CLINICAL RELEVANCE: Understanding the quality of care provided by existing refractive error services and aspects that influence quality enables educators and the workforce to develop interventions for delivering high-qua...CLINICAL RELEVANCE: Understanding the quality of care provided by existing refractive error services and aspects that influence quality enables educators and the workforce to develop interventions for delivering high-quality services. BACKGROUND: High-quality eye care services are required not only to address uncorrected refractive error but also maintain the needs of those wearing spectacles. This study aims to evaluate the quality of refractive error care in China by estimating the proportion and assessing factors associated with receiving optimal spectacles. METHODS: This cross-sectional study utilised trained unannounced standardised patients with various refractive error profiles to attend optical services in 2024 in Dali, China. Patients requested an eye examination, ordered and collected spectacles and a written prescription, and recorded testing provided. Baseline refractions were averaged from measurements conducted by three qualified refractionists. Spectacles and prescriptions were compared against the baseline and optimal criteria, and then against each other to assess appropriateness of spectacles made. Proportions for quality outcomes were calculated with robust standards errors to account for intra-service correlation. Univariable and multivariable logistic regression explored potential associations between spectacle quality and visit factors. RESULTS: Fourteen unannounced standardised patients visited 67 optical services completing 259 visits with 249 spectacles dispensed (181 single vision distance, 68 single vision near). Overall, 25.7% (95%CI:20.0-32.4%) and 38.8% (95%CI:33.5-44.5%) of spectacles and prescriptions, respectively, met the optimal criteria. Regression analyses indicated that males (OR:0.42, 95%CI:0.19-0.92, = 0.03) were at reduced odds of receiving optimal spectacles, whereas those attending rural services were at significantly increased odds of receiving optimal spectacles (OR:2.82, 95%CI:1.40-5.69, = 0.004). CONCLUSION: The quality of refractive error care in Dali, China, shows a distinct need for improvement. The observed gender disparity in care requires further investigation, while understanding the systems and structures of rural services may provide insights to foster and improve urban services.
CLINICAL RELEVANCE: There is potential to expand the number of collaborative care and multidisciplinary team-based care models that optometrists are involved in, working at full scope to deliver high quality patient care...CLINICAL RELEVANCE: There is potential to expand the number of collaborative care and multidisciplinary team-based care models that optometrists are involved in, working at full scope to deliver high quality patient care. Ongoing work to generate research evidence, change policy and secure long-term funding is needed to support implementation. BACKGROUND: Implementation of new models of multidisciplinary team-based care or collaborative care can support quality healthcare delivery and the sustainability of future health systems. METHODS: This narrative review synthesises research on models of multidisciplinary team-based care or collaborative care that involve optometrists in Australia and New Zealand. Outcomes related to patient health and experience, health service delivery including costs, and practitioner experience including workforce satisfaction were extracted from published evaluations. Additionally, barriers and facilitating factors to implementation were synthesised from identified studies. RESULTS: In total, 12 models of care were identified, most were task shifting or task sharing models between optometry and hospital-based ophthalmology for managing eye conditions. These collaborative models were developed to address long waiting lists for hospital-based ophthalmology services, and their implementation resulted in a corresponding decrease in waiting times for appointments. However, patient health outcomes, patient, and practitioner experiences were seldom reported. In primary care settings, models of multidisciplinary team-based care ( =3) were generally well-received by patients and practitioners. However, more objective measures may help quantify the social and economic benefits of these models. CONCLUSION: Despite the impetus for multidisciplinary team-based care, barriers to wider implementation persist. Implementation science can help identify strategies to overcome barriers to adopting evidence-based models of care. Future studies should incorporate economic evaluations, to inform advocacy and policy, to generate system-level change that support health organisations to deliver multidisciplinary team-based care. Finally, future work should consider embedding the patient perspective from outset to ensure that models of care are people-centred.
CLINICAL RELEVANCE: Diabetic retinopathy is a leading cause of blindness among working-age adults. Regular fundus examinations by optometrists enable its early detection and intervention, thus preventing vision loss. BAC...CLINICAL RELEVANCE: Diabetic retinopathy is a leading cause of blindness among working-age adults. Regular fundus examinations by optometrists enable its early detection and intervention, thus preventing vision loss. BACKGROUND: Patients with diabetes are particularly susceptible to microvascular complications, with retinal microaneurysms (RMAs) serve as an early indicator of these diabetic retinal microvascular complications. Although glycaemic control is the principal strategy for preventing diabetic complications, the specific effects of various blood glucose control methods on the development of RMA remain unclear. METHODS: On the basis of the 2005-2008 National Health and Nutrition Examination Survey (NHANES) data, the baseline data of 5,398 participants were analysed using a Pearson correlation coefficient matrix. Univariate logistic regression was employed to examine the differences in demographic characteristics, behavioural factors, and other lifestyle variables. Variables that demonstrated statistical significance in the univariate analysis, as well as those identified as clinically relevant on the basis of practical experience, were included inmultivariate regression analysis. RESULTS: Insulin monotherapy significantly increased RMA risk, with an odds ratio (OR) of 7.449 ( < 0.001). In contrast, the use of diabetic pills alone did not have a significantly affect on RMA risk (OR = 1.597, = 0.135). Furthermore, combination therapy, which included both insulin and diabetic pills, led to a 72% reduction in RMA risk (OR = 0.281, < 0.01). In patients with diabetes, sex and fasting glucose levels were identified as independent risk factors for RMA. CONCLUSION: There is a synergistic protective effect of combination therapy on diabetic RMA, providing valuable evidence for blood glucose control in insulin-dependent patients.
CLINICAL RELEVANCE: The safety of orthokeratology needs to be regularly monitored. Retrospective studies of orthokeratology can provide safety data for real-world clinical settings. BACKGROUND: This study aimed to evalua...CLINICAL RELEVANCE: The safety of orthokeratology needs to be regularly monitored. Retrospective studies of orthokeratology can provide safety data for real-world clinical settings. BACKGROUND: This study aimed to evaluate the safety of an orthokeratology lens (Paragon CRT® 100 and Paragon CRT® Dual Axis [CRT-E], Paragon Vision Sciences, Inc. a CooperVision company; paflufocon D) among myopic Chinese children and adults. METHODS: Patient records were reviewed for ocular adverse events at five clinical sites in China. Patient records meeting all of the following criteria were selected for data extraction: sphere refraction within -4.00 D (inclusive) and astigmatism within 1.50 D (inclusive) before wearing corneal refractive therapy (CRT) lenses, and wear of CRT lenses for over 335 days. Ocular adverse events are reported, by person, as number of events, incidence, and incidence rate. RESULTS: In total, 2,793 patient records were screened, and 2,768 met the data-extraction criteria. Patients were aged 6 to 33 years; median age was 10 years (IQR: 9-12 years). Most patients (2,318) wore CRT lenses in both eyes, although 450 patients had monocular treatment. Lens wear totalled 3,269 patient-years, during which there were no serious ocular adverse events. There were 300 ocular adverse events among 241 patients (incidence of 8.7%); 282 events were mild, and 18 events were moderate. Device-related ocular adverse events occurred 175 times among 134 patients (4.8% incidence); 167 events were mild, and 8 events were moderate. The most common device-related events were corneal epithelial defects (108) - including corneal epithelial staining, abrasion, and epithelial roughness - and conjunctival hyperaemia (23), most of which self-resolved. The rate of device-related ocular adverse events was 5.4 per 100 patient-years (95% CI: 4.6-6.2). CONCLUSION: The orthokeratology lenses are safe for overnight wear among Chinese myopes, as demonstrated by the low incidence and mild-to-moderate nature of ocular adverse events.
CLINICAL RELEVANCE: Understanding the teaching methodologies for reflective practice in optometry education is vital to ensure that the current curricula reflect the requirements of contemporary professional practice. BA...CLINICAL RELEVANCE: Understanding the teaching methodologies for reflective practice in optometry education is vital to ensure that the current curricula reflect the requirements of contemporary professional practice. BACKGROUND: Reflective practice is seen as necessary in health professional education for promoting ongoing learning and critical thinking. Optometrists are increasingly expected to engage in reflection as part of their professional development. This study aims to explore how reflective practice is taught in optometry education. METHODS: A scoping review was conducted in accordance with the Johanna Briggs Institute methodology. Reflective practice methodologies were identified and examined using content analysis. Six databases were searched from their inception to 1 November 2023. RESULTS: Of 3495 publications, 120 full-text articles were reviewed, with 37 found to include reflective activities within optometry education. The retrieved publications primarily addressed professional skills development, curricular planning, and technical knowledge. The relevant reflective practice activities commonly featured in the sources of evidence included focus group discussions, interviews, portfolio and reflective writing, open-ended questionnaires, and activities designed to prompt reflect-in-action responses. The effectiveness of how reflection had transformed and improved student learning was discussed in eight articles. CONCLUSION: Reflective practice is not explicitly discussed in the published optometry literature. Despite evidence of reflective activities, the limited discussion surrounding their effectiveness suggests that students may be unaware that they are being trained for this skillset. While there are growing interests in reflective practice, its implementation remains implicit and under-evaluated. To ensure that students are intentionally and effectively trained in this critical competency, further research is needed to explore its application, impact, and integration within optometry education.
CLINICAL RELEVANCE: Childhood myopia is increasingly prevalent in routine optometric practice and is associated with a lifetime risk of ocular complications. Clinically acceptable and evidence-based strategies to slow my...CLINICAL RELEVANCE: Childhood myopia is increasingly prevalent in routine optometric practice and is associated with a lifetime risk of ocular complications. Clinically acceptable and evidence-based strategies to slow myopia progression are therefore important for long-term eye health management across diverse populations. BACKGROUND: To assess the efficacy, feasibility and safety of repeated red-light laser (RLRL) therapy among multi-ethnic school-aged children in Australia. METHODS: Randomised controlled trial. 34 multi-ethnic children aged 8-13 years with myopia were enrolled. Participants were randomly assigned to the RLRL therapy with single-vision spectacles (SVS) group or the SVS group. RLRL therapy was administered for 3 minutes, twice daily for 5 days per week, while SVS group continued routine activities. Assessments were scheduled at baseline and follow-up visits at 1, 3, 6 & 12 months, with compliance monitoring and safety assessments throughout. Axial length (AL), spherical equivalence refraction (SER) and Optical coherence tomography were conducted. RESULTS: A total of 34 children were randomised to 17 in the RLRL group and 17 in the SVS group. Three children in the RLRL group withdrew due to headache ( = 1) and poor compliance to treatment ( = 2). Adjusted mean changes of 12-month AL and SER were -0.03 (95% CI, -0.05 to -0.01) mm and 0.08 (95% CI, 0.04 to 0.13) D for RLRL group and 0.12 (95% CI, 0.10 to 0.14) mm and -0.20 (95% CI, -0.29 to -0.10) D for SVS group. No severe adverse events were observed during the study period. CONCLUSION: This pilot study in a non-Chinese Australian population demonstrated that RLRL therapy may be a promising alternative treatment for myopia control in multi-ethnic school-aged children, with no documented functional and structural damages. Further research with a larger cohort is warranted to confirm results and explore the long-term efficacy and safety of RLRL therapy.
CLINICAL RELEVANCE: Blue-violet light-filtering daily contact lenses are becoming more popular as a way of addressing the visual challenges associated with prolonged exposure to digital screens and low-light environments...CLINICAL RELEVANCE: Blue-violet light-filtering daily contact lenses are becoming more popular as a way of addressing the visual challenges associated with prolonged exposure to digital screens and low-light environments. Optimising contrast sensitivity in such situations is important for visual comfort, functional performance and patient satisfaction, especially among individuals with high visual demands or frequent exposure to glare. BACKGROUND: Digital device use has increased exposure to short-wavelength light, contributing to visual fatigue and reduced contrast sensitivity. Blue-violet - filtering soft contact lenses have been developed to enhance visual performance; however, independent clinical data comparing such lenses to non-filtering designs manufactured from the same material remain limited. METHODS: This retrospective comparative study analysed 45 myopic adults fitted with two senofilcon-A daily disposable lenses: OASYS (non-filtering) and MAX (blue-violet filtering). Contrast sensitivity (photopic, mesopic, glare), corneal aberrations, and non-invasive tear break-up time (NIBUT) were assessed. Repeated-measures ANOVA and regression analyses were used to evaluate lens-related differences and identify predictors of contrast sensitivity. RESULTS: MAX lenses demonstrated significantly higher contrast sensitivity at medium-to-high spatial frequencies under photopic and mesopic conditions, and at low-to-mid frequencies with glare. Tear-film stability was preserved with both lenses without clinically meaningful differences. Corneal aberration changes were small; higher coma and trefoil values correlated with reduced contrast sensitivity during MAX wear. No demographic or pupil-related factors influenced outcomes. CONCLUSION: Blue-violet - filtering MAX lenses provide measurable improvements in contrast sensitivity, particularly under low light and glare. While tear-film stability remained comparable between lenses, optical design features of the MAX lens contributed to enhanced visual performance. These findings support their use in patients with high digital-screen exposure or night-time visual demands.
CLINICAL RELEVANCE: Objective eye-tracking provides quantitative metrics of oculomotor control and reading performance that complement conventional binocular vision testing. Integration of eye-movement analysis into clin...CLINICAL RELEVANCE: Objective eye-tracking provides quantitative metrics of oculomotor control and reading performance that complement conventional binocular vision testing. Integration of eye-movement analysis into clinical practice may support more comprehensive functional assessment of patients with binocular vision disorders. BACKGROUND: The aim of this work is to compare oculomotor parameters between patients with strabismus and healthy controls, integrating classical optometric/ophthalmological tests with objective video-oculography and eye-tracking measurements. METHODS: This observational cross-sectional study included 56 participants (20 with manifest strabismus and 36 visually normal controls). All subjects underwent a standardised optometric and ophthalmological examination, including refraction, visual acuity, cover test, near point of convergence, stereopsis, and Worth 4-dot testing. Oculomotor function and reading performance were objectively assessed using a binocular eye-tracking system, which recorded Developmental Eye Movement (DEM) test performance, fixation stability, horizontal saccades, smooth pursuit, and reading-related eye-movement metrics. Between-group comparisons were performed, effect sizes were calculated, and penalised logistic regression and receiver operating characteristic (ROC) analyses were used to identify the most discriminative variable. RESULTS: Participants with strabismus showed significantly longer DEM vertical and horizontal times (both = 0.002), higher DEM error rates ( = 0.006), reduced reading speed ( < 0.001), and increased fixation and saccadic counts compared with controls. In penalised multivariable modelling, DEM times, DEM error measures, and reading speed emerged as the strongest independent predictors of strabismus. ROC analyses demonstrated good to excellent discriminatory accuracy for DEM horizontal time, DEM vertical time, total DEM errors, and reading speed (AUC > 0.80). CONCLUSIONS: Strabismus is associated with marked impairments in oculomotor sequencing and reading-related eye-movement control. Objective eye-tracking-derived metrics, particularly DEM performance and reading efficiency, provide clinically relevant information beyond traditional binocular vision tests and may serve as sensitive functional biomarkers for the characterisation of strabismus.
CLINICAL RELEVANCE: Early diagnosis and intervention are of vital importance in delaying the irreversible vision loss caused by wet age-related macular degeneration (wAMD). BACKGROUND: wAMD can lead to blindness in sever...CLINICAL RELEVANCE: Early diagnosis and intervention are of vital importance in delaying the irreversible vision loss caused by wet age-related macular degeneration (wAMD). BACKGROUND: wAMD can lead to blindness in severe cases. At present, the pathogenesis of wAMD is still unclear, so a new biomarker is needed to study wAMD. METHODS: A total of 190 subjects were included in this study, including the control group ( = 90) and the wAMD group ( = 100). The expression of miR-335-5p and the diagnostic value of miR-335-5p in wAMD were analysed. ARPE-19 cells treated with 300 µM t-BHP for 24 h or 600 µM HO for 24 h were selected as oxidative damage models. MiR-335-5p mimic and miR-335-5p inhibitor were transfected into oxidative damage models to up-regulate and down-regulate miR-335-5p, and then proliferation and apoptosis were measured. Targetscan was used to forecast the target of miR-335-5p and gain VEGFA, which was confirmed by the dual-luciferase reporter system. MiR-335-5p and VEGFA were overexpressed in oxidative damage models to detect the role of both in wAMD. RESULTS: MiR-335-5p was reduced and may have high diagnostic value in wAMD. MiR-335-5p was a risk factor for wAMD. In the oxidative damage models, overexpressed miR-335-5p increased the cell viability and decreased the apoptosis, while the inhibition of miR-335-5p was reversed. VEGFA was the target of miR-335-5p and was negatively regulated by miR-335-5p in the oxidative damage models. VEGFA and miR-335-5p were negatively correlated in wAMD. CONCLUSION: MiR-335-5p may have a high diagnostic value in wAMD, suggesting that miR-335-5p might be a biomarker of wAMD. VEGFA was the target of miR-335-5p, and the two were negative correlation in wAMD. MiR-335-5p regulates VEGFA secretion in RPE cells, thereby indirectly participating in the core pathological process of wAMD.
CLINICAL RELEVANCE: Non-arteritic anterior ischaemic optic neuropathy is a major cause of optic nerve dysfunction in older adults. Understanding its structural and microvascular consequences is essential for identifying...CLINICAL RELEVANCE: Non-arteritic anterior ischaemic optic neuropathy is a major cause of optic nerve dysfunction in older adults. Understanding its structural and microvascular consequences is essential for identifying disease susceptibility and guiding clinical monitoring. BACKGROUND: Non-arteritic anterior ischaemic optic neuropathy results from impaired perfusion of the optic nerve head, leading to permanent structural and vascular injury. Although clinically affected eyes show marked damage, fellow eyes may also demonstrate anatomical crowding and reduced vascular supply. METHODS: This retrospective observational study included eyes with chronic non-arteritic anterior ischaemic optic neuropathy, their unaffected fellow eyes, and age- and sex-matched controls. Structural parameters, including peripapillary retinal nerve fibre layer thickness, ganglion cell complex thickness, and optic disc morphology, were assessed using swept-source optical coherence tomography. Macular vessel density, radial peripapillary capillary plexus density, and inside-disc vessel density were evaluated using optical coherence tomography angiography. RESULTS: Eyes with chronic non-arteritic anterior ischaemic optic neuropathy showed marked neuroaxonal loss, with significantly reduced inferior pRNFL thickness (78.15 ± 29.42 µm vs 131.64 ± 16.44 µm in controls; < 0.001) and foveal GCC thickness (31.0 µm vs 47.0 µm; < 0.001). The vertical cup-to-disc ratio was significantly lower in both affected and fellow eyes compared to controls (0.29 and 0.25 vs 0.45; < 0.001). Macular parafoveal vessel density and radial peripapillary capillary plexus density were significantly reduced in affected eyes (e.g. superior SCP 41.44 ± 3.38% vs 46.61 ± 3.44%; RPC superior 38.14 ± 4.94% vs 50.82 ± 2.54%; both < 0.001), while fellow eyes demonstrated intermediate structural and vascular values. CONCLUSIONS: Chronic non-arteritic anterior ischaemic optic neuropathy is associated with persistent neuroaxonal thinning and microvascular reduction. Fellow eyes exhibit a disc-at-risk configuration and subtle peripapillary perfusion changes, suggesting bilateral anatomical susceptibility. Optical coherence tomography and optical coherence tomography angiography may help identify subclinical vulnerability and support longitudinal monitoring.
CLINICAL RELEVANCE: Amblyopia is a neurodevelopmental binocular disorder, managed mostly by patching and increasingly by dichoptic binocular therapy. The criteria to cease therapy is usually determined by monocular (ambl...CLINICAL RELEVANCE: Amblyopia is a neurodevelopmental binocular disorder, managed mostly by patching and increasingly by dichoptic binocular therapy. The criteria to cease therapy is usually determined by monocular (amblyopic eye) visual acuity improvement. Grades of binocular vision may also provide additional clinical information for amblyopia management. BACKGROUND: Absence of simultaneous macular perception (SMP, Grade 1 of binocular vision) is indicative of suppression. In amblyopia, all grades of binocular vision are reduced or absent. With therapy, improvements in these grades of binocular vision may occur sequentially or simultaneously. The present study investigated these patterns. METHODS: A retrospective study was conducted. Patients who had undergone anti-suppression vision therapy for amblyopia were included. Visual acuity, stereoacuity, and suppression size were measured before and after therapy. Suppression size was measured using a commercially available device (VTS4) that presents dissimilar dichoptic targets. RESULTS: Twenty three patients (mean±SD age: 15 ± 6.55 years) were included. Suppression size was significantly ( = 0.004) reduced from a median [Q1-Q3] of 2.1° [0.6°-5.0°] to 0.6° [0.6°-1.5°], following therapy. Improvement in stereoacuity (2.14 [1.84-3] to 1.84 [1.43-2.60] log arcseconds, = 0.002) and mean visual acuity in the amblyopic eye (by 0.11 ± 0.09 logMAR, < 0.001) was also observed. A greater proportion of patients (71%) showed a reduction in suppression size compared with those showing improvement in stereoacuity (21%), particularly among patients with larger baseline suppression size. In those starting with suppression size < 1°, the potential for improving the stereoacuity was higher (100%). CONCLUSION: Greater improvement in Grade 1 binocular vision compared with Grade 3 (stereoacuity) suggests a hierarchical recovery of binocular function in amblyopia. Additional therapy sessions may be considered to improve stereoacuity once suppression size is reduced to ≤1°. Measurement of SMP, alongside visual acuity and stereoacuity, may provide additional insights for amblyopia management.
To close the gap in eye health outcomes, optometrists must acknowledge the link between clinical and cultural safety, recognise Indigenous sovereignty, and accept the ongoing harms of colonisation. The Optometry Aborigin...To close the gap in eye health outcomes, optometrists must acknowledge the link between clinical and cultural safety, recognise Indigenous sovereignty, and accept the ongoing harms of colonisation. The Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework requires optometry programmes to embed culturally safe and responsive eye care for Aboriginal and Torres Strait Islander Peoples in their curricula. However, the Optometry Council of Australia and New Zealand recognised a complementary Māori Health Curriculum Framework was needed. A Kaupapa Māori approach, drawing upon traditional cultural knowledge and embedding critical decolonising theories, was used to create the framework. Māori curriculum experts ensured the Framework privileged Indigenous knowledges, and a Māori Health Curriculum Framework Reference group, comprised of Māori and non-Māori optometry educators, guided the project. A common foundation for Māori health curricula in Australasian optometry programmes was created through an Indigenous-led, evidence-based process. The Framework incorporated nine key themes reflecting Māori worldviews and honouring the principles of Te Tiriti o Waitangi. The Optometry Māori Health Curriculum Framework is an example of active partnership between Māori and non-Māori to achieve an accreditation framework developed by Māori, with Māori, and for Māori through consultation, codesign, and collaboration.
CLINICAL RELEVANCE: Anterior segment morphometric parameters, including the iris, ciliary body, ciliary process and anterior sclera, re ect uveal vascular physiology and scleral biomechanics. These structures may help cl...CLINICAL RELEVANCE: Anterior segment morphometric parameters, including the iris, ciliary body, ciliary process and anterior sclera, re ect uveal vascular physiology and scleral biomechanics. These structures may help clinicians better understand disorders associated with altered ocular uid dynamics within the pachychoroid spectrum. BACKGROUND: Complex central serous chorioretinopathy is characterised by serous neurosensory retinal detachment and is commonly associated with pachychoroid features, including increased subfoveal choroidal thickness. However, the potential contribution of anterior uveal and scleral structures to its pathophysiology remains insu ciently de ned. METHODS: This study included 32 eyes with active complex central serous chorioretinopathy and 31 age- and gender-matched controls. Iris, ciliary body, and ciliary process thicknesses were measured using ultrasound biomicroscopy under standardised photo-pic conditions. Anterior scleral thickness was measured at 1, 2 and 3 mm posterior to the scleral spur using anterior segment optical coherence tomography. Subfoveal choroidal and central macular thickness were measured by spectral-domain optical coherence tomography. Correlations were analysed with false discovery rate correction. RESULTS: Ciliary body (0.93 ± 0.11 mm vs 0.78 ± 0.10 mm) and anterior scleral thickness (0.57 ± 0.06 mm vs 0.49 ± 0.05 mm) were signi cantly greater in complex disease than in controls (both p < 0.001). Subfoveal choroidal thickness (425.7 ± 83.8 µm vs 290.7 ± 68.5 µm) and central macular thickness (330.7 ± 74.0 µm vs 226.5 ± 18.8 µm) were also higher (p < 0.001). Anterior scleral thickness correlated with ciliary body (r = 0.494), ciliary process (r = 0.498) and subfoveal choroidal thickness (r = 0.509) (all p < 0.001). Temporal iris thickness correlated with temporal anterior scleral thickness (rs = 0.410; p = 0.006). CONCLUSION: Active complex disease is associated with increased anterior uveal and scleral thickness, suggesting anterior segment involvement parallel to posterior pachychoroid changes.