Am. J. Ophthalmol. [JOURNAL]
Sun
200 papers
Photocoagulation-induced Large Posterior Staphyloma in Choroidal Osteoma.
Zhou N, Liang L, Wei W
Am J Ophthalmol · 2026 Jul · PMID 41916489 · Publisher ↗
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Macular Optical Coherence Tomography Angiography Biomarkers Predict Regional Retinal Nonperfusion Patterns on Ultrawidefield Angiography in Diabetes.
Kakihara S, Busza AM, Duffy BV … +3 more , Zhuang K, AbdelSalam M, Fawzi AA
Am J Ophthalmol · 2026 Jul · PMID 41912063 · Full text
OBJECTIVE: To determine whether foveal avascular zone (FAZ) enlargement and geometric perfusion deficits in the deep capillary plexus (GPDd) are independently associated with retinal nonperfusion in different regions of...
OBJECTIVE: To determine whether foveal avascular zone (FAZ) enlargement and geometric perfusion deficits in the deep capillary plexus (GPDd) are independently associated with retinal nonperfusion in different regions of ultrawidefield fluorescein angiography (UWF-FA) in diabetes. DESIGN: Prospective cross-sectional observational study. PARTICIPANTS: A total of 159 eyes from 112 patients with diabetes, and without center-involving diabetic macular edema, across the spectrum of diabetic retinopathy severity. METHODS: Nonperfusion in the posterior, peripheral (inside and outside ETDRS 7-fields, respectively), and total retina were quantified on UWF-FA. Averaged 3 × 3 mm en-face optical coherence tomography (OCT) and OCT angiography (OCTA) were used to measure the structural and functional FAZ areas, respectively, and the discrepancy between them defined as FAZ enlargement. GPDd was defined as the proportion of retinal areas located ≥30 µm from the nearest perfused capillary on OCTA in the deep capillary plexus. Linear mixed-effects models adjusted for key covariates were applied, and model fit was evaluated using likelihood ratio tests and information criteria. MAIN OUTCOME MEASURES: Standardized associations (β) and improvements in model fit for FAZ enlargement and GPDd in predicting posterior, peripheral, and total nonperfusion. RESULTS: Posterior nonperfusion was significantly associated with GPDd (β = 0.216, P < .001), FAZ enlargement (β = 0.128, P = .016), and hemoglobin A1c (β = 0.240, P = .008). Both peripheral and total nonperfusion were associated with GPDd (β = 0.216 and 0.237; P = .008 and 0.001, respectively) and diabetes duration (β = 0.214 for both; P = .046 and 0.040), but not with FAZ enlargement. Model comparisons further confirmed the added value of GPDd across all regions (P ≤ .009), whereas FAZ enlargement improved model fit only for posterior nonperfusion (P ≤ .018). CONCLUSIONS: Our findings suggest that GPDd is a robust biomarker of ischemic burden across all retinal regions, significantly improving model fit in predicting retinal nonperfusion on UWF-FA. On the other hand, FAZ enlargement reflected posterior ischemia but did not improve model performance outside that region. These findings highlight the complementary contributions of OCTA-derived metrics for regional characterization of retinal ischemia in diabetes, with implications for OCTA biomarker-based stratification.
Optic Disc Microvasculature Reduction and Visual Field Progression in Advanced Primary Open-Angle Glaucoma.
Suh MH, Weinreb RN, Hallaj S … +1 more , Zangwill LM
Am J Ophthalmol · 2026 Jul · PMID 41912062 · Publisher ↗
PURPOSE: To assess the relationship between optic disc vessel density (ODVD) reduction and visual field (VF) progression according to disease severity in primary open-angle glaucoma (POAG). DESIGN: Retrospective case ser...
PURPOSE: To assess the relationship between optic disc vessel density (ODVD) reduction and visual field (VF) progression according to disease severity in primary open-angle glaucoma (POAG). DESIGN: Retrospective case series. METHODS: A total of 345 POAG patients categorized into early (n = 153), moderate (n = 98), and advanced (n = 94) groups according to the baseline VF mean deviation (≥-6 dB, -12 dB - -6 dB, and < -12 dB) underwent ≥ 5 optical coherence tomography (OCT), OCT angiography (OCTA), and ≥ 3 years of VFs. ODVD was calculated as the ratio of pixels occupied by vessels within the temporal optic disc on OCTA. The association between VF progression and the ODVD change rate per year was assessed using logistic and Cox Proportional Hazards (PH) models across the three groups. RESULTS: ODVD reduction rate was significantly faster in VF progressors than in non-progressors in all three groups (P < .001). VF progression was associated with the rate of global ODVD change (odds ratio [OR] = 1.27 for the early, OR = 1.39 for the moderate, and OR = 1.48 for the advanced; all P < .05) and with the binary ODVD reduction (OR = 6.13 for early, OR = 5.23 for moderate, and OR = 14.0 for advanced; all P < .05) in the multivariable logistic regression across all three groups. In the multivariable Cox PH model, a significant association of the rate of global ODVD change and the binary ODVD reduction with VF progression was observed in both early (hazards ratios [HRs] (95% CI) = 1.29 and 4.32; both P < .001) and moderate-to-advanced glaucoma (HRs (95% CI) = 1.23 and 2.83; both P < .001). CONCLUSIONS: Reduction of optic disc microvasculature is useful for detecting glaucoma progression, in patients with advanced glaucoma, as well as those with early and moderate glaucoma.
Comment on: "Association Between Pseudoexfoliation Glaucoma and Central Serous Chorioretinopathy".
Nitzan I
Am J Ophthalmol · 2026 Jul · PMID 41912061 · Publisher ↗
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Vision Care Disparities by Nativity Among US Adults and Children: An Analysis of the 2023 National Health Interview Survey.
Humeda S, Cavuoto KM
Am J Ophthalmol · 2026 Jul · PMID 41903928 · Publisher ↗
PURPOSE: To evaluate disparities in access to vision care among US-born and foreign-born adults and children in the United States, with particular attention to duration of US residence and language spoken with healthcare...
PURPOSE: To evaluate disparities in access to vision care among US-born and foreign-born adults and children in the United States, with particular attention to duration of US residence and language spoken with healthcare providers. DESIGN: Retrospective cohort study. SUBJECTS: US-born and foreign-born adults and children participating in the 2023 National Health Interview Survey. METHODS: Data from the 2023 National Health Interview Survey were analyzed using survey-weighted methods. Outcomes included delayed medical care due to cost or transportation, receipt of an eye examination, vision testing history among children, and self- or parent-reported vision difficulty. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics and insurance status. Among foreign-born adults, analyses were further stratified by years lived in the United States and language spoken with healthcare providers. MAIN OUTCOME MEASURES: Delayed medical care due to cost or transportation, receipt of an eye examination in the past 12 months, lifetime vision testing among children, and vision-related functional outcomes. RESULTS: Among 27,822 adults, foreign-born individuals had lower adjusted odds of receiving an eye examination in the past 12 months compared with US-born adults (aOR 0.91; 95% CI 0.84-0.98). Among foreign-born adults, use of a non-English language with healthcare providers was associated with lower odds of recent eye examination (aOR 0.66; 95% CI 0.53-0.83). Cost-related delays to care were more common in unadjusted analyses among foreign-born adults but attenuated after adjustment. Among 6615 children, those from foreign-born households had significantly lower odds of ever having undergone vision testing (aOR 0.50; 95% CI 0.36-0.69) and lower odds of receiving an eye examination in the past year (aOR 0.74; 95% CI 0.57-0.96). CONCLUSIONS: The 2023 NHIS data identified possible disparities in access to preventive vision care for both immigrant adults and children. Language barriers and insurance-related factors primarily affected adults, whereas reduced exposure to preventive screening appeared to contribute to disparities among children. Targeted, age-specific strategies could potentially promote equitable access to vision care in immigrant populations.
F-Fluorodeoxyglucose Positron Emission Tomography as a Marker of Extraocular Muscle Function.
Rasool N, Tefera E, Jiang AC … +6 more , Nanji AR, Hage R, Levin MH, Bahroos E, Hoyt C, Flavell RR
Am J Ophthalmol · 2026 Jul · PMID 41903927 · Publisher ↗
PURPOSE: To determine whether F-Fluorodeoxyglucose (F-FDG) Positron Emission Tomography (F-FDG PET) can be utilized as a marker for extraocular muscle function, particularly in extraocular muscle paresis. METHODS: A retr...
PURPOSE: To determine whether F-Fluorodeoxyglucose (F-FDG) Positron Emission Tomography (F-FDG PET) can be utilized as a marker for extraocular muscle function, particularly in extraocular muscle paresis. METHODS: A retrospective study was performed evaluating F-FDG uptake in extraocular muscles of patients with normal ocular motility across a broad age range (range 1-87 years), to establish a normative reference database. Additionally, F-FDG uptake was evaluated in paretic extraocular muscles and compared to the control cohort to assess whether F-FDG PET could demonstrate changes in metabolic activity associated with functional impairment. RESULTS: The normative database included a total of 857 rectus muscles from 111 patients. F-FDG uptake declined progressively with age in all rectus muscles, with statistically significant associations for each muscle in the coronal plane. The medial and lateral recti demonstrated the steepest age-related decline in F-FDG uptake (P < .0005 and P <.0002, respectively). F-FDG uptake in 23 paretic rectus muscles from 10 patients demonstrated markedly reduced uptake compared with controls for each rectus muscle (P < .003). This difference remained highly significant when all paretic muscles were analyzed collectively using multilevel modeling (P = 9.07e-18). CONCLUSIONS: F-FDG PET shows promise as a surrogate marker of extraocular muscle function, particularly in hypometabolic conditions such as extraocular muscle paresis. The development of a muscle-specific normative reference database provides a foundation for broader applications of this modality, with the potential to better characterize a wide range of ocular motility disorders (NOTE: Publication of this article is sponsored by the American Ophthalmological Society).
Ophthalmic Manifestations of Danon Disease: A Systematic Review.
Emfietzoglou M, Sakuno G, Awh C … +9 more , Hoyek S, Bantounou MA, Baroutis KG, Chatziralli I, Papaconstantinou D, Theodossiadis P, Charonis A, Patel NA, Vavvas DG
Am J Ophthalmol · 2026 Jul · PMID 41895389 · Publisher ↗
OBJECTIVE: Danon disease is a rare X-linked disorder caused by pathogenic variants in the LAMP2 gene. It is characterized by severe cardiomyopathy, arrhythmias, and skeletal myopathy. Ophthalmic findings have been descri...
OBJECTIVE: Danon disease is a rare X-linked disorder caused by pathogenic variants in the LAMP2 gene. It is characterized by severe cardiomyopathy, arrhythmias, and skeletal myopathy. Ophthalmic findings have been described but are often overlooked due to limited awareness of their prevalence and characteristics. This study aims to review the ophthalmic manifestations of Danon disease and their clinical relevance. DESIGN: Systematic review. METHODS: A systematic review of PubMed and EMBASE was conducted from inception through October 15, 2025, to identify studies reporting ophthalmic findings in genetically or clinically confirmed Danon disease. Data were extracted on demographics, LAMP2 variants, ocular features, and imaging results. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Descriptive statistics were performed in SPSS Statistics v29. The protocol was prospectively registered in PROSPERO (CRD42024608745). RESULTS: We identified 34 studies (25 case reports, 8 case series, and 1 retrospective cohort) describing 70 patients, aged 6 to 81 years. Retinal abnormalities were the most common finding (81%), typically midperipheral and peripheral salt-and-pepper pigmentary changes. Macular involvement was frequent (62%), usually presenting as nonspecific retinal pigment epithelium changes; a minority (13%) developed more severe pathology, including macular atrophy, bull's-eye maculopathy, or cystoid macular edema. Optical coherence tomography, available in nearly half of patients, most often showed retinal pigment epithelium and ellipsoid zone disruption (85%) and outer nuclear layer hyperreflectivity (61%). Fundus autofluorescence and electroretinography, when abnormal, revealed mottled hypo- and hyperautofluorescence and mild cone and rod dysfunction, respectively. Other ocular findings included myopia (16%) and lens opacities (13%). CONCLUSIONS: Retinal manifestations are the most common ophthalmic finding in Danon disease and can lead to significant vision loss. Ophthalmic findings, particularly retinal abnormalities, may precede or represent the only manifestation of disease in some patients. Recognition of these features may prompt earlier systemic evaluation, genetic testing, and multidisciplinary management of this life-threatening lysosomal disorder.
Concomitant Tarsorrhaphy During Penetrating Keratoplasty for Promoting Epithelial Healing in Neurotrophic Keratopathy.
Huang RS, Agarwal M, Mimouni M … +1 more , Chan CC
Am J Ophthalmol · 2026 Jul · PMID 41887389 · Publisher ↗
PURPOSE: To evaluate the effectiveness of concomitant tarsorrhaphy in promoting epithelial healing in eyes with neurotrophic keratopathy (NK) undergoing penetrating keratoplasty (PK). DESIGN: Retrospective clinical cohor...
PURPOSE: To evaluate the effectiveness of concomitant tarsorrhaphy in promoting epithelial healing in eyes with neurotrophic keratopathy (NK) undergoing penetrating keratoplasty (PK). DESIGN: Retrospective clinical cohort study. METHODS: Eyes with NK that underwent PK with concomitant permanent or temporary tarsorrhaphy at 3 tertiary academic centers between January 2017 and June 2025 were included. The primary outcome was the proportion of eyes achieving complete epithelial closure. Secondary outcomes included the time to epithelial healing and the change in best-corrected visual acuity (BCVA) from preoperative baseline to final follow-up. RESULTS: A total of 85 eyes (mean age 68.5 ± 14.2 years; 61.2% male) were included, with a median follow-up duration of 24.1 months. Most tarsorrhaphies were performed laterally (92.9%, n = 79), and the majority were permanent (70.6%, n = 60), while 25 (29.4%) were temporary. Following tarsorrhaphy, epithelial defects completely resolved in 75 eyes (88.2%). The mean time to epithelial closure was 14.7 ± 4.1 days. Visual acuity significantly improved from a mean baseline BCVA of 2.23 ± 0.34 logMAR to 1.75 ± 0.60 at final follow-up (P = .01). Outcomes were similar between permanent and temporary tarsorrhaphy, with no significant differences in epithelial closure rates (P = .49), time to healing (P = .18), or final BCVA (P = .22). Postoperative complications related to tarsorrhaphy were uncommon and generally mild, occurring in 11 eyes (12.9%). CONCLUSIONS: Concomitant tarsorrhaphy in eyes with NK undergoing PK achieved high rates of epithelial closure with a mean healing time of approximately 2 weeks and was associated with significant visual improvement. These findings support routine use of tarsorrhaphy in eyes with NK at high risk for delayed epithelial healing.
Trends in Amblyopia Risk Factors and Socioeconomic Disparities in Scottish Children Aged 3.5 to 5.5 Years.
Conway ML, Evans BJW, Pentland L … +3 more , Edgar DF, Shah R, Evans BEW
Am J Ophthalmol · 2026 Jul · PMID 41887388 · Publisher ↗
OBJECTIVE: Scotland's comprehensive orthoptist-led vision screening program for children (3.5-5.5 years) has participation of ∼85% (∼45,000 annually). Tests include presenting vision, cover test, and other orthoptic eval...
OBJECTIVE: Scotland's comprehensive orthoptist-led vision screening program for children (3.5-5.5 years) has participation of ∼85% (∼45,000 annually). Tests include presenting vision, cover test, and other orthoptic evaluations. Screening failures are referred for an eye examination, including cycloplegic refraction, by an optometrist/ophthalmologist. PRIMARY OBJECTIVES: report prevalence of amblyopia risk factors (ARFs) in a defined population. SECONDARY OBJECTIVE: investigate associations between ARFs and deprivation/housing/location. DESIGN: Retrospective cohort and trend study. PARTICIPANTS: Scottish children aged 3.5 to 5.5 years. METHODS: ARFs considered were constant manifest strabismus, hyperopia (spherical equivalent refraction, SER) >+4.00D (one/both eyes), astigmatism >1.75DC (one/both eyes), anisometropia >1.25DC for astigmatism and >1.25D (SER) for hyperopic or mixed anisometropia. Data are from 2013/14, 2014/15, 2015/16, 2020/21, and 2021/22 school years, from Health Boards containing 87% of Scotland's population. MAIN OUTCOME MEASURES: Refractive error and cover test results. RESULTS: Prevalence (95% CI) of ≥ one ARF ranged from 4.41% (4.21-4.60, 2013-14) to 5.15% (4.92-5.38, 2021-22), with no statistically significant relationship between prevalence of any ARF and time (for Bonferroni corrected adjusted P-value = .008). In 2021 to 22, for children with ≥1 ARF, 48.23% had astigmatism, 35.10% hyperopia (SER), 26.59% hyperopic anisometropia (SER), 13.73% constant manifest strabismus and 12.64% astigmatic anisometropia. Correlations between ARFs and deprivation/housing/location were not significant (P = .06 to 1.00). For all years, odds ratios for referral following screening failure in quintile 1 (most deprived) were significantly higher (39% to 60% higher, P < .001) than middle quintile 3. CONCLUSIONS: In this Scottish population (3.5 to 5.5 years) the prevalence of children with ≥1 ARF was approximately 5%, validating the universal vision screening program's importance. Children in the most deprived quintile were significantly more likely to fail screening.
Hyperreflective Foci Contiguous With the Retinal Pigment Epithelium Associated With Visual Function in Aging, Early, and Intermediate Age-Related Macular Degeneration: MACUSTAR Study Report.
Goerdt L, Basten V, Terheyden JH … +13 more , Dunbar H, Luhmann U, Zakaria N, Leal S, Moll KP, Poor S, Tufail A, Schmid M, Finger RP, Schmitz-Valckenberg S, Holz FG, Saßmannshausen M, MACUSTAR consortium
Am J Ophthalmol · 2026 Jul · PMID 41881234 · Publisher ↗
PURPOSE: To evaluate the association of hyperreflective foci contiguous with the retinal pigment epithelium (rpeHRF) with visual function impairment in aged normals, early age-related macular degeneration (eAMD), and int...
PURPOSE: To evaluate the association of hyperreflective foci contiguous with the retinal pigment epithelium (rpeHRF) with visual function impairment in aged normals, early age-related macular degeneration (eAMD), and intermediate AMD (iAMD). DESIGN: Prospective cohort study. SUBJECTS: Participants of the MACUSTAR study. METHODS: MACUSTAR participants underwent color fundus photography, optical coherence tomography (OCT) imaging, best corrected visual acuity (BCVA), low-luminance VA (LLVA), rod-mediated dark adaptation (RMDA) at 12°, contrast sensitivity (CS), mesopic (mesPSD), and scotopic pointwise sensitivity deviation (scPSD) testing. rpeHRF presence and count were determined using custom FiJi software. Group comparisons and associations with visual function were analyzed using analysis of variance, linear regression, and Spearman correlation. MAIN OUTCOME MEASURES: Presence, burden, and topographic distribution of rpeHRF, as well as association with functional parameters, were determined. RESULTS: Fifty-six normal aged (33 female, mean age 68.1 ± 6.4 years), 34 eAMD (27 female, 71.7 ± 6.4 years), and 583 iAMD eyes (387 female, 72.0 ± 7.0 years) were included. rpeHRF counts were 0.16 ± 0.85 in normals, 0.33 ± 0.96 in eAMD, and 1.61 ± 2.49 in iAMD (P < .001). BCVA, LLVA, CS (all P < .001), and scPSD (P = .001) differed between disease groups, whereas RMDA and mesPSD did not. In iAMD, eyes with rpeHRF showed worse BCVA, LLVA, CS, scPSD (all P < .001), and mesPSD (P = .02). rpeHRF was found to be associated modestly with only CS, scPSD, LLVA, and BCVA. CONCLUSIONS: Presence and burden of rpeHRF were independently associated with impaired visual function and may thus serve as a prognostic biomarker for disease progression and enrichment criterion for future interventional trials.
Forecasting the Workforce of Uveitis Specialists.
Shah A, Berkowitz ST, Tsui E … +3 more , Gonzales JA, Crowell EL, Gangaputra S
Am J Ophthalmol · 2026 Jul · PMID 41881233 · Publisher ↗
OBJECTIVE: The uveitis subspeciality faces workforce inadequacy in the setting of a rising burden of uveitis coupled with a decline in the number of specialists. While workforce projections exist for other ophthalmologic...
OBJECTIVE: The uveitis subspeciality faces workforce inadequacy in the setting of a rising burden of uveitis coupled with a decline in the number of specialists. While workforce projections exist for other ophthalmologic sub-specialties, none have modeled the future supply of uveitis specialists. The objective of our study was to characterize the current workforce and project its future supply in the United States through 2055. DESIGN: Simulation projection study using retrospective trend data. SUBJECTS: AUS-Registered uveitis specialists in the United States. METHODS: We identified 224 specialists self-identifying as practicing in the U.S. using the American Uveitis Society (AUS) roster and characterized their years in practice and geographic distribution. Two Monte Carlo simulations were developed incorporating dual-training, age-specific mortality, retirement rates and fellowship match data. A fixed-entry model simulated low, status-quo, or optimistic scenarios assuming a constant annual number of new entrants, while a stochastic model incorporated annual growth and variability. Simulations were run over 100 iterations. MAIN OUTCOME MEASURE: Projected number of practicing uveitis specialists in the United States through 2055. RESULTS: The current workforce had a median of 12 years in practice (IQR, 7-24). Specialists were clustered in states with large metropolitan regions, while 11 states lacked any AUS-registered physicians and 32 states had fewer than 1 specialist per million residents. Five states have a high risk of workforce attrition based on average years in practice. Under the fixed entrant model, the number of uveitis specialists is expected to decline to 145 in the low scenario (-35%), increase to 268 in the status-quo (+20%), and expand to 418 in the optimistic scenario (+87%) by 2055. The stochastic projection estimated 512 uveitis specialists by 2055. CONCLUSION: Our findings highlight the importance of sustaining the current pipeline of uveitis specialists and encouraging the development of more trainees to strengthen the workforce to allow for timely access to uveitis subspeciality care in the coming years. Future work is needed to evaluate the future uveitis workforce relative to patient demand.
Short-Term Axial Length Changes Predict Progression of Myopic Maculopathy in Pediatric High Myopia.
Jiang F, Wang L, Ding X … +3 more , He M, Zeng J, Li Z
Am J Ophthalmol · 2026 Jul · PMID 41871728 · Publisher ↗
OBJECTIVE: To characterize changes in long-term myopic maculopathy (MM) progression and to investigate short-term axial length (AL) and spherical equivalent (SE) changes as predictors for long-term MM progression in high...
OBJECTIVE: To characterize changes in long-term myopic maculopathy (MM) progression and to investigate short-term axial length (AL) and spherical equivalent (SE) changes as predictors for long-term MM progression in highly myopic children and adolescents. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 310 eyes from 155 highly myopic individuals aged 7 to 17 years with an 8-year follow-up. METHODS: Ocular examinations were performed every two years. MM was classified according to the Meta-PM system. Logistic regression models with generalized estimating equations were used to identify predictors of MM progression. Internal validation was performed using bootstrap resamples. MAIN OUTCOME MEASURES: Two-year changes of AL and SE to predict 8-year MM progression. RESULTS: Over 8 years, 31.29% of eyes showed MM progression. A total of 97 participants demonstrated 112 lesion changes, with the most common being the new appearance of tessellated fundus (44.64%). Multivariable models demonstrated that combination of baseline AL (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.15-2.28, P = .005) and 2-year AL change rate (OR = 1.62; 95% CI: 1.27-2.07, P < .001) provided superior predictive performance for long-term MM progression compared to baseline AL alone (OR = 1.52, 95% CI: 1.13-2.05, P = .006), after adjustment for age and pathologic myopia (PM). The area under the receiver operating characteristic curve (AUC) values were 0.829 (combined model) and 0.772 (baseline AL-only model), respectively (P = .013). Similarly, the model incorporating baseline SE (OR = 0.83; 95% CI, 0.73-0.96; P = .011) and 2-year SE change rate (OR = 0.44; 95% CI, 0.22-0.88; P = .020) achieved a higher AUC (0.793) than the baseline SE model (AUC = 0.764; P = .039) following adjustment for age and PM. The predictive model demonstrated an optimism-corrected AUC of 0.821 based on bootstrap internal validation. The optimal cut-off value for the 2-year AL change rate, determined by maximizing Youden's Index, was 0.325 mm/year. CONCLUSIONS: Nearly one-third of pediatric high myopes experienced MM progression over 8 years. Short-term changes in AL could predict MM progression with high accuracy, highlighting the importance of early risk identification and timely intervention in high-risk children.
Quantifying Orbital Segmentation in Thyroid Eye Disease- Fat to Muscle Ratio Correlates With Restrictive Strabismus.
Armarnik S, Hilewitz D, Kinori M … +9 more , Barnea Hamama N, Lederer M, Bachar O, Zloto O, Simon GB, Landau-Prat D, Haviv L, Orkin D, Priel A
Am J Ophthalmol · 2026 Jul · PMID 41865860 · Publisher ↗
OBJECTIVE: To evaluate the contribution and application of orbital fat-to-muscle ratio (FMR) in Thyroid Eye Disease related restrictive strabismus. DESIGN: Retrospective cross-sectional study. SUBJECTS, PARTICIPANTS: Adu...
OBJECTIVE: To evaluate the contribution and application of orbital fat-to-muscle ratio (FMR) in Thyroid Eye Disease related restrictive strabismus. DESIGN: Retrospective cross-sectional study. SUBJECTS, PARTICIPANTS: Adult patients (≥18 years) with a confirmed diagnosis of TED evaluated at a tertiary referral thyroid eye disease clinic between 2017 and 2025 who had high-resolution orbital CT imaging available for quantitative analysis. METHODS: Orbital CT scans were analyzed using three-dimensional (3D) volumetric segmentation to quantify orbital fat and extraocular muscle (EOM) volumes. The FMR was calculated for each orbit. A simplified single-slice two-dimensional (2D) FMR was also measured for comparison. Clinical data included presence and magnitude of strabismus, restrictive ocular motility, Clinical Activity Score (CAS), thyroid-stimulating immunoglobulin (TSI) levels, and surgical history. Associations were assessed using correlation analyses, multivariable logistic regression, intraclass correlation coefficients (ICC), and receiver operating characteristic (ROC) analysis. MAIN OUTCOME MEASURES: Association of FMR with TED factors associated with disease severity, restrictive ocular motility and strabismus presence. RESULTS: Of 579 screened patients, 197 met inclusion criteria (mean age 54.9 ± 16.3 years; 69.7% female). Restrictive ocular motility was present in 39.1% and was associated with significantly lower FMR compared with nonrestrictive disease (0.69 ± 0.36 vs 0.91 ± 0.42; P < .001). Strabismus angle correlated inversely with FMR (r = -0.169; P = .030), as did the number of EOMs operated during strabismus surgery (r = -0.160; P = .027). FMR was negatively correlated with CAS (r = -0.186; P = .010) and TSI (r = -0.188; P = .047). In multivariable analysis, lower FMR remained an independent predictor of restrictive motility. An FMR cutoff of 0.66 best discriminated the presence of strabismus (sensitivity 0.59; specificity 0.72). Agreement between 2D and 3D measurements was good (ICC = 0.77). CONCLUSIONS: Quantitative FMR derived from CT segmentation is a clinically relevant imaging biomarker in TED that reflects a continuous spectrum of muscle and fat involvement. Lower FMR identifies patients at increased risk for restrictive motility, strabismus, and inflammatory activity. Three-dimensional FMR provides superior anatomical and clinical relevance compared with 2D measurements and may enhance risk stratification and longitudinal assessment in TED.
Imaging Measures for the Assessment of Disease Activity in Noninfectious Posterior Uveitis - Multimodal Imaging in Uveitis (MUV) Taskforce: Report 10.
Agarwal A, Ramtohul P, Invernizzi A … +12 more , Gangaputra S, Tsui E, Okada AA, Thorne JE, Smet MD, Bodaghi B, Pavesio C, Jabs DA, Sadda S, Sarraf D, Gupta V, MULTIMODAL IMAGING IN UVEITIS (MUV) TASKFORCE
Am J Ophthalmol · 2026 Jul · PMID 41861898 · Publisher ↗
PURPOSE: To develop imaging-based measures for disease assessment in noninfectious posterior uveitis (NIPU). DESIGN: A mixed-methods design, beginning with a review of previously developed imaging recommendations formula...
PURPOSE: To develop imaging-based measures for disease assessment in noninfectious posterior uveitis (NIPU). DESIGN: A mixed-methods design, beginning with a review of previously developed imaging recommendations formulated by separate subcommittees of the multimodal imaging in uveitis (MUV) initiative, followed by a structured consensus process using the nominal group technique (NGT), facilitated by an independent expert committee. METHODS: An expert committee reviewed and extracted all consensus-based imaging recommendations from the MUV subcommittee manuscripts focused on five major NIPU entities. The primary objective was to categorize imaging features as suggestive of active disease (SAD), suggestive of inactive disease (SID), or equivocal. This process was conducted using the NGT to reach consensus-based imaging measures. These recommendations were further voted upon by members of the full task force. RESULTS: A total of 49 imaging statements were deliberated using two rounds of NGT and independent voting. For the five included diseases, a total of 21 statements qualified as features of SAD, whereas 12 statements were classified as SID. The remaining 16 statements were categorized as equivocal features that need further investigation to determine whether the disease is active. CONCLUSIONS: This study builds upon the multinational efforts of the MUV initiative to extend the standardization of uveitis nomenclature (SUN) work through the integration of additional multimodal imaging information. Defining clear imaging-based outcome measures for NIPU, it establishes a structured framework supporting objective disease assessment. These standardized imaging measures are expected to enhance the utility of multimodal imaging in both routine uveitis care and future clinical trials.
Noninfectious Posterior Uveitides - Atypicals, Variants, and Masquerades: The Jungle of Differential Diagnosis.
Bianco L, Berni A, Del Fabbro S … +4 more , Antropoli A, Bandello F, Cicinelli MV, Miserocchi E
Am J Ophthalmol · 2026 Jul · PMID 41861897 · Publisher ↗
PURPOSE: Consensus efforts by the Multimodal Imaging in Uveitis (MUV) Task Force have established standardized diagnostic criteria for the major non-infectious posterior and panuveitides (NIPUs), historically referred to...
PURPOSE: Consensus efforts by the Multimodal Imaging in Uveitis (MUV) Task Force have established standardized diagnostic criteria for the major non-infectious posterior and panuveitides (NIPUs), historically referred to as "white dot syndromes". Nevertheless, a substantial proportion of cases deviate from classical presentations and fall into diagnostic "grey zones", blurring boundaries between diseases entities and complicating both differential diagnosis and management. This paper aims to describe the broad spectrum of atypical, variant, and secondary forms of NIPUs as well as masquerade syndromes. METHODS: Perspective article with narrative review and illustrative cases. RESULTS: Atypical multiple evanescent white dot syndrome (MEWDS) includes bilateral presentations or complicated courses, while multifocal choroiditis and panuveitis/punctate inner choroiditis (MFCPU/PIC) with outer retinal atrophy emerges as a notable entity with unclear therapeutic implications. Inflammatory reactions resembling both MEWDS and MFCPU/PIC may also occur as secondary phenomena, triggered by other chorioretinal disorders, most notably inherited retinal diseases (IRDs). Placoid chorioretinopathies, including acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, and relentless placoid chorioretinitis, are often distinguished only a posteriori based on disease course, but likely represent a continuum of disorders unified by choroidal ischemia. Atypical presentations of birdshot chorioretinopathy may feature extensive outer retinal damage, mimicking IRDs. Equally important is the consideration of masquerade syndromes in all suspected cases of NIPUs, as they can present with similar features yet require entirely different treatments. Infectious masquerades include tuberculosis-associated serpiginous-like choroiditis, acute syphilitic posterior placoid chorioretinopathy, and West Nile virus chorioretinitis, whereas vitreoretinal lymphoma is the most frequent neoplastic masquerade. CONCLUSIONS: Integrating clinical context with high-quality multimodal imaging remains essential to navigate the jungle of differential diagnosis in NIPUs. Future studies should aim to integrate imaging phenotypes with immunologic and molecular biomarkers to refine disease classification and support more targeted therapeutic strategies.
The Multimodal Imaging in Uveitis Virtual Special Issue.
Davis JL
Am J Ophthalmol · 2026 Mar · PMID 41856227 · Publisher ↗
Abstract loading — click title to view on PubMed.
Swept-Source Optical Coherence Tomography Angiography Vascular Metrics as Biomarkers for Renal Function in Patients with Diabetes Mellitus.
Garg I, Duich M, Uwakwe C … +17 more , Wai KM, Rodriguez JM, Lu ES, Cui Y, Le R, Katz R, Lains I, Vingopoulos F, Moon JY, Zhu Y, Eliott D, Miller JW, Kim LA, Patel NA, Husain D, Vavvas DG, Miller JB
Am J Ophthalmol · 2026 Jul · PMID 41856226 · Publisher ↗
PURPOSE: This study evaluates swept-source optical coherence tomography angiography (SS-OCTA) quantitative metrics as noninvasive biomarkers of diabetic nephropathy (DN) in patients with diabetes mellitus. DESIGN: This i...
PURPOSE: This study evaluates swept-source optical coherence tomography angiography (SS-OCTA) quantitative metrics as noninvasive biomarkers of diabetic nephropathy (DN) in patients with diabetes mellitus. DESIGN: This is a cross-sectional study of patients with diabetes mellitus. SUBJECTS: This study included 375 eyes of 234 patients imaged using 12 × 12-mm angiograms centered on the fovea. METHODS: OCTA metrics that were analyzed included nonperfusion area (NPA), foveal avascular zone (FAZ) area, vessel density (VD), and vessel skeletonized density (VSD). These metrics were compared with the presence and severity of DN. MAIN OUTCOME MEASURES: Primary outcomes were albuminuria (albumin-to-creatinine ratio ≥30 mg/g) and chronic kidney disease (CKD, estimated glomerular filtration rate [GFR] ≤60 or >60 mL/min/1.73 m with albuminuria). Secondary outcomes included albuminuria severity (A1: <30, A2: 30-300, A3: >300 mg/g), CKD severity (normal GFR: ≥90, mild CKD: 60-89, moderate-severe CKD: ≤59 mL/min/1.73 m) and Kidney Disease: Improving Global Outcomes (KDIGO) risk categories for CKD progression and/or mortality. Subgroup analysis assessed early microvascular changes in patients with no or mild diabetic retinopathy (DR) and DN association. Multivariate regression adjusted for age, smoking status, glycated hemoglobin, and mean arterial blood pressure. RESULTS: Of 234 patients, 145 (62%) had CKD and 111 (47%) had albuminuria. Increasing NPA was associated with albuminuria (odds ratio [OR]: 1.17, P = .038), CKD (OR: 1.06, P < .001), CKD severity (P < .05), and KDIGO risk categories on pairwise analysis (P < .05). VD and VSD were significantly different between extremes of KDIGO risk categories (very high vs low and moderate risk, P < .05) and albuminuria severity (A3 vs A1, P < .05). In the no/mild DR subgroup, more circular FAZ and higher VD were associated with absent albuminuria (P < .05). CONCLUSIONS: NPA is a potential biomarker for predicting DN and is associated with DN severity. This study is the first to link OCTA metrics with KDIGO risk categories for CKD severity and mortality.
Outcomes and Risk Factors for Failure After PRESERFLO™ MicroShunt Implantation in a Multicenter Japanese Cohort.
Mieno H, Mori K, Kano K … +6 more , Yoshii K, Kazuo K, Ikeda Y, Ueno M, Kuwayama Y, Sotozono C
Am J Ophthalmol · 2026 Jul · PMID 41850668 · Publisher ↗
PURPOSE: To evaluate real-world outcomes of PRESERFLO MicroShunt (PMS) implantation and identify risk factors for surgical failure in a large multicenter Japanese cohort. DESIGN: Multicenter, retrospective cohort study....
PURPOSE: To evaluate real-world outcomes of PRESERFLO MicroShunt (PMS) implantation and identify risk factors for surgical failure in a large multicenter Japanese cohort. DESIGN: Multicenter, retrospective cohort study. METHODS: This study involved 699 patients (N = 856 eyes) who underwent PMS implantation with ≥ 3 months of follow-up postsurgery. The main outcome measures were 12-month-postoperative complete and qualified surgical success and risk factors for failure. Surgical success was defined by three criteria: A, B, and C corresponded to the intraocular pressure (IOP) thresholds of ≤ 18, ≤15, and ≤ 12 mm Hg, respectively, each combined with a ≥ 20% reduction from baseline. Outcomes were categorized as complete success (CS, without medication) or qualified success (QS, with or without medication). Kaplan-Meier and Cox regression analyses were used to evaluate success rates and risk factors. RESULTS: Median IOP decreased from 18 mm Hg preoperatively to 11 mm Hg at 12 months postoperatively, with median medications reduced from 4 to 0 (P < .001). At 12-months postoperative, CS rates were 69.5%, 67.6%, and 59.4% under Criteria A, B, and C, respectively; corresponding QS rates were 81.0%, 77.3%, and 66.0%, respectively. Risk factors for CS failure across all three criteria included greater medication use and prior or concomitant cataract surgery, whereas older age and posterior tube fixation were protective. CONCLUSIONS: PMS implantation achieved sustained IOP reduction, decreased medication use, and favorable safety in a large Japanese cohort, underscoring the importance of patient selection and surgical technique in optimizing outcomes.
Long-Term Follow-Up of PLACE and SPECTRA Trials: Outcomes After Successful and Unsuccessful Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy.
van den Tillaart FM, Chang-Wolf JM, Feenstra HMA … +7 more , van Rijssen TJ, Hoyng CB, Diederen RMH, Schlingemann RO, Boon CJF, Yzer S, van Dijk EHC
Am J Ophthalmol · 2026 Jul · PMID 41850667 · Publisher ↗
PURPOSE: To prospectively evaluate and compare long-term functional and structural outcomes between successful and unsuccessful first half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioret...
PURPOSE: To prospectively evaluate and compare long-term functional and structural outcomes between successful and unsuccessful first half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC). DESIGN: Multicenter, prospective cohort study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Participants with cCSC enrolled in the PLACE and SPECTRA trials and treated with half-dose PDT in the participating Dutch medical centers, with visits at 5 to 10 years after inclusion. METHODS, INTERVENTION, OR TESTING: Participants were randomly assigned to half-dose PDT, oral eplerenone or high-density subthreshold micropulse laser and had protocol-defined retreatment and/or crossover treatment in case of persistent subretinal fluid (SRF). After 1 to 2 years of follow-up, patients were managed at clinicians' discretion and recalled for a 5 to 10-year visit. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA; measured in Early Treatment of Diabetic Retinopathy Study [ETDRS] letters), retinal sensitivity on microperimetry, presence of macular neovascularization, presence of SRF at long-term follow-up, recurrence of SRF, and retreatment during follow-up. RESULTS: Sixty percent (107/179) of eligible participants completed the long-term follow-up, performed at a median of 7.0 years. The first half-dose PDT was successful in 78 patients and unsuccessful in 29 patients. Due to a recurrence of SRF or persisting SRF, additional treatments were performed in 14.1% and 89.7% of patients in the successful and unsuccessful first PDT group during follow-up, respectively. BCVA at long-term follow-up was higher in the successful first PDT group (P < .001). Between baseline and long-term follow-up, BCVA increased significantly in the successful first PDT group (81.8 ± 7.8 vs 87.2 ± 8.7 ETDRS letters, P < .001), with the highest increase observed between baseline and the first control visit, followed by stabilization of BCVA thereafter. BCVA remained stable in the unsuccessful first PDT group (73.4 ± 12.1 vs 77.2 ± 16.2 ETDRS letters, P = .108). At long-term follow-up SRF was present in 16.7% and 44.8% of eyes in the successful and unsuccessful first PDT group, respectively (P = .005). CONCLUSIONS: cCSC patients with a successful first PDT show better long-term clinical outcomes than those with an unsuccessful first PDT. Notably, BCVA remained stable in both groups from the first follow-up after half-dose PDT onward, which is a reassuring finding even for patients without initial treatment success.
Spherical Equivalent Refraction Versus Axial Length for Monitoring Childhood Myopia and Estimating Disease Risk: A Systematic Review and Meta-Analysis.
Clark RA, Wong RK
Am J Ophthalmol · 2026 Jun · PMID 41825844 · Publisher ↗
TOPIC: To determine the relative merits of spherical equivalent refraction (SER) vs axial length (AL) as the primary measure for monitoring childhood myopia progression and predicting adult myopia-related pathology. CLIN...
TOPIC: To determine the relative merits of spherical equivalent refraction (SER) vs axial length (AL) as the primary measure for monitoring childhood myopia progression and predicting adult myopia-related pathology. CLINICAL RELEVANCE: Myopia prevalence is rising worldwide, but most patients only reach low-to-moderate myopia. Many guidelines emphasize AL over SER using fixed thresholds to define ``high risk'' (eg, ≥26 mm), yet a large proportion of myopia-related pathology occurs in eyes that never reach those lengths. METHODS: We conducted a systematic review and meta-analysis of population-based observational studies (≥200 eyes; PubMed and Embase searched from 1990 to July 2025) reporting AL and/or SER with demographics and/or retinal, cataract, or primary open-angle glaucoma (POAG) outcomes. Random effects meta-analyses with Hartung-Knapp adjustment were performed when k ≥ 3; other results were synthesized descriptively. Risk of bias was assessed with the Newcastle-Ottawa Scale and certainty of evidence with Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Seventy studies met inclusion criteria. Normal AL varied strongly with age, sex, height, and ethnicity, whereas SER showed much weaker dependence. A small tail of emmetropes reached AL ≥26 mm. Retinal pathology rose steeply with longer AL (odds ratio [OR] 3.85 per +1 mm), implying risk ratio ≈25 at AL 26 mm relative to AL 23.6 mm (pooled gradient), but this long-eye threshold applied to <10% of eyes. SER data, although less frequent, showed consistent retinal risk increases with OR ≈1.5 to 1.8 per -1 diopter and OR 2 to 12 for high myopia. For cataract prevalence, SER-defined moderate/high myopia yielded ORs of 3.09 for nuclear and 4.58 for posterior subcapsular cataract, whereas AL-defined effects were null or modest. For POAG prevalence, AL per +1 mm showed OR 1.37, whereas SER-defined moderate/high myopia showed OR 2.95. Certainty of evidence was moderate for prevalence analyses and lower for incidence and descriptive blocks. CONCLUSION: Absolute AL thresholds clearly identify a small tail of very long eyes at high retinal risk, but SER better captures cataract and POAG risk gradients across the myopic range that most patients will reach. SER should be the primary progression and risk metric for monitoring childhood myopia control, with AL used selectively to monitor the minority of children with greater axial elongation.
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