PURPOSE: To compare anatomical and functional outcomes as well as postoperative complication rates between cryotherapy and illuminated endolaser retinopexy in chandelier-assisted scleral buckling (CASB) for rhegmatogenou...PURPOSE: To compare anatomical and functional outcomes as well as postoperative complication rates between cryotherapy and illuminated endolaser retinopexy in chandelier-assisted scleral buckling (CASB) for rhegmatogenous retinal detachment. METHODS: This retrospective study included 63 eyes from 63 patients treated with CASB between January 2021 and January 2024. Group 1 (n = 31) underwent retinopexy with cryotherapy, whereas Group 2 (n = 32) received illuminated endolaser through the same cannula as the chandelier light. All surgeries were performed using a noncontact wide-angle viewing system by a single experienced vitreoretinal surgeon. Outcome measures included best-corrected visual acuity (BCVA), intraocular pressure, swept-source OCT, and postoperative complications. RESULTS: Mean BCVA improved significantly in both groups. In Group 1, BCVA improved from 1.39 ± 0.74 logMAR (approx. Snellen 20/490) to 1.01 ± 0.63 (20/204), P < 0.001. In Group 2, BCVA improved from 1.50 ± 0.67 (20/632) to 1.14 ± 0.66 (20/276), P < 0.001. Final BCVA ( P = 0.21) and retinal reattachment rates ( P = 0.67) were similar. However, cystoid macular edema (CME) occurred significantly more in Group 1 (19.3%) than in Group 2 (3.1%) ( P = 0.04). Rates of epiretinal membrane, cataract, and intraocular pressure elevation did not differ significantly ( P > 0.05). No buckle exposure or infection was observed. CONCLUSION: Both techniques are effective for CASB. Endolaser provides a lower risk of CME and enhanced surgical precision, suggesting it may be a favorable option in selected cases.
Hasan N, Zarnegar A, Sadeghi E
… +26 more, Singh SR, Sahoo N, Cao J, Saju S, Zhou A, Wykoff CC, Khateb S, Ashfaq Y, Kroeger Z, Wang JC, Khurana RN, Checchin L, Pili L, Parodi MB, Piccoli G, Vujosevic S, Shah P, Singhanetr P, Rossin E, Villafeurte-Trisoloni C, Yiu G, Winter H, Gill MK, Wu L, Chhablani J, MICRoN Study Group
PURPOSE: To describe a novel optical coherence tomography finding called "scolex sign" in cases of central serous chorioretinopathy. METHODS: This retrospective multicenter study included patients with central serous cho...PURPOSE: To describe a novel optical coherence tomography finding called "scolex sign" in cases of central serous chorioretinopathy. METHODS: This retrospective multicenter study included patients with central serous chorioretinopathy with serous pigment epithelial detachments (PEDs) greater than 100 µ m, with or without subretinal fluid. Eyes showing a distinct hyperreflective focus on the PED wall (scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on subretinal fluid status was also performed. RESULTS: Of 291 eyes with large serous PEDs, 52 eyes exhibited the "scolex sign" and were compared with 52 age-matched controls. Baseline characteristics including sex, systemic comorbidities, best-recorded visual acuity and optical coherence tomography parameters were similar in both the groups. However, eyes with the "scolex" sign exhibited a greater number of central PEDs and shorter distance from the foveal center. On follow-up, eyes with the "scolex" sign showed a higher rate of PED flattening and subretinal fluid resolution trended to be higher compared with controls. CONCLUSION: The "scolex" sign represents a novel, benign optical coherence tomography feature seen in a subset of central serous chorioretinopathy cases. While not associated with poorer outcomes or adverse sequelae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.
PURPOSE: To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in neovascular age-related macular degeneration (nAMD) using automated volumetric retinal fluid analysis. METHODS: This retros...PURPOSE: To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in neovascular age-related macular degeneration (nAMD) using automated volumetric retinal fluid analysis. METHODS: This retrospective study included 186 eyes with nAMD showing inadequate response after ≥3 bevacizumab injections. Patients were switched to a second-line anti-VEGF agent and categorized as early (3-5 injections) or late (≥6 injections) switchers. Optical coherence tomography (OCT) scans were analyzed using the Notal-OCT Analyzer (NOA), an AI-based algorithm for retinal fluid quantification. Parameters included total retinal fluid (TRF), intraretinal fluid (IRF) volume, subretinal fluid (SRF) volume, pigment epithelial detachment (PED) volume, central subfield thickness (CST), and visual acuity (VA), assessed at baseline, after bevacizumab, and after three injections of the new agent. RESULTS: Early switchers showed an increase in TRF from 105 nL to 158 nL after bevacizumab, then a reduction to 20 nL postswitch ( P < 0.001); PED volume decreased postswitch ( P = 0.010). Late switchers showed fluid reductions both after bevacizumab and postswitch (TRF: P < 0.001; PED: P = 0.007). CST significantly improved only in early switchers ( P = 0.004), while VA changes were not statistically significant. CONCLUSION: Automated fluid analysis reliably quantifies treatment response in nAMD. Early switchers showed worsening after bevacizumab, while late switchers had partial responses. These findings highlight the potential of automated analysis to support more individualized, data-driven treatment strategies. Prospective studies are required to confirm impact on patient outcomes.
PURPOSE: To evaluate the use of povidone-iodine infusion during pars plana vitrectomy and to assess its clinical outcomes in the treatment of severe endophthalmitis. METHODS: A retrospective case series of 40 patients (4...PURPOSE: To evaluate the use of povidone-iodine infusion during pars plana vitrectomy and to assess its clinical outcomes in the treatment of severe endophthalmitis. METHODS: A retrospective case series of 40 patients (41 eyes) with clinically or culture-confirmed endophthalmitis underwent pars plana vitrectomy with 0.025% povidone-iodine in the infusion solution. Outcomes included infection resolution, improvements in visual acuity, the need for additional surgeries, and signs of ocular toxicity. RESULTS: Of the 41 eyes treated, infection resolved in 33 (80.4%) eyes postoperatively. Visual acuity improved postoperatively in 29 eyes (70.7%). Mean uncorrected visual acuity improved from 20/3,337 (2.22 ± 0.70 logMAR) preoperatively to 20/540 (1.43 ± 0.88 logMAR) postoperatively ( P < 0.0001). No ocular toxicity or unexplained vision loss related to povidone-iodine infusion was observed. CONCLUSION: The addition of 0.025% povidone-iodine infusion during pars plana vitrectomy appears safe and led to favorable post-surgical outcomes in a traditionally high-risk cohort.
PURPOSE: To investigate the relationship between the spatial arrangement of pachyvessels and polypoidal choroidal vasculopathy (PCV) lesions in relation to recurrence. METHODS: This retrospective study included 58 eyes o...PURPOSE: To investigate the relationship between the spatial arrangement of pachyvessels and polypoidal choroidal vasculopathy (PCV) lesions in relation to recurrence. METHODS: This retrospective study included 58 eyes of 58 patients with treatment-naive PCV who were followed for at least 1 year after receiving anti-vascular endothelial growth factor injections, with or without photodynamic therapy. Using en face optical coherence tomography, the eyes were categorized into 2 groups based on the presence or absence of transmacular pachyvessels passing beneath PCV lesions (polypoidal lesions or branching neovascular networks). The primary outcome was the recurrence rate of PCV within 1 year. RESULTS: Of the 58 eyes, 35 (60.3%) had pachyvessels located beneath PCV lesions. The 1-year recurrence rate was significantly higher in eyes with pachyvessels than without (71.4% vs. 39.1%, P = 0.017). Univariable logistic regression analysis identified the presence of pachyvessels beneath lesions as a significant predictor (odds ratio, 3.89; 95% confidence interval, 1.28-11.84; P = 0.017). This remained the only significant predictor of recurrence within 1 year on multivariable logistic regression (odds ratio, 3.84; 95% confidence interval, 1.22-12.09; P = 0.022). CONCLUSION: The presence of transmacular pachyvessels may serve as a novel biomarker to predict prognosis and guide individualized treatment strategies for patients with PCV. These findings suggest that the anatomical relationship between pachyvessels and PCV lesions could be a critical factor in treatment response.
PURPOSE: To evaluate the retinal, peripapillary, and choroidal microvascular structures in patients with essential thrombocythemia (ET), a myeloproliferative neoplasm characterized by sustained thrombocytosis and an incr...PURPOSE: To evaluate the retinal, peripapillary, and choroidal microvascular structures in patients with essential thrombocythemia (ET), a myeloproliferative neoplasm characterized by sustained thrombocytosis and an increased risk of thrombotic events, using optical coherence tomography angiography (OCTA). METHODS: This prospective, cross-sectional study included 20 ET patients and 20 age- and sex-matched healthy controls. All participants underwent spectral-domain OCTA to assess vessel density (VD) in the superficial and deep retinal capillary plexuses (SCP and DCP), radial peripapillary capillary (RPC) network, and choriocapillaris (CC). Structural parameters, including central macular thickness (CMT), macular ganglion cell complex (mGCC), retinal nerve fiber layer (RNFL), and foveal avascular zone (FAZ), were also evaluated. Statistical analyses included independent samples t-tests or Mann-Whitney U tests based on data distribution. RESULTS: Patients with ET exhibited significantly increased CMT compared with controls ( P = 0.019), whereas RNFL and mGCC thicknesses showed no significant differences. Peripapillary whole image VD and RPC VD in the nasal-inferior quadrant were significantly reduced in the ET group ( P = 0.042 and P = 0.039, respectively). Most notably, DCP VD was significantly decreased in both parafoveal ( P = 0.004) and perifoveal ( P = 0.010) regions across all quadrants. No significant differences were observed in SCP VD, FAZ metrics, or CC flow parameters ( P > 0.05 for all). CONCLUSION: Patients with ET demonstrate subclinical retinal microvascular alterations predominantly affecting the DCP and peripapillary circulation, whereas superficial retinal and choroidal vasculature remains relatively preserved. OCTA may serve as a sensitive, noninvasive tool for detecting early retinal involvement in ET.
PURPOSE: To describe the multimodal imaging characteristics and clinical associations of choroidal synphlebia, a newly recognized configuration of the choroidal venous system. METHODS: This retrospective study analyzed p...PURPOSE: To describe the multimodal imaging characteristics and clinical associations of choroidal synphlebia, a newly recognized configuration of the choroidal venous system. METHODS: This retrospective study analyzed patients imaged with the DREAM swept-source OCT system (Intalight, San Jose, CA), capable of deep choroidal penetration. Choroidal synphlebia was defined as a confluent vascular structure ≥750 µ m in smallest lateral or vertical dimension. The multimodal imaging characteristics were evaluated. RESULTS: Nineteen eyes of 16 patients (mean age 63.2 years; eight male) were identified. Associated diagnoses included central serous chorioretinopathy in 16 eyes, neovascular age-related macular degeneration in 2, and myopia in 1. Three patients had bilateral involvement. Two morphologic patterns were observed: (1) broad confluence of large choroidal veins forming a lobulated venous lake and (2) a caput medusa-type arrangement with smaller tributaries converging radially into a dilated central channel. The lesions often occurred near presumed choroidal watershed zones. Macular neovascularization was present in seven eyes. In several central serous chorioretinopathy cases, subretinal fluid was resistant to photodynamic therapy but responsive to faricimab. CONCLUSION: Choroidal synphlebia represents a distinct choroidal venous phenotype characterized by fusion or coalescence of major veins with a lack of visible vessels in the overlying Sattler's layer and inner choroid. Alterations in the capacitance, resistance, and pressure distribution in the venous drainage system appear to be affected by synphlebia lesions. Recognition of synphlebia may provide insight into choroidal hemodynamics and may help explain atypical or treatment-resistant central serous chorioretinopathy and neovascular presentations.
PURPOSE: To assess the clinical characteristics and surgical outcomes of retinal detachment (RD) associated with presumed trematode-induced granulomatous intermediate uveitis (PTIGIU). METHODS: A review of the medical re...PURPOSE: To assess the clinical characteristics and surgical outcomes of retinal detachment (RD) associated with presumed trematode-induced granulomatous intermediate uveitis (PTIGIU). METHODS: A review of the medical records of patients diagnosed with RD secondary to PTIGIU over a 3-year period was conducted. Main outcome measures were the type and morphology of RD, final functional and anatomical outcomes. RESULTS: Out of 98 eyes with PTIGIU, 41 eyes (41.8%) were diagnosed with RD secondary to PTIGIU and were operated upon and completed 6-month follow-up period. Mean age was 12.6 years and logMAR corrected distance visual acuity 1.76. All eyes had vitritis of variable grades. Thirty-five eyes (85.4%) had tractional retinal detachment (TRD) and four eyes (9.8%) had combined tractional-rhegmatogenous retinal detachment. According to the extent of retinal detachment, the eyes were grouped into Group 1: 28 eyes, with subtotal peripheral RD, and Group 2: 13 eyes, with total RD or subtotal RD reaching posterior pole. The former group showed better functional and anatomical outcomes ( P = 0.019 and 0.028, respectively). Approximately 80.5% of all eyes showed final anatomical success and visual improvement (median corrected distance visual acuity 0.40, P < 0.001) at the final follow-up. CONCLUSION: Tractional retinal detachment is a common complication to PTIGIU, and early intervention is essential to avoid devastating ocular complications.
PURPOSE: To characterize persistent diffuse photoreceptor disorganization, a newly recognized retinal disorder, and establish diagnostic criteria differentiating it from similar outer retinopathies. METHODS: This retrosp...PURPOSE: To characterize persistent diffuse photoreceptor disorganization, a newly recognized retinal disorder, and establish diagnostic criteria differentiating it from similar outer retinopathies. METHODS: This retrospective observational case series included 14 patients (21 eyes) with subacute vision loss, unremarkable fundus, and persistent diffuse photoreceptor disorganization on optical coherence tomography, from 2020 to 2025. Medical records, multimodal imaging (optical coherence tomography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography), and visual function (electroretinography, visual field) findings were analyzed. RESULTS: Patients (mean age 30.7 years) presented with subacute vision loss [mean best-corrected visual acuity 0.9 LogMAR (20/160), range, 2.0-0.2 (FC-20/32)]. Seven patients (50%) had bilateral involvement. Infectious uveitis and known retinal dystrophy mutations (via whole-exome sequencing) were excluded. Fundus, fundus autofluorescence, and indocyanine green angiography were largely unremarkable. Optical coherence tomography revealed blurred/rough ellipsoid zone and absent interdigitation zone in the posterior pole of all eyes (including fovea in 100% of eyes, periphery in 95.2%). The retinal pigment epithelium layer was preserved. Outer retina thickness was significantly thinner in involved eyes compared with fellow eyes (118.3 vs. 147.6 µ m, P = 0.031). Fundus angiography showed peripheral venous leakage in 75% of eyes. Full-field electroretinography indicated reduced amplitudes (normal latency, scotopic/photopic), and visual fields showed significant defects. Eleven patients received immunosuppressive therapies. Over 17 months, optical coherence tomography abnormalities persisted, outer retina thickness slowly decreased, and visual acuity remained stable with gradual deteriorations in some patients. CONCLUSION: Persistent diffuse photoreceptor disorganization is characterized by subacute, diffuse, and persistent photoreceptor disorganization with largely unremarkable fundus, distinct from other outer retinopathies. Visual prognosis is generally poor, necessitating further research into pathogenesis and treatment.
PURPOSE: To study the morphologic characteristics of Type1 macular neovascularization (MNV) in eyes with chronic central serous chorioretinopathy (CSCR) using optical coherence tomography (OCT) and OCT angiography (OCTA)...PURPOSE: To study the morphologic characteristics of Type1 macular neovascularization (MNV) in eyes with chronic central serous chorioretinopathy (CSCR) using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: Patients with chronic CSCR and secondary Type 1 MNV were included in the study. Macular OCT and OCTA images were acquired, and morphologic characteristics along with quantifiable features were analyzed. RESULTS: Twenty eyes of 19 patients were included. All eyes exhibited neovascular flow signal on OCTA images. Nineteen eyes (95%) showed flat-irregular pigment epithelium detachment (flat irregular pigment epithelium detachment [FIPED]). Subretinal fluid (SRF) was detected in 90% of patients with no intraretinal fluid. Membranes were mostly located at the subfoveal area (65%). All membranes were identified in the location overlying choroidal pachyvessels. Mature membranes with a loose vascular configuration were identified in 75% of eyes. Morphologic biomarkers of "indistinct" (65%), "tangled" (30%), and "sea-fan" (5%) patterns were recorded. Feeder vessels was identified in 75% of membranes. The average vascular density was measured as 46% (±10%). CONCLUSION: Neovascular membranes of chronic CSCR sprout under the retinal pigment epithelium within the macular area (Type 1 MNV) inside an FIPED overlying pachyvessels. Morphologic characteristics assessed by OCTA of loose and indistinct pattern improve our understanding of vessel formation and maturation in patients with chronic CSCR and might be valuable to guide therapy.
PURPOSE: Optical coherence tomography angiography is widely used to detect choroidal neovascularization in retinal diseases, but acquiring high-density raster scans can prolong acquisition time and increase motion artifa...PURPOSE: Optical coherence tomography angiography is widely used to detect choroidal neovascularization in retinal diseases, but acquiring high-density raster scans can prolong acquisition time and increase motion artifacts due to patient fatigue. This study evaluates whether the 250 kHz ultrahigh-speed mode (3× faster than baseline) reduces scan time and motion artifacts while maintaining image quality compared with the FDA-approved 125 kHz mode. METHODS: Fifty-eight eyes underwent 10°×10° fovea-centered optical coherence tomography angiography imaging using both modes. In 38 choroidal neovascularization eyes, AngioTool was used to analyze vascular metrics. In 20 nonchoroidal neovascularization eyes, superficial foveal avascular zone area was measured using ImageJ. Two masked retina specialists graded paired images for image quality, motion artifacts, and clinical diagnosis. Acquisition time was recorded. RESULTS: The 250 kHz mode reduced acquisition time by 43% (17.5 ± 9.0 seconds vs. 33.6 ± 20.7 seconds, P < 0.00001). Image quality and motion artifacts favored the 250 kHz mode. Clinical diagnosis was rated similarly across modes. Quantitative metrics, including vessel area, junctions, lacunarity, and foveal avascular zone area, showed no significant differences (all P > 0.1). CONCLUSION: This is the first intraindividual comparison of Heidelberg's 250 kHz and 125 kHz optical coherence tomography angiography modes. The findings demonstrate that ultrahigh-speed scanning can enhance efficiency and image quality without compromising diagnostic or quantitative utility, highlighting its potential clinical impact pending Food and Drug Administration approval.
PURPOSE: This retrospective study aimed to evaluate age, sex, intervortex vein anastomosis|intervortex vein anastomoses (IVA), and subfoveal choroidal thickness (SFCT) across different entities of the pachychoroid spectr...PURPOSE: This retrospective study aimed to evaluate age, sex, intervortex vein anastomosis|intervortex vein anastomoses (IVA), and subfoveal choroidal thickness (SFCT) across different entities of the pachychoroid spectrum (PCS). METHODS: A total of 147 eyes were analyzed, including: 65 chronic central serous chorioretinopathy, 29 uncomplicated pachychoroid (UCP), 25 pachychoroid pigment epitheliopathy (PPE), 15 pachychoroid neovasculopathy (PNV), nine aneurysmal choroidal neovascularization Type 1 (ACNV-1), and four peripapillary pachychoroid syndrome. Subfoveal choroidal thickness was assessed by optical coherence tomography and IVA by indocyanine green angiography. RESULTS: Neovascular PCS entities (PNV, ACNV-1) were significantly older (61 ± 10 vs. 54 ± 12 years, P = 0.003) and had a higher female prevalence (57% vs. 22%, P < 0.001) than their nonneovascular counterparts. Intervortex vein anastomosis|intervortex vein anastomoses differed only between UCP and PPE (31% vs. 64%, P = 0.03), with a trend toward lower SFCT in IVA-positive eyes. While ANOVA showed SFCT differences among PCS entities, multivariable regression identified age ( P < 0.001) and neovascular status ( P = 0.01) as independently and inversely associated with SFCT. CONCLUSION: Neovascular PCS entities were characterized by older age, higher female prevalence, and reduced SFCT. Both age and neovascularization independently associated with reduced SFCT, suggesting a potential role in choroidal remodeling. Intervortex vein anastomosis|intervortex vein anastomoses showed a limited discriminatory value but was associated with a trend toward lower SFCT.
PURPOSE: To evaluate subclinical retinal and peripapillary microvascular alterations in pediatric patients with Henoch-Schönlein purpura (HSP) without ocular involvement using optical coherence tomography angiography. ME...PURPOSE: To evaluate subclinical retinal and peripapillary microvascular alterations in pediatric patients with Henoch-Schönlein purpura (HSP) without ocular involvement using optical coherence tomography angiography. METHODS: This prospective observational study included 95 right eyes of 95 children aged 5 years to 15 years, comprising 40 patients with HSP and 55 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic examination and optical coherence tomography angiography imaging. Quantitative parameters included superficial capillary plexus and deep capillary plexus vessel densities (VD) in foveal, parafoveal, and perifoveal regions; foveal avascular zone area; radial peripapillary capillary-VD; and peripapillary retinal nerve fiber layer thickness. Intergroup comparisons and correlation analyses between optical coherence tomography angiography metrics and disease duration, clinical finding score, and disease activity score were performed in the HSP group. RESULTS: Baseline ocular parameters were comparable between the HSP and control groups, except for lower central corneal thickness ( P = 0.002). Optical coherence tomography angiography revealed significantly decreased foveal superficial capillary plexus-VD ( P = 0.003) and decreased deep capillary plexus-VD in the nasal perifoveal region ( P = 0.004) in patients with HSP. Correlation analysis revealed that foveal avascular zone area positively correlated with disease duration (r = 0.48, P = 0.001), whereas parafoveal superficial capillary plexus-VD negatively correlated with clinical finding score (r = -0.45, P = 0.004). In addition, nasal perifoveal deep capillary plexus-VD showed significant negative correlations with both clinical finding score (r = -0.52, P < 0.001) and disease duration (r = -0.44, P = 0.005). CONCLUSION: Pediatric patients with HSP without clinical ocular involvement demonstrate measurable macular microvascular impairment and foveal avascular zone enlargement on optical coherence tomography angiography. Optical coherence tomography angiography may serve as a sensitive, noninvasive tool for early detection of subclinical retinal vascular alterations, facilitating risk stratification and individualized ophthalmic monitoring.
PURPOSE: To evaluate large-sized human amniotic membrane (hAM) patch-assisted vitrectomy for managing postoperative proliferative vitreoretinopathy (PVR) in complex rhegmatogenous retinal detachment (RRD). METHODS: A ret...PURPOSE: To evaluate large-sized human amniotic membrane (hAM) patch-assisted vitrectomy for managing postoperative proliferative vitreoretinopathy (PVR) in complex rhegmatogenous retinal detachment (RRD). METHODS: A retrospective analysis of 12 eyes (12 patients) with complex RRD and severe PVR undergoing large-sized hAM patch-assisted vitrectomy. Indications included open globe injury-associated RRD (n = 8) and RRD with PVR grade D (n = 4). Surgical procedures, clinical outcomes, and complications were documented. RESULTS: Patients were followed for 9.75 ± 1.60 months. Each eye received 2.75 ± 1.22 hAM patches (mean area: 3.37 ± 1.51 cm 2 ). Two eyes (Cases 1 and 2) with small and regular retinal defects achieved full hAM coverage and retinal reattachment without significant PVR. Ten eyes with extensive defects could not achieve complete coverage of the exposed retinal pigment epithelium. In five eyes (Cases 3-7), the hAM patches covered the most exposed retinal pigment epithelium and retinal edge, but PVR on hAM surface caused hAM-traction of retina, leading to recurrent detachment in three eyes. In the other five eyes (Cases 8-12), a hAM-retina gap was maintained and prevented retinal interference from hAM contraction. Visual acuity improved significantly from 2.40 ± 0.25 LogMAR (Snellen: 20/5,023) to 1.43 ± 0.60 LogMAR (Snellen: 20/533) ( P = 0.003). CONCLUSION: Human amniotic membrane patch-assisted vitrectomy is a promising strategy for managing complex RRD with advanced PVR. When complete coverage of the exposed retinal pigment epithelium is not feasible, maintaining a hAM-retina gap reduces postoperative traction and improves anatomical/functional outcomes.
PURPOSE: Treatment options for retinitis pigmentosa (RP) have been limited. A new generation of innovative but potentially expensive treatments under development may halt or reverse disease progression. METHODS: Using an...PURPOSE: Treatment options for retinitis pigmentosa (RP) have been limited. A new generation of innovative but potentially expensive treatments under development may halt or reverse disease progression. METHODS: Using an existing database, a closed-cohort microsimulation model of all genetic subtypes of RP was conducted from a U.S. societal perspective. A hypothetical gene-agnostic therapy was compared with standard care at age 30. Outcomes included VF and VA progression; incremental cost-effectiveness ratio (ICER: dollars per quality-adjusted life-year (QALY) gained); and lifetime medical and productivity-related costs. RESULTS: Baseline cohort (age 30, N = 381; mean VA logMAR, 0.26 (20/36); mean VF sum total degrees (III4e), 749). By age 45, 79% of patients with untreated RP reached legal blindness or worse, compared with significantly delayed progression with treatment. ICER of gene-agnostic therapy was $158,554/QALY, yielding better outcomes compared with untreated RP (20.5 vs. 16.7 QALYs) and substantial indirect cost savings ($691,961) if a drug price of $1.5 million was assumed. CONCLUSION: A gene-agnostic treatment for RP with drug price of $1.5 million (both eyes) may be cost-effective for most types of RP, particularly with earlier initiation. These findings can inform clinical, economic, and health policy decisions, potentially supporting early intervention strategies and resource allocation for novel RP treatments.