Both these conditions are associated with hypertension and smoking. Thus, it was expected that patients with CVD might be at higher risk for AMD, and AMD would be closely associated with CVD. However, such a general association has never been shown in dozens of studies. Instead, current evidence suggests that there are associations only between certain subsets of CVD and AMD. A strong association was shown to exist between specific high-risk cardiovascular diseases (HRCVDs) that confer compromised choroidal perfusion and the presence of subretinal drusenoid deposit (SDD), not ordinary soft drusen, which are considered the hallmark of intermediate AMD. We propose that this compromised choroidal perfusion is the underlying mechanism driving the formation of SDDs. We also propose, more generally, that the formation of SDDs result from the disruption of the normal metabolic support between the choriocapillaris and photoreceptors (PRs). We recommend that HRCVDs need to be studied in association with genetic risk-alleles to better understand the association between decreased choroidal perfusion and AMD progression. CONCLUSION: The strong association between SDDs to HRCVDs merits further investigation, especially in cardiovascular patients with SDDs carrying the high-risk alleles for AMD. Further prospective studies in both HRCVD and AMD patients are needed to elucidate the totality of clinical and genetic factors that drive AMD. These disease models can then be deployed to identify vasculopathic patients who need a retinal referral for AMD as well as AMD patients who need a cardiovascular workup to address undetected HRCVDs in patients with SDDs.
Davé N, Gonzalez DJT, Cernichiaro-Espinosa LA
… +2 more, King BA, Wilson MW
Am J Ophthalmol
· 2026 May · PMID 42128079
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OBJECTIVE: To evaluate the prognostic significance of one-year tumor volume regression (TVR) following low-dose-rate iodine-125 episcleral plaque brachytherapy (EPBT) in patients with uveal melanoma. DESIGN: Retrospectiv...OBJECTIVE: To evaluate the prognostic significance of one-year tumor volume regression (TVR) following low-dose-rate iodine-125 episcleral plaque brachytherapy (EPBT) in patients with uveal melanoma. DESIGN: Retrospective single-center clinical cohort study. PARTICIPANTS: A total of 1,180 patients with uveal melanoma treated with low-dose-rate iodine-125 EPBT delivered at 52.8 cGy/h over 168 hours at a large academic medical center with an ocular oncology service between 1984 and 2022. Patients had tumor ultrasound measurements at diagnosis and one-year follow-up, with complete survival data available. Patients without complete survival data or ultrasound measurements at either timepoint were excluded. MAIN OUTCOMES AND MEASURES: TVR was calculated using ultrasound-derived ellipsoid modeling at baseline and 1 year. Patients were stratified into delayed (≤33.3%), intermediate (33.3%-75%), and accelerated (≥75%) regression groups. Thresholds were selected using a log-rank test sweep across -100% to 100% regression in conjunction with locally weighted scatterplot smoothing (LOWESS) analysis. Inflection points were identified at 33.3% (p = .029) and 75% (p = .001). Kaplan-Meier (KM) survival analysis was used to compare overall survival (OS) among regression groups, with significance assessed by log-rank tests. RESULTS: Mean tumor volume decreased from 336.3 mm³ to 129.5 mm³ by one year, with 94.4% (N = 1,114) showing volume reduction. KM survival analysis demonstrated that patients with delayed and accelerated tumor regression had worse OS than those with intermediate-range regression across the full cohort (p < .0001, p < .0001). This association was conserved when tumors were stratified by Collaborative Ocular Melanoma Study (COMS) size and American Joint Committee on Cancer (AJCC) clinical stage guidelines. No difference was seen between the intermediate and accelerated regression groups for COMS small and cT1 tumors. CONCLUSION: TVR at 1 year following EPBT is a significant prognostic biomarker for OS in UM, with intermediate regression (33.33% to 75%) conferring the greatest survival benefit. These findings support 1 year tumor regression metrics as a practical tool for risk stratification and patient counseling.
Mizobuchi K, Inooka T, Aoki T
… +28 more, Anzai H, Torii K, Hashimoto K, Suga A, Ando R, Hiraoka M, Kominami T, Sato S, Tsujikawa M, Nishida K, Murakami Y, Nakazawa T, Maeda A, Kuniyoshi K, Ikeda Y, Kondo H, Kondo M, Nishiguchi KM, Murakami A, Fukami M, Nishina S, Iwata T, Saitsu H, Tsunoda K, Ueno S, Hotta Y, Nakano T, Hayashi T
Am J Ophthalmol
· 2026 May · PMID 42102949
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PURPOSE: To investigate genotype-phenotype correlations in a nationwide Japanese cohort of patients with RPGRIP1-associated retinal dystrophy. DESIGN: Retrospective, multicenter cohort study. METHODS: Japanese patients w...PURPOSE: To investigate genotype-phenotype correlations in a nationwide Japanese cohort of patients with RPGRIP1-associated retinal dystrophy. DESIGN: Retrospective, multicenter cohort study. METHODS: Japanese patients with biallelic pathogenic RPGRIP1 variants diagnosed with Leber congenital amaurosis (LCA) or achromatopsia (ACHM) were recruited from university hospitals throughout Japan. Genetic analyses included polymerase chain reaction for detection of the exon 18 deletion variant (exon 18-DEL), whole-exome sequencing, and whole-genome sequencing. Ophthalmic evaluations comprised best-corrected visual acuity (BCVA), visual field testing, full-field electroretinography, and multimodal retinal imaging. RESULTS: Thirty-four patients from 26 families (23 [18 families] with ACHM and 11 [8 families] with LCA) were included. Fourteen distinct RPGRIP1 variants were identified, with exon 18-DEL being the most prevalent (43 of 68 alleles, 63.2%). In ACHM, variants were predominantly clustered around exon 18, whereas LCA showed more diverse variant combinations. BCVA was significantly worse in LCA than in ACHM, although the rate of BCVA decline did not differ between phenotypes. Multimodal imaging demonstrated relatively preserved macular structure even in older patients with LCA, while ACHM showed age-dependent progressive outer retinal degeneration. Electroretinography revealed near-complete loss of rod and cone function in early infancy in LCA, whereas rod function was initially preserved in ACHM but gradually deteriorated. CONCLUSIONS: RPGRIP1 variants cause two distinct clinical phenotypes, LCA and ACHM, with clear genotype-phenotype correlations. The exon 18-DEL, observed in both phenotypes, likely represents a founder variant in the Japanese population. These findings expand the clinical spectrum of RPGRIP1-associated retinal dystrophy and have implications for molecular diagnosis, prognostic counseling, and future therapeutic development.
Am J Ophthalmol
· 2026 May · PMID 42102948
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PURPOSE: An aspiration of modern medicine is for disease treatment to improve progressively. Here we examine outcomes of treatment for monocular deprivation amblyopia, caused by a congenital cataract, at an academic medi...PURPOSE: An aspiration of modern medicine is for disease treatment to improve progressively. Here we examine outcomes of treatment for monocular deprivation amblyopia, caused by a congenital cataract, at an academic medical center over several decades. The question we addressed was whether outcomes have improved substantially, or whether they have remained stubbornly disappointing. DESIGN: Retrospective, trend study. METHODS: Patients with deprivation amblyopia due to primary monocular congenital cataract removed before 1 year of age were studied. Preoperative and outcome data were collated from sequential examinations to document corrected distance visual acuity (CDVA), binocular visuomotor behaviors, anterior segment and vitreo-retinal health, adherence to therapies, demographic variables, and the need for subsequent surgical interventions. Biometry measurements were recorded at the time of initial cataract surgery. The primary outcome measure was CDVA. Additional outcomes measures were prevalence of nystagmus, strabismus, ocular hypertension (OHT)/glaucoma, and number of ocular surgeries. RESULTS: A total of 80 children met inclusion criteria, with a median follow-up age of 12 years. Median CDVA of amblyopic eyes at last follow-up was 1.40 logMAR or 20/500 (interquartile range = 0.75-CF). There were no significant differences in CDVA for patients with cataract extraction between 1990 and 1999, 2000 and 2009, and 2010 and 2022 (P = .25), with medians of 1.00, 1.44, and 1.40 logMAR, respectively. Better CDVA was related systematically to earlier age at surgery, but the correlation was weak (P = .06). In all, 96% of the children (77 of 80) had secondary implantation of an intraocular lens. Strabismus developed in 98% of the children (78 of 80), and fusion maldevelopment nystagmus in 73% (58 of 80). A total of 43% (34 of 80) required subsequent surgery for removal of a secondary cataract, and 30% (24 of 80) required surgery to treat aphakic or pseudophakic OHT/glaucoma. The median number of total ophthalmic surgeries was 5 (IQR = 3-6). CONCLUSIONS: Visual acuity outcomes for monocular deprivation amblyopia remain disappointing. Adherence to patching therapy and contact lens wear is burdensome and often is not achieved. Children with the condition require an average of 4 subsequent surgeries in the first decade of life for intraocular lens implantation, removal of a secondary cataract, strabismus, or glaucoma.
Cordisco AJ, Jin F, Hamedani AG
… +1 more, VanderBeek BL
Am J Ophthalmol
· 2026 May · PMID 42097475
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PURPOSE: Multiple sclerosis (MS) is associated with an increased risk of noninfectious uveitis (NIU). Whether disease-modifying therapies (DMTs) for MS alter this risk is unknown. Our objective was to determine the compa...PURPOSE: Multiple sclerosis (MS) is associated with an increased risk of noninfectious uveitis (NIU). Whether disease-modifying therapies (DMTs) for MS alter this risk is unknown. Our objective was to determine the comparative risk of NIU after DMT initiation for MS. DESIGN: Retrospective clinical cohort study using Optum's deidentified Clinformatics Data Mart database, which is comprised of medical claims for patients enrolled in commercial and Medicare Advantage insurance plans from January 1, 2000, to June 30, 2022. PARTICIPANTS: Adults with MS, defined by ≥3 diagnosis codes on separate dates, who received ≥1 DMT prescription and had ≥2 years of prior enrollment. Participants could contribute multiple treatment episodes if they switched therapies. METHODS: Users of interferons, fumarates, nucleic acid synthesis inhibitors/sphingosine-1-phosphate (S1P) modulators, natalizumab, and anti-CD20 monoclonal antibodies were compared to glatiramer acetate as the reference. MAIN OUTCOME MEASURES: Marginal Cox models with robust sandwich covariance matrix estimation were used to calculate adjusted hazard ratios (aHR) for incident NIU, defined as a new International Classification of Diseases code for NIU with a 2nd confirmatory diagnosis within 120 days. A sensitivity analysis varied this definition to require a new concurrent corticosteroid prescription or ocular injection within 120 days of diagnosis. DMT-specific propensity score models were constructed using multivariable logistic regression with generalized estimating equations to calculate overlap weights for adjustment. Participants were censored if they switched treatments, underwent intraocular surgery, or disenrolled. RESULTS: Across 48,221 treatment episodes for 43,501 patients, median follow-up ranged from 562 to 703 days. Compared to glatiramer acetate, the NIU incidence was lower for nucleic acid synthesis inhibitors/S1P modulators (aHR 0.14, 95% CI: 0.07-0.29), fumarates (aHR 0.51, 95% CI: 0.36-0.74), anti-CD20 (aHR 0.66, 95% CI, 0.51-0.85), and interferons (aHR 0.67, 95% CI: 0.50-0.91), but not natalizumab (aHR 0.87, 95% CI: 0.61-1.24). Sensitivity analysis confirmed findings for fumarates (aHR 0.56, 95% CI: 0.38-0.82) and nucleic acid synthesis inhibitors/S1P modulators (aHR 0.16, 95% CI: 0.08-0.33). CONCLUSIONS: Certain DMT classes are associated with a protective effect for NIU in MS. If confirmed, these medications could be targeted for personalized MS treatment and potentially repurposed to treat NIU in other patient populations.
Arora A, Sharma M, Gentile P
… +4 more, Agarwal A, Dogra M, Sharma A, Gupta V
Am J Ophthalmol
· 2026 May · PMID 42092574
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PURPOSE: Ocular tuberculosis (OTB) affecting the posterior segment commonly presents with choroiditis lesions. However, tubercular retinitis (TBR) is a rare and poorly characterized phenotype. This study aims to define t...PURPOSE: Ocular tuberculosis (OTB) affecting the posterior segment commonly presents with choroiditis lesions. However, tubercular retinitis (TBR) is a rare and poorly characterized phenotype. This study aims to define the clinical spectrum, multimodal imaging characteristics, natural course of TBR lesions, and differentiate it from similar appearing chorioretinal lesions in OTB. DESIGN: Single-center, retrospective case series. METHODS: The study included patients presenting with lesions clinically suggestive of retinitis. Clinical data, fundus findings, and multimodal imaging (ultrawidefield fundus photography, fluorescein and indocyanine green angiography, and optical coherence tomography [OCT]) were analyzed. The diagnosis of OTB was established based on the Collaborative Ocular Tuberculosis Study criteria, which includes supportive immunological and radiological evidence (positive Mantoux test or interferon-gamma release assay, and chest imaging). All patients received standard four-drug antitubercular therapy (ATT) with adjunctive corticosteroids and were followed for anatomical and functional outcomes. RESULTS: Eight patients (six males; age range: 21-54 years) were included. A total of 37 lesions were identified in 12 eyes (median: 2 lesions per eye). Twenty-five lesions (67.6%) were purely retinal with no choroidal involvement and were classified as TBR. Twelve lesions (32.4%) showed involvement of the choroid, retinal pigment epithelium (RPE), and outer retina, and were classified as tubercular retinochoroiditis (TBRC). All the eyes demonstrated occlusive retinal vasculitis. Fluorescein angiography of TBR lesions demonstrated early central hypofluorescence with circumferential perilesional hyperfluorescence ("moat sign"). On OCT, TBR lesions were intraretinal and characterized by full-thickness hyper-reflectivity and disruption of inner retinal architecture with no choroidal/RPE changes. TBRC lesions showed outer retinal disruption, RPE irregularity with focal defects, and choroidal shadowing. Indocyanine green angiography showed focal hypofluorescence in TBRC lesions, but was unremarkable in TBR. Following ATT, TBR lesions healed without pigmentation or scarring, whereas TBRC lesions resolved with discrete pigmented scars with retinal thinning and RPE disruption on OCT (32.4%) (P = .028s). CONCLUSIONS: The spectrum of posterior segment involvement in OTB includes intraretinal inflammation that can present as TBR and TBRC. These lesions are typically present in eyes with occlusive retinal vasculitis. Features on clinical examination and multimodal imaging help identify the tubercular etiology and differentiate between TBR and TBRC lesions.
Yang LY, Kam AW, Chen FK
… +17 more, Jeffery RCH, Farag A, Kalevar A, Chhablani J, Lupidi M, Chilov M, Branley M, Ip J, Kalatzis D, Dhanji S, Bestch D, Gupta RR, Choudhry N, Cabral D, Baumal CR, Freund KB, Fung AT
Agarwal A, Menia NK, Invernizzi A
… +8 more, Ramtohul P, Marchese A, Fonollosa A, Pichi F, Tyagi M, Baharani A, Baddar D, Mehta S
Am J Ophthalmol
· 2026 May · PMID 42086101
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PURPOSE: Endogenous fungal endophthalmitis (EFE) is a rare, sight-threatening intraocular infection with heterogeneous clinical presentations. Candida and Aspergillus species are the most common etiologic agents and may...PURPOSE: Endogenous fungal endophthalmitis (EFE) is a rare, sight-threatening intraocular infection with heterogeneous clinical presentations. Candida and Aspergillus species are the most common etiologic agents and may manifest with retinochoroiditis lesions that can be challenging to differentiate clinically. Accurate identification of the causative organism is essential for targeted antifungal therapy, anticipating disease progression, and optimizing outcomes. This study aimed to differentiate the etiology of EFE-associated retinochoroiditis using detailed clinical and optical coherence tomography (OCT) analysis. DESIGN: International, multicenter, retrospective comparative case series. METHODS: Demographic information, clinical characteristics, fundus photography, and OCT scans of patients with culture-proven Candida or Aspergillus EFE presenting with retinochoroiditis lesions were collected from eight tertiary-care centers worldwide. Lesion morphology (size, location, multifocality, and associated features) and OCT patterns (vitreal changes, vitreoretinal interface abnormalities, inner/outer retinal infiltration, and choroidal involvement) were compared between groups. Student's t-tests were used for continuous variables and Fisher's exact tests for categorical variables. Multivariable logistic regression and a random forest classifier were applied to identify the features most predictive of fungal species. RESULTS: Thirty-eight eyes of 30 patients (mean age: 64.7 ± 15 years) were included: 28 with Candida and 10 with Aspergillus EFE. Foveal involvement occurred only in Candida cases (28.6% eyes). Compared with Aspergillus, Candida EFE showed significantly more multifocal lesions (P = .008), mid-peripheral/peripheral involvement (P = .004), satellite lesions (P = .001), and "string-of-pearls" vitreous exudates (P = .05). Aspergillus eyes had larger lesions (2.4 vs. 1.2 disc-diameters; P = .001), more pre-/subretinal hemorrhage (P = .03), and higher rates of occlusive vasculitis (P = .008). On OCT, Candida eyes demonstrated more vitreous condensations/rain-cloud sign (P = .03), preretinal aggregates (P = .02), and intraretinal fluid (IRF) (P = .04). Aspergillus infections more commonly exhibited full-thickness involvement with dense shadowing (P = .001) and choriocapillaris alteration (P = .008). Multivariable regression and random forest analysis identified lesion size, multifocality, satellite lesions, hemorrhage/vasculitis, IRF, and choriocapillaris alteration as the most discriminative features. These features allowed species differentiation with ∼85% accuracy using machine-learning classification. CONCLUSIONS: Candida and Aspergillus EFE presenting with retinochoroiditis exhibit distinct features that allow reliable differentiation between these fungal etiologies. These OCT-based biomarkers may inform early organism-specific management while awaiting microbiological confirmation.
Am J Ophthalmol
· 2026 May · PMID 42082070
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PURPOSE: To analyze patterns of nonsuccess in phase 2 and 3 interventional retinal clinical trials conducted in the United States between 2015 and 2025. DESIGN: Perspective based on retrospective analysis of unsuccessful...PURPOSE: To analyze patterns of nonsuccess in phase 2 and 3 interventional retinal clinical trials conducted in the United States between 2015 and 2025. DESIGN: Perspective based on retrospective analysis of unsuccessful clinical trials. METHODS: Unsuccessful trials that were terminated, withdrawn, or completed without meeting primary endpoints were evaluated across indications, trial phases, intervention classes, and mechanisms of action to identify recurring design, feasibility, and operational challenges. RESULTS: High attrition rates were observed across diabetic macular edema, diabetic retinopathy, neovascular age-related macular degeneration, and geographic atrophy. Phase 2 trials were more frequently discontinued following interim analyses, whereas phase 3 trials more often failed to meet primary efficacy endpoints. Later-phase studies were associated with increased sample size, geographic dispersion, follow-up duration, and assessment burden. Differences in endpoint selection, comparator choice, and population heterogeneity may contribute to attenuation of treatment effects. Operational and sponsor-level factors, including strategic and financial considerations, were also associated with trial discontinuation. CONCLUSIONS: Translating early-stage findings into successful late-phase outcomes remains challenging in retinal drug development. Improved alignment of biological rationale, endpoint selection, and operational feasibility may enhance trial success.
Am J Ophthalmol
· 2026 May · PMID 42082068
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PURPOSE: To benchmark multiple automated machine learning (AutoML) platforms for diabetic retinopathy (DR) screening from fundus photographs using a unified training and evaluationframework, with human consensus grading...PURPOSE: To benchmark multiple automated machine learning (AutoML) platforms for diabetic retinopathy (DR) screening from fundus photographs using a unified training and evaluationframework, with human consensus grading and an FDA-approved autonomous system (IDx-DR) as reference standards. DESIGN: Retrospective, diagnostic performance and benchmarking study. METHODS: Image classifiers were trained on large public datasets labeled according to the International Clinical Diabetic Retinopathy (ICDR) scale (APTOS, n = 5590; DDR, n = 12,524; EyePACS, n = 31,557) after automated image-quality filtering. Performance was evaluated on an independent, institutionally collected patient-level test cohort (n = 726) using the highest DR grade across all images for patient-level classification. The evaluated platforms included Google Vertex AI, Amazon Rekognition, Amazon SageMaker Canvas, AutoGluon, AutoKeras, and Apple CreateML. Models were assessed for 3 screening endpoints-any DR, referable DR (RDR), and sight-threatening DR (STDR)-across probability thresholds of 20%, 50%, and 70%. The primary endpoints were the Area Under the Receiver Operating Characteristic Curve (AUC) and sensitivity for RDR at a 50% decision threshold. Secondary endpoints included specificity, positive predictive value, negative predictive value, accuracy, and F1-score with 95% confidence intervals. Pairwise comparisons were performed using bootstrap testing (n = 1000) for AUC differences and McNemar's test (at a 50% threshold) for binary outcomes, both subjects to Bonferroni correction (P < .0033). Grad-CAM was applied to locally deployable convolutional neural network-based models. RESULTS: Using human consensus grading as the reference standard, Amazon SageMaker Canvas and AutoGluon demonstrated the strongest overall discrimination, achieving AUC values up to0.96 for STDR and 0.93 to 0.94 for RDR. At the 50% decision threshold, Canvas showed the most balanced performance for RDR (sensitivity 88.3%, specificity 85.5%, accuracy 86.0%), whereasAutoGluon favored sensitivity (any DR sensitivity 95.9%) at the expense of specificity. Vertex AI showed consistently weaker and unstable performance (any DR AUC 0.58; RDR AUC 0.38). Relative to IDx-DR, Amazon Rekognition and Canvas showed the highest agreement, particularly for STDR (AUC up to 0.88-0.90; κ up to ∼0.56). Agreement with human graders was generallylow to moderate (κ ≈ 0.3-0.6) and increased at higher probability thresholds. CONCLUSIONS: AutoML platforms can achieve clinically meaningful performance for DR screening. Differences across tools and thresholds reflect their adaptability to diverse clinical settings, underscoring the importance of external validation and threshold calibration.
PURPOSE: To report the clinical outcomes of intrascleral fixation of implantable capsular hooks for managing subluxated lenses. DESIGN: Prospective, noncomparative, interventional case series. METHODS: Patients with subl...PURPOSE: To report the clinical outcomes of intrascleral fixation of implantable capsular hooks for managing subluxated lenses. DESIGN: Prospective, noncomparative, interventional case series. METHODS: Patients with subluxated lenses who underwent in-the-bag intraocular lens (IOL) implantation assisted by capsular tension ring and implantable capsular hook(s) made of 7-0 polypropylene sutures were included. The main postoperative outcome measure was IOL position, including IOL decentration, tilt, postoperative anterior chamber depth, and the distance between IOL and iris. Secondary postoperative outcomes included best-corrected visual acuity, spherical equivalent, corneal endothelial cell density, intraocular pressure, and complications. RESULTS: Seventy-four eyes of 74 patients were enrolled, with a mean follow-up of 13.2 ± 8.9 months (range: 6-36 months). The IOL position remained stable throughout the follow-up period, with a mean IOL decentration of 0.31 ± 0.24 mm and a mean tilt of 1.83 ± 1.35° at the final follow-up visit. Both postoperative anterior chamber depth and the distance between IOL and iris remained stable, with values of 3.91 ± 0.33 mm and 0.65 ± 0.26 mm at the final follow-up visit, respectively. The mean best-corrected visual acuity improved from 0.75 ± 0.73 logarithm of the minimum angle of resolution (Snellen 20/112) preoperatively to 0.24 ± 0.28 logarithm of the minimum angle of resolution (Snellen 20/35) at the final follow-up visit (P < .05). The mean spherical equivalent was -2.37 ± 4.68 D preoperatively and -1.09 ± 1.33 D at the final follow-up visit (P < .05). The mean endothelial cell density decreased from 2577.64 ± 486.10 cells/mm preoperatively to 2171.31 ± 707.23 cells/mm at the final follow-up visit with a mean loss of 14.70 ± 14.60% (P < .05). The intraoperative complication was transient mild bleeding during penetration of the scleral wall (n = 4, 5.4%). Postoperative complications included intraocular pressure elevation (n = 9, 12.2%), hypotony (n = 2, 2.7%), grade 2 anterior chamber cells (n = 2, 2.7%), retinal detachment (n = 1, 1.4%), cystoid macular edema (n = 1, 1.4%), and posterior capsule opacification (n = 1, 1.4%). CONCLUSIONS: Intrascleral fixation of implantable capsular hooks enables in-the-bag IOL implantation in eyes with subluxated lenses and represents a feasible, stable, and safe approach.
PURPOSE: To estimate the cumulative incidence of strabismus among children diagnosed with retinopathy of prematurity (ROP). DESIGN: Retrospective cohort study. METHODS: Participants were children and adolescents aged ≤18...PURPOSE: To estimate the cumulative incidence of strabismus among children diagnosed with retinopathy of prematurity (ROP). DESIGN: Retrospective cohort study. METHODS: Participants were children and adolescents aged ≤18 years with a diagnosis of ROP, with or without treatment exposure. We defined treated ROP as receipt of laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, whereas untreated ROP had no record of either intervention. We estimated the cumulative incidence of strabismus at 1, 3, and 5 years after ROP diagnosis using Kaplan-Meier analysis. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for demographic variables and ocular comorbidities. The main outcome measure was development of strabismus following ROP diagnosis. RESULTS: The cohort included 27,720 ROP patients: 973 were treated, and 26,747 were untreated. cumulative incidence of strabismus was consistently higher among treated patients. At 5 years, cumulative incidence was 34.78% in treated patients compared with 22.14% in untreated patients, with esodeviations as the most common subtype, occurring in 22.35% of treated patients and 11.87% of untreated patients. Treatment exposure was independently associated with an increased hazard of strabismus (aHR = 1.58; 95% CI = 1.29-1.95; P < .001). Amblyopia (aHR = 2.58; 95% CI = 2.25-2.96; P < .001) and nystagmus (aHR = 1.76; 95% CI = 1.48-2.10; P < .001) were also independently associated with increased hazard. CONCLUSIONS: ROP confers an increased hazard of developing subsequent strabismus, with higher cumulative incidence among children who underwent treatment for ROP.
OBJECTIVE: To examine the association between retinal nerve fiber layer (RNFL) thickness and the severity of cardiovascular-kidney-metabolic (CKM) syndrome in a large community cohort. DESIGN: Retrospective cross-section...OBJECTIVE: To examine the association between retinal nerve fiber layer (RNFL) thickness and the severity of cardiovascular-kidney-metabolic (CKM) syndrome in a large community cohort. DESIGN: Retrospective cross-sectional analysis of a community-based cohort. PARTICIPANTS: UK residents 40 to 60 years of age at enrollment of UK Biobank. METHODS: The cohort underwent baseline examination from April 2007 to October 2010. We analyzed high-quality optical coherence tomography images and identified the presence of CKM syndrome. We explored associations between RNFL and CKM syndrome severity using multivariable logistic regression. MAIN OUTCOME MEASURES: Odds ratios (OR) for having advanced CKM syndrome (stage 3 or higher) at baseline were calculated after adjustment for age, sex, ethnicity, intraocular pressure, education and socioeconomic status. RESULTS: A total of 17,082 participants were included (mean age 57.63 ± 7.66 years old, 56.8% females) in the study, and 15,892 participants (93.0%) had CKM syndrome stage 1 or higher at baseline. Advanced CKM syndrome was observed more frequently in the thinnest quintile of RNFL thickness (14.8%) in comparison to the thickest quintile (9.1%). A multivariate regression controlling for potential confounders showed that decrease in RNFL thickness by 1 µm increased the risk of having advanced CKM syndrome by 2.4% (OR 1.024, 95% CI: 1.010-1.039, P = .001) at baseline. CONCLUSIONS: Thinner RNFL is associated with advanced CKM syndrome in individuals without a previous neurodegenerative or ocular disease. Our findings suggest that RNFL may serve as a valuable marker for monitoring disease severity of CKM syndrome. Further research, however, is warranted to investigate the pathways linking RNFL and CKM syndrome and to validate RNFL as a prognostic marker for CKM syndrome in larger populations.