Am. J. Ophthalmol. [JOURNAL]
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200 papers
Intraindividual Comparison of Two Refractive Extended-Depth-of-Focus Intraocular Lens Designs.
Zeilinger J, Palkovits S, Ruiss M … +4 more , Pilwachs C, Necpal P, Elahi A, Findl O
Am J Ophthalmol · 2026 Apr · PMID 42044763 · Publisher ↗
PURPOSE: To compare intraindividual differences in visual performance of two refractive extended-depth-of-focus (EDF) intraocular lenses (IOLs) targeted for emmetropia. DESIGN: Prospective, randomized, patient- and exami...
PURPOSE: To compare intraindividual differences in visual performance of two refractive extended-depth-of-focus (EDF) intraocular lenses (IOLs) targeted for emmetropia. DESIGN: Prospective, randomized, patient- and examiner-masked intraindividual comparative study. METHODS: A total of 40 patients (80 eyes) with bilateral age-related cataract underwent phacoemulsification with implantation of refractive EDF IOL in each eye: a wavefront-shaped refractive EDF IOL (DEN00V, Johnson & Johnson Vision) in one eye and a sector-segmented EDF IOL (AN6V, Teleon) in the fellow eye. After 3 months, monocular distance- corrected and uncorrected distance (CDVA/UDVA) intermediate (DIVA/UIVA) and near (DNVA/UNVA) visual acuity, refractive outcomes, defocus curves, contrast sensitivity, halometry, and subjective visual quality using questionnaires were compared. RESULTS: In 37 patients (74 eyes), mean UDVA at 4 m, DIVA at 66 cm and UDNVA at 40 cm were 0.05 ± 0.10, 0.17 ± 0.11, and 0.31 ± 0.11 logMAR for the DEN00V and 0.06 ± 0.10, 0.15 ± 0.10, and 0.32 ± 0.11 logMAR for the AN6V, respectively, with no significant differences. A statistically significant difference was observed for the primary endpoint, UIVA, with 0.18 ± 0.13 logMAR for the DEN00V and 0.12 ± 0.09 logMAR for the AN6V. Nominal differences were observed for CDVA and UNVA with 0.01 ± 0.07 and 0.32 ± 0.12 logMAR for the DEN00V and -0.02 ± 0.07 (P = .01) and 0.25 ± 0.10 (P = .01) logMAR for the AN6V. Further nominal differences could be shown for contrast sensitivity under photopic and mesopic conditions. However, these differences did not remain statistically significant after adjustment for multiple comparisons. CONCLUSIONS: Both IOLs demonstrated an extended range of functional vision, preserved contrast sensitivity, and minimal photopic phenomena. A statistically significant difference was observed for the primary endpoint, UIVA, favoring the AN6V.
Axial Length, Refraction, and the Language of Ophthalmology.
Chang TCP, Bartlett CF, Khan AO
Am J Ophthalmol · 2026 Apr · PMID 42035860 · Publisher ↗
PURPOSE: To examine the historical and conceptual divergence between refractive terminology (myopia, hyperopia, emmetropia) and ocular axial length, to quantify the relative contributions of axial length and other biomet...
PURPOSE: To examine the historical and conceptual divergence between refractive terminology (myopia, hyperopia, emmetropia) and ocular axial length, to quantify the relative contributions of axial length and other biometric components to refractive error, and to propose linguistic and clinical strategies to improve precision in ophthalmic communication. DESIGN: Perspectives. RESULT: Historical review shows refractive terms originated as descriptors of visual function rather than globe anatomy; only in the 19th century did axial elongation become linked to myopia. Contemporary biometric and modeling studies demonstrate that axial length is the dominant single contributor to refractive error but is not determinative. Population analyses report moderate to strong correlations between spherical equivalent and axial length and stronger correlations with composite indices such as the axial length-to-corneal radius ratio. Axial length alone explains roughly 29% of refractive variance and the axial length-to-corneal radius ratio approximately 56%, whereas multivariable models incorporating axial length, corneal curvature, anterior chamber depth, and lens power account for >99% of variance. Therefore, the Greek-derived terms dolichophthalmia ("long eye") and brachyophthalmia ("short eye") more accurately denote globe dimensions compared with refractive terminology, while finding an appropriate term to describe an eye with "normal" or "typical" axial length remains challenging. CONCLUSION: Refractive state and axial length are related but distinct constructs. Greater precision-by specifying structural contributors (axial, lenticular, corneal) or reporting biometric measures relative to age-adjusted norms, and by adopting anatomically explicit terminology-will improve clinical communication, risk assessment, and research clarity.
Reply to Comment on: Prediction of 9 Artificial Intelligence-Based Intraocular Lens Power Calculation Formulas in Long Caucasian Eyes.
Stopyra W, Voytsekhivskyy O, Grzybowski A … +2 more , Wang LI, Koch DD
Am J Ophthalmol · 2026 Apr · PMID 42034211 · Publisher ↗
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Visual Impairment as a Marker of Systemic Vulnerability and Cause-Specific Mortality in U.S. Adults.
Kim T, Liu JZ, Zhou J … +6 more , Yang AJ, Sheen M, Parvaresh-Rizi A, Chaaya C, Weng CH, Patel NA
Am J Ophthalmol · 2026 Apr · PMID 42034210 · Publisher ↗
OBJECTIVE: To determine whether the excess mortality associated with visual impairment (VI) in U.S. adults is driven primarily by non-cardiovascular, non-cancer causes of death rather than cardiovascular or malignant cau...
OBJECTIVE: To determine whether the excess mortality associated with visual impairment (VI) in U.S. adults is driven primarily by non-cardiovascular, non-cancer causes of death rather than cardiovascular or malignant causes. DESIGN: Population-based cohort study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults aged 40 years or older participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2008 with measured presenting visual acuity in both eyes and eligibility for linkage to the National Death Index. METHODS, INTERVENTION, OR TESTING: Presenting visual impairment was defined as visual acuity worse than 20/40 in the better-seeing eye using standardized examination protocols. Mortality outcomes were ascertained through December 31, 2019. Survey-weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and clinical covariates. MAIN OUTCOME MEASURES: All-cause mortality. Secondary outcomes included non-cardiovascular, non-cancer mortality, cardiovascular mortality, and cancer mortality. RESULTS: The analytic cohort included 11,938 participants, of whom 1179 (9.9%) had visual impairment at baseline. Over a mean follow-up of 13.2 years, visual impairment was most strongly associated with non-cardiovascular, non-cancer mortality (adjusted HR, 1.55; 95% CI, 1.30-1.84). Visual impairment was also associated with increased all-cause mortality (HR, 1.36; 95% CI, 1.17-1.57) and cardiovascular mortality (HR, 1.33; 95% CI, 1.02-1.72), but not cancer mortality (HR, 0.98; 95% CI, 0.69-1.40). Associations were robust across sensitivity analyses, including exclusion of participants with diabetes, exclusion of early deaths, and alternative visual impairment thresholds. CONCLUSIONS: In this nationally representative cohort, visual impairment was independently associated with increased mortality, driven primarily by non-cardiovascular, non-cancer causes of death. These findings suggest that vision loss may serve as a marker of systemic vulnerability and support integrating vision assessment into chronic disease management and preventive care strategies.
Vitamin B Intake Is Associated With Lower Incidence of Open-Angle Glaucoma: The Rotterdam Study.
van Haarlem MT, van Garderen KA, de Vries VA … +4 more , van Rooij FJA, Klaver CCW, Vergroesen JE, Ramdas WD
Am J Ophthalmol · 2026 Apr · PMID 42034209 · Publisher ↗
OBJECTIVE: There is increasing evidence that B-vitamins may be important for open-angle glaucoma (OAG) prevention due to their roles in neuroprotection, vascular health, and the regulation of homocysteine metabolism, whi...
OBJECTIVE: There is increasing evidence that B-vitamins may be important for open-angle glaucoma (OAG) prevention due to their roles in neuroprotection, vascular health, and the regulation of homocysteine metabolism, which may influence optic nerve integrity and intraocular pressure (IOP). Therefore, we examined the association between dietary intake of B-vitamins and incident OAG (iOAG). DESIGN: We used data from the Rotterdam Study, a prospective, population-based cohort study in the Netherlands. PARTICIPANTS: We included participants who were free of OAG at baseline, had at least 1 ophthalmic follow-up, and complete data on dietary intake. Among 6742 participants (mean [standard deviation]; age, 62.4 [7.4] years; 58.2% female), 162 developed iOAG. METHODS: The associations between energy-adjusted dietary intake of B-vitamins and iOAG, IOP, retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer (GCL) thickness were assessed using multivariable logistic and linear regression analyses, respectively. All analyses were adjusted for at least age, sex, caloric intake, diet quality, and follow-up time. MAIN OUTCOME MEASURES: The primary outcome was iOAG. Secondary outcomes included IOP, RNFL thickness, and GCL thickness. RESULTS: Dietary intakes of niacin (vitamin B3; odds ratio [OR] with corresponding 95% confidence interval [CI]: 0.94 [0.90-0.98] per mg/d) and cobalamin (vitamin B12; OR [95%CI]: 0.90 [0.83-0.97] per µg/d) were significantly associated with decreased iOAG. Participants with the highest niacin intake (Q5, mean crude intake: 23.27 mg/d) had a significantly lower risk of iOAG (OR [95%CI]: 0.43 [0.21-0.86], p-trend=0.02) compared to those with the lowest intake (Q1, mean crude intake: 9.98 mg/d). A similar association was observed for cobalamin (Q5 [mean crude intake: 10.47 µg/d] vs. Q1 [mean crude intake: 0.19 µg/d], OR [95%CI]: 0.25 [0.12-0.52], p-trend<0.001). Moreover, there was a significant trend towards a lower IOP with higher niacin (p-trend=0.04) and cobalamin (p-trend=0.03) intake. Additionally, cobalamin intake was associated with increased GCL thickness (Beta [95%CI]: 0.01 [0.00-0.03] µg/d; p-trend=0.002). Other B-vitamins were not associated with iOAG or the OAG-associated outcomes. CONCLUSIONS: Higher dietary intake of niacin and cobalamin was associated with a lower risk of iOAG. Niacin supplementation may be recommended to individuals with a high genetic susceptibility for OAG. More research on cobalamin is warranted.
Reply to Comment on: Assessing the Fragility of Statistically Significant Outcomes in Randomized Controlled Trials of Minimally Invasive Glaucoma Surgery (MIGS).
Ansari AS, Gazzard G
Am J Ophthalmol · 2026 Apr · PMID 42031089 · Publisher ↗
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Glucagon-Like Peptide-1 Receptor Agonists and Risk of Systemic and Ocular Vascular Complications in Patients With Type 2 Diabetes and Diabetic Retinopathy.
Shah J, Makwana B, Panchal K … +11 more , Patel V, Patel T, Khadke S, Verma A, Vivekanandan S, Kong Y, Upadhyay J, Dani SS, Ramsey KM, Ganatra S, Ramsey DJ
Am J Ophthalmol · 2026 Apr · PMID 42025665 · Publisher ↗
PURPOSE: To evaluate the association of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) use on macrovascular and microvascular outcomes in patients with type 2 diabetes (T2D) and diabetic retinopathy (DR)-a high-ri...
PURPOSE: To evaluate the association of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) use on macrovascular and microvascular outcomes in patients with type 2 diabetes (T2D) and diabetic retinopathy (DR)-a high-risk group often excluded from clinical trials. DESIGN: Retrospective, population-based cohort study. PARTICIPANTS: Adults aged ≥18 years with T2D (with hemoglobin A1c of ≥6.5%) and a pre-existing diagnosis of DR from the TriNetX research network database between January 1, 2015, and December 31, 2022. METHODS: The study included 173,216 adults with T2D, all of whom had DR, adjusted for baseline characteristics through propensity score matching (PSM) based on whether the individuals received at least 2 prescriptions of a GLP-1 RA (semaglutide, dulaglutide, liraglutide, exenatide, tirzepatide, or lixisenatide) at least 6 months apart. MAIN OUTCOME MEASURES: Cox proportional hazard regression models were used to evaluate the association between GLP-1 RAs and the risk of incident macrovascular and microvascular complications over a 2-year follow-up period. RESULTS: After PSM, 30,613 individuals (mean [SD] age, 61.6 [11.4] years; 53.2% were females) were prescribed GLP-1 RAs. Patients on GLP-1 RAs had a decreased risk of myocardial infarctions (MIs; hazard ratio [HR], 0.65; 95% CI, 0.61-0.69), coronary artery revascularization procedures (HR, 0.75; 95% CI, 0.67-0.84), heart failure exacerbations (HR, 0.78; 95% CI, 0.76-0.81), ischemic strokes (HR, 0.78; 95% CI, 0.74-0.83), lower extremity amputations (HR, 0.78; 95% CI, 0.69-0.88), acute kidney injuries (AKI; HR, 0.68; 95% CI, 0.66-0.71), or the need for renal replacement therapy (RRT; HR, 0.40; 95% CI, 0.36-0.43). Fewer individuals also progressed to proliferative diabetic retinopathy (HR, 0.78; 95% CI, 0.71-0.86), experienced retinal vein occlusions (RVOs; HR, 0.70; 95% CI, 0.61-0.80), or developed neovascular glaucoma (HR, 0.65; 95% CI, 0.47-0.89); no association was observed for retinal artery occlusions (RAOs; HR, 0.85; 95% CI, 0.57-1.26) or cases of non-arteritic ischemic optic neuropathy (NAION; HR, 0.88; 95% CI, 0.54-1.44). CONCLUSIONS: In patients with T2D and pre-existing DR, the use of GLP-1 RAs was associated with a reduced risk of major macrovascular and microvascular complications, including those directly affecting the retina. Future studies are needed to assess the extent to which GLP-1 RAs benefit long-term outcomes.
Temporal Incidence of Dry Eye Disease, Visual Disturbances, and Ocular Pain After Laser-Assisted In Situ Keratomileusis Versus Photorefractive Keratectomy.
Kang S, Persad LS, Woreta FA … +1 more , Yoo SH
Am J Ophthalmol · 2026 Apr · PMID 42025664 · Publisher ↗
PURPOSE: To compare the incidence and timing of postoperative complications between laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) within a national clinical registry. DESIGN: Retrosp...
PURPOSE: To compare the incidence and timing of postoperative complications between laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) within a national clinical registry. DESIGN: Retrospective registry-based clinical cohort study. PARTICIPANTS: A total of 48,892 eyes of 27,372 patients who underwent refractive surgery in the IRIS Registry (Intelligent Research in Sight). METHODS: LASIK and PRK procedures were identified using Healthcare Common Procedure Coding System codes. Postoperative complications, including dry eye disease (DED), visual disturbances, and ocular pain, were identified using International Classification of Diseases codes and analyzed at the eye level. Incidence was evaluated across three postoperative intervals (1 day to 1 month, 1 to 3 months, and 3 to 12 months). Interval-specific incidence rates and incidence rate ratios (IRRs) comparing LASIK and PRK were estimated using multivariable-adjusted Poisson generalized estimating equations. MAIN OUTCOME MEASURES: Interval-specific incidence of postoperative complications and comparative IRRs between LASIK and PRK. RESULTS: DED was the most frequently documented postoperative complication, occurring in 16.1% of LASIK eyes and 15.6% of PRK eyes over the follow-up period. During the 1 to 3 months interval, LASIK was associated with a lower incidence of DED compared with PRK (IRR, 0.8 [95% confidence interval (CI), 0.7-0.9]). In the first postoperative month, visual disturbances occurred more frequently after PRK (IRR, 0.3 [95% CI, 0.3-0.4]), but differences between procedures were not significant at later intervals. Ocular pain was rare after both procedures, with no consistent differences in early intervals, but showed a lower incidence after LASIK in the 3 to 12 months interval (IRR, 0.5 [95% CI, 0.3-0.9]). CONCLUSIONS: Postoperative complication profiles following refractive surgery varied by procedure and postoperative interval. PRK was associated with a higher risk of visual disturbances in the early postoperative period and a higher incidence of DED during the 1 to 3 months interval compared with LASIK. Ocular pain was rare overall but showed a lower incidence after LASIK in the 3 to 12 months interval, whereas most other complication rates were comparable between procedures. Recognition of these temporal patterns may help inform patient counseling, optimize postoperative follow-up strategies, and guide postoperative management during different phases of corneal recovery after refractive surgery.
Comment on: Prediction of 9 Artificial Intelligence-based Intraocular Lens Power Calculation Formulas in Long Caucasian Eyes.
Li D, Li J, Yin M … +1 more , Zhang H
Am J Ophthalmol · 2026 Apr · PMID 42025663 · Publisher ↗
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Ocular Symptoms Lead to Shortest Diagnostic Delay in Biopsy-Proven Giant Cell Arteritis: A Nationwide Veterans Health Study.
Placide J, Phan M, Tedla S … +2 more , Kay PS, Winges KM
Am J Ophthalmol · 2026 Apr · PMID 42019597 · Publisher ↗
PURPOSE: To evaluate diagnostic delays in biopsy-proven giant cell arteritis (GCA) within the Veterans Health Administration (VHA), with a focus on the impact of presenting symptoms and provider specialty on time to trea...
PURPOSE: To evaluate diagnostic delays in biopsy-proven giant cell arteritis (GCA) within the Veterans Health Administration (VHA), with a focus on the impact of presenting symptoms and provider specialty on time to treatment. DESIGN: Retrospective, multicenter cohort study. SUBJECTS: Using the VHA Informatics and Computing Infrastructure, we identified 24,857 patients with GCA-related diagnostic codes or temporal artery biopsy procedures. METHODS: A multistep filtering process, including positive diagnostic coding and pathology-confirmed biopsy report review, yielded 300 cases of biopsy-proven GCA for final analysis. Detailed chart review captured presenting symptoms, initial provider specialty, and diagnostic timeline intervals, including symptom onset to clinical visit and visit to corticosteroid initiation. Group comparisons were assessed using the Kruskal-Wallis test, and post-hoc pairwise comparisons used Dunn's Test with Bonferroni adjustments. MAIN OUTCOME MEASURES: Time from first symptom to initial clinical visit, and time from initial visit to corticosteroid initiation. RESULTS: The cohort was predominantly male (94.3%) and White (89.9%), with a mean age of 75.3 years. The average delay from symptom onset to first clinical encounter was 22 days (SD: 31.9), and from encounter to treatment initiation was 11 days (SD: 26.0). Patients initially evaluated by emergency department or eye care providers were treated significantly sooner than those seen by primary care. Presenting symptoms influenced timeliness: patients with ocular symptoms, including transient vision loss and visual disturbances, were treated more promptly (mean: 8.3 days from presentation compared to those with headache (12.9 days) or systemic complaints (20.2 days; P < .001). Classic symptoms such as scalp tenderness and temporal pain led to the shortest delays following examination. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein were elevated in the majority of cases, while platelet elevation was less frequent. CONCLUSIONS: This is the first national VHA study to evaluate diagnostic delay in biopsy-proven GCA by provider specialty and symptom type. Our findings demonstrate that visual symptoms prompt more rapid diagnosis and treatment, whereas nonspecific symptoms result in significant delays, particularly in primary care settings. These results highlight a need for improved provider education and systematic approaches to recognize and manage GCA in its varied presentations. Early diagnosis remains critical to prevent irreversible vision loss and other complications.
Genomic Approaches to Diagnosis in Congenital and Developmental Cataract: Comparison of Panel Versus Whole Genome Sequencing, Diagnostic Yield, Variant Spectrum, Genotype-Phenotype Correlations, and Implications for Counseling.
Lloyd IC, Marlowe S, Piergentili M … +5 more , Gomez B, Cullup T, Shireby G, Mazur K, Hay E
Am J Ophthalmol · 2026 Apr · PMID 42013947 · Publisher ↗
PURPOSE: Congenital cataracts are a leading cause of childhood blindness, with clinical impact due both to visual impairment and associated systemic disorders. They exhibit clinical and genetic heterogeneity, with pathog...
PURPOSE: Congenital cataracts are a leading cause of childhood blindness, with clinical impact due both to visual impairment and associated systemic disorders. They exhibit clinical and genetic heterogeneity, with pathogenic variants identified in more than 100 genes complicating genotype-phenotype correlation. Accurate molecular diagnosis is essential for prognosis, reproductive counseling, and tailored surveillance and management. Whole genome sequencing (WGS) offers advantages over gene panels by detecting a broader spectrum of variants, including copy number changes, structural rearrangements, cryptic variants, and those in repetitive regions, thereby improving diagnostic yield, especially when interpreted through multidisciplinary team meetings (MDTMs). METHODS: A retrospective review was performed of 119 consecutive patients undergoing genetic testing for congenital cataracts in the North Thames Genomic Laboratory Hub. Genetic analysis was performed using either targeted gene panels in 76 probands (64%) (2016-2021) or WGS in 43 (36%) (2021-2025). Clinical data were extracted to classify cases as syndromic or nonsyndromic and assess diagnostic outcomes, with complex cases discussed at MDTMs. RESULTS: Nonsyndromic (isolated or wider ocular) and syndromic cataracts accounted for 52.1% and 47.8% of cases, respectively, consistent with previous literature describing frequent multisystem involvement. WGS increased diagnostic yield by 10% compared with gene panels, primarily through detection of variants missed by panel-based approaches. Overall molecular diagnosis was 42%, with higher rates achieved in nonsyndromic forms (51.6%). CONCLUSION: WGS appears more effective for establishing a diagnosis in congenital cataracts than gene panels, because of its ability to detect diverse pathogenic variants. This is critical for provision of prognosis, reproductive counseling, and further management, especially given the high rate of associated syndromic conditions. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
Reply to Comment on: A Nomogram Based on Ocular Hemodynamics for Predicting Ischemic Stroke.
Zhou ZH, Wang JL
Am J Ophthalmol · 2026 Apr · PMID 42009271 · Publisher ↗
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Comment on "A Nomogram Based on Ocular Hemodynamics for Predicting Ischemic Stroke".
Cai X, Zhao Y, Yan F
Am J Ophthalmol · 2026 Apr · PMID 42009270 · Publisher ↗
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Validation of the "FIRST-ROP" Algorithm at a Neonatal Intensive Care Unit Tertiary Center over Three Decades.
Malek DA, Altamirano F, Chaaya C … +9 more , Negron C, Arias N, Lockward JS, Fan KC, Al-Khersan H, Yannuzzi NA, Hua HU, Berrocal AM, Patel NA
Am J Ophthalmol · 2026 Apr · PMID 42002018 · Publisher ↗
PURPOSE: To validate the FIRST-ROP algorithm in a medium-risk cohort of infants undergoing screening for retinopathy of prematurity (ROP). DESIGN: Retrospective diagnostic comparison. METHODS: Infants who did not meet cr...
PURPOSE: To validate the FIRST-ROP algorithm in a medium-risk cohort of infants undergoing screening for retinopathy of prematurity (ROP). DESIGN: Retrospective diagnostic comparison. METHODS: Infants who did not meet criteria for microprematurity or nanoprematurity (gestational age ≥ 27 weeks and birth weight ≥ 800 g) were included. Outcomes assessed included rates of ROP diagnosis and treatment-warranted ROP (TW-ROP), as well as postmenstrual age (PMA) at first diagnosis and initiation of treatment. Paired binary detection outcomes between traditional ROP screening strategies and the FIRST-ROP algorithm, which defers screening until 34 weeks PMA, were compared using the McNemar test. RESULTS: Among 8564 infants screened, 3641 (36%) met inclusion criteria, of whom 604 (17%) developed ROP. Median PMA at first ROP diagnosis was 35.1 weeks (interquartile range [IQR], 34.0-36.6 weeks; range, 31.3-51.4 weeks). Median PMA at stage 3 diagnosis was 35.6 weeks (IQR, 34.0-37.0 weeks; range, 32.3-47.6 weeks). Median PMA at first treatment was 40.0 weeks (IQR, 37.1-41.4 weeks; range, 34.3-44.4 weeks). Fifteen infants (2%) required treatment, of whom 10 (67%) had type 1 ROP. Initiating screening at 34 weeks PMA significantly reduced examinations compared with standard screening (P < .001), corresponding to an estimated 17% fewer visits per patient. No cases of TW-ROP would have been missed under the FIRST-ROP strategy (95% CI, 99.3%-100%). CONCLUSIONS: Over 3 decades, no infants in this medium-risk cohort required treatment before 34 weeks PMA. These findings validate the FIRST-ROP algorithm and support safe deferral of the initial ROP examination to 34 weeks PMA, reducing screening burden while maintaining sensitivity for TW-ROP.
Comment on: Assessing the Fragility of Statistically Significant Outcomes in Randomised Controlled Trials of Minimally Invasive Glaucoma Surgery (MIGS).
González-Martín-Moro J
Am J Ophthalmol · 2026 Apr · PMID 42002017 · Publisher ↗
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Association of Deep Optic Nerve Head Structural Remodeling with Choroidal Microvasculature Dropout in Glaucoma with and without Myopia.
Jiravarnsirikul A, Belghith A, Rezapour J … +11 more , Micheletti E, Nishida T, Moghimi S, Suh MH, Jonas JB, Walker E, Christopher M, Fazio MA, Weinreb RN, Yang H, Zangwill LM
Am J Ophthalmol · 2026 Apr · PMID 41997474 · Publisher ↗
PURPOSE: To evaluate associations between parapapillary choriocapillaris microvascular dropout (MvD) and optical coherence tomography (OCT)-detected deep optic nerve head (ONH) structures in glaucomatous eyes with and wi...
PURPOSE: To evaluate associations between parapapillary choriocapillaris microvascular dropout (MvD) and optical coherence tomography (OCT)-detected deep optic nerve head (ONH) structures in glaucomatous eyes with and without myopia. DESIGN: Cross-sectional study from clinical trial data. METHODS: 394 eyes from 262 patients with primary open-angle glaucoma (POAG) and glaucoma suspects were stratified into three groups of no myopia (axial length (AL)<24 mm; n = 144), mild myopia (24 mm ≤ AL < 26 mm; n = 174), and high myopia (AL ≥ 26 mm; n = 76). Spectralis ONH OCT radial B-scans were acquired relative to the Foveal-Bruch's Membrane Opening (FoBMO) axis. Bruch's Membrane Opening (BMO) and anterior scleral canal opening (ASCO) were manually segmented, and their size and shape were calculated. BMO/ASCO offset magnitude, neural canal obliqueness, and neural canal minimum cross-sectional area (NCMCA) were measured. The presence, area, and angular circumference of juxtapapillary MvD were evaluated using OCT-angiography en face choroidal images and B-scans. RESULTS: The MvD area (95% CI) was significantly greater in highly myopic eyes (0.38 [0.30, 0.47] mm²), compared with mild myopia (0.33 [0.27, 0.39] mm²) and no myopia (0.21 [0.14, 0.27] mm²) (P = .002). The MvD angular circumference was also significantly larger in mild myopia (75.4 [64.0, 86.9]°), followed by high myopia (74.5 [58.0, 90.9]°) and no myopia (52.6[39.9, 65.3]°) (P = .017). The highly myopic group showed a significantly larger BMO area, NCMCA ovality index, BMO/ASCO offset magnitude, and neural canal obliqueness, along with smaller NCMCA, compared to the other groups (all P < .01). In multivariable analysis, NCMCA, NCMCA ovality index, BMO/ASCO offset magnitude, and neural canal obliqueness were significantly associated with both MvD presence (all P < .05) and MvD area (all P < .05). Additionally, NCMCA ovality index and neural canal obliqueness were associated with MvD angular circumference (P = .01 and P = .004, respectively). CONCLUSIONS: In myopic POAG eyes, the presence and area of MvD were associated with NCMCA, NCMCA ovality index, BMO/ASCO offset magnitude, and neural canal obliqueness, whereas MvD angular circumference was associated only with NCMCA ovality index and neural canal obliqueness. Evaluating choriocapillaris MvD alongside deep ONH structural alterations may provide clinical insights into the pathogenesis of glaucoma in myopia.
Comment on: Impact of Phacoemulsification on Vitreomacular Traction Release and Complications.
Çağlar Ç, Güven F
Am J Ophthalmol · 2026 Jul · PMID 41997473 · Publisher ↗
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What Should Patients With Age-Related Macular Degeneration Eat?
Keenan TDL, Hébert M, Chew EY … +1 more , Johnson MW
Am J Ophthalmol · 2026 Apr · PMID 41990981 · Full text
PURPOSE: To summarize relevant data on what individuals with age-related macular degeneration (AMD) should eat and to propose simple, evidence-based, dietary and micronutrient supplement guidelines that can be shared wit...
PURPOSE: To summarize relevant data on what individuals with age-related macular degeneration (AMD) should eat and to propose simple, evidence-based, dietary and micronutrient supplement guidelines that can be shared with patients and physicians. DESIGN: Focused literature review with interpretation and clinical perspective METHODS: We selectively reviewed literature on the associations between diet, oral micronutrient supplementation, and AMD progression, synthesizing evidence by disease stage. Sources included the Age-Related Eye Disease Studies (AREDS/AREDS2) in the United States, and major epidemiologic and cohort studies in Europe and North America. RESULTS: Across disease stages, closer adherence to a Mediterranean diet is consistently associated with substantially slower AMD progression. In AREDS, individuals with early AMD who adhered more closely to a Mediterranean diet were significantly less likely to develop intermediate AMD. In AREDS/AREDS2 participants with intermediate AMD, higher Mediterranean diet adherence was strongly associated with decreased risk of progression to late AMD, especially for geographic atrophy (GA). Specific dietary components were particularly influential: higher fish intake was most protective, followed by higher vegetable and lower red meat intake. For individuals with geographic atrophy (GA), a Mediterranean diet was associated with markedly slower GA enlargement, including slower expansion towards the fovea. Higher intake of fruit and vegetables, lower intake of red meat, and avoidance of heavy alcohol consumption were most important in the modulation of GA expansion. Oral micronutrient supplementation with the AREDS2 formulation decreased progression to late AMD for individuals with intermediate AMD (or advanced disease in one eye) and slowed expansion of extrafoveal GA towards the fovea. Notably, the benefits of healthy diet and AREDS2 supplementation were found to be complementary and non-redundant. CONCLUSION: Individuals with AMD should adopt a Mediterranean diet (or similar pattern), which appears beneficial at all disease stages. Dietary emphasis may vary by stage. A predominantly plant-based diet appears preferable to an animal-based diet, particularly for late AMD with GA. The AREDS2 formulation is recommended for individuals with intermediate or advanced AMD, and may be especially helpful for those with extrafoveal GA. A Mediterranean diet and micronutrient supplementation have complementary actions, so should be used together for maximal benefit.
Clinicopathological and Imaging Distinction Between Ocular Adnexal MALT Lymphoma and IgG4-Related Ophthalmic Disease.
Zhang H, He W
Am J Ophthalmol · 2026 Apr · PMID 41985855 · Publisher ↗
PURPOSE: To characterize clinicopathologic and imaging differences between ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) and IgG4-related ophthalmic disease (IgG4-ROD) and to evaluate clinical and arti...
PURPOSE: To characterize clinicopathologic and imaging differences between ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) and IgG4-related ophthalmic disease (IgG4-ROD) and to evaluate clinical and artificial intelligence-assisted approaches for differentiating these entities. DESIGN: Retrospective, single-center observational cross-sectional study. PARTICIPANTS: Four hundred patients with pathologically confirmed orbital lymphoproliferative disease, including OAML (n = 287) and IgG4-ROD (n = 113), treated at West China Hospital between 2010 and 2024. METHODS: Clinical, serologic, imaging, histopathologic, immunophenotypic, and molecular features were systematically compared between groups. A multivariable logistic regression model based on routinely available clinical variables was developed for early differentiation. Artificial intelligence models were additionally trained using radiological CT/MRI images and digital pathology whole-slide images. MAIN OUTCOME MEASURES: Distinct clinical and pathologic characteristics between OAML and IgG4-ROD and diagnostic discrimination assessed by area under the receiver operating characteristic curve (AUC). RESULTS: OAML more frequently presented as unilateral orbital or conjunctival lesions and showed monoclonal features, including light-chain restriction and immunoglobulin gene rearrangements. In contrast, IgG4-ROD predominantly involved bilateral lacrimal glands and demonstrated fibro-inflammatory changes with abundant IgG4⁺ plasma cells. Serum IgG4 levels overlapped substantially between groups. The clinical model achieved an AUC of 0.865. Radiology- and pathology-based artificial intelligence models achieved AUCs of 0.933 and 0.946, respectively, and pathology-informed radiology training further improved discrimination (AUC 0.974). CONCLUSIONS: Integrated clinical, imaging, and pathologic assessment provides practical distinctions between OAML and IgG4-ROD. Artificial intelligence-assisted imaging analysis may complement conventional diagnostic pathways and support differentiation in clinically ambiguous orbital lymphoproliferative disease.
Association Between PDE-5 Inhibitor Therapy and the Hazard of Open-Angle Glaucoma.
Elhusseiny AM, Abboud I, Almobayed A … +1 more , Medeiros FA
Am J Ophthalmol · 2026 Apr · PMID 41974319 · Publisher ↗
PURPOSE: To evaluate the association between phosphodiesterase type-5 inhibitor (PDE-5i) therapy and the development of glaucoma suspect (GS) status or open-angle glaucoma (OAG) in men with erectile dysfunction (ED). DES...
PURPOSE: To evaluate the association between phosphodiesterase type-5 inhibitor (PDE-5i) therapy and the development of glaucoma suspect (GS) status or open-angle glaucoma (OAG) in men with erectile dysfunction (ED). DESIGN: Multicenter, retrospective cohort study using deidentified electronic health records. SUBJECTS: Male adults aged ≥ 40 years with ED, with or without chronic PDE-5i exposure. METHODS: We used propensity score matching (PSM) to balance demographics, systemic and ophthalmic comorbidities, medications, laboratory measures. Additionally, we applied Cox proportional models on the unmatched cohorts to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURES: Development of GS or OAG at 1, 2, and 3-years following PDE-5i exposure. RESULTS: Before matching, 40,676 men received PDE-5i therapy and 32,415 had no exposure. After PSM, the development of GS status was less frequent among PDE-5i users at 1 year (6.49% vs 9.73%, P < .01), 2 years (9.27% vs 10.86%, P < .01), and 3 years (11.17% vs 12.06%, P = .01). Similarly, the development of OAG was less frequent among PDE-5i users at 1 year (2.13% vs 3.22%, P < .01), 2 years (3.00% vs 3.80%, P < .01), and 3 years (3.88% vs 4.28%, P = .04). Cox proportional models demonstrated reduced hazards for GS at 1 year (aHR 0.78; 95% C: 0.75-0.81; P < .01), 2 years (0.89; 0.86-0.93; P < .01), and 3 years (0.94; 0.90-0.97; P = .01), and for OAG at 1 year (0.76; 0.71-0.81; P < .01), 2 years (0.79; 0.75-0.83; P < .01), and 3 years (0.84; 0.79-0.88; P = .01). CONCLUSION: Chronic PDE-5i use was associated with a lower hazard of developing GS and OAG over 1-, 2-, and 3-years of follow-up. These findings suggest a potential protective association between PDE-5i and glaucoma development that requires confirmation in prospective studies.
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