OBJECTIVE: To investigate the prevalence and risk of new-onset oculomotor and trochlear nerve palsy following coronavirus disease (COVID-19) vaccination. DESIGN: This retrospective, cross-sectional study analyzed data fr...OBJECTIVE: To investigate the prevalence and risk of new-onset oculomotor and trochlear nerve palsy following coronavirus disease (COVID-19) vaccination. DESIGN: This retrospective, cross-sectional study analyzed data from the COVID-19 Research Network of TriNetX. PARTICIPANTS: We identified patients who received COVID-19, influenza, or tetanus, diphtheria, and pertussis (Tdap) vaccinations or who had COVID-19 infection. METHODS: We calculated the relative risk (RR) across groups. We performed propensity score matching to balance the cohorts. Significance tests were paired and 2-sided, with 95% confidence intervals (CI) and p < 0.05. The primary outcome was new oculomotor or trochlear nerve palsies within 21 days of vaccination. RESULTS: Among >6,500,000 vaccinated patients (mean age: 46.7 ± 21.4 years), 11 and 15 developed oculomotor and trochlear nerve palsy, respectively, within 21 days of the first COVID-19 dose. The RR for oculomotor palsy after the first COVID-19 dose was similar to influenza (RR, 1.00, 95% CI, 0.416 - 2.40; p = 0.99), Tdap (RR, 0.99, 95% CI, 0.41 - 2.40; p = 0.99), and second COVID-19 dose vaccinations (RR, 1.00, 95% CI, 0.41- 2.40; p = 0.99), but lower than COVID-19 infection (RR, 0.16, 95% CI, 0.08 - 0.33; p < 0.0001). Trochlear nerve palsy risk was comparable across all groups. CONCLUSIONS: The risk of oculomotor and trochlear nerve palsies after COVID-19 vaccination is similar to other vaccines. The risk of oculomotor nerve palsy is lower after vaccination than after COVID-19 infection. No evidence suggests a causal relationship between COVID-19 vaccination and these cranial neuropathies.
PURPOSE: Lattice degeneration (LD) of the retina is a peripheral retinal disorder marked by retinal thinning, vitreoretinal adhesions, and abnormal pigmentation. LD is often asymptomatic but can lead to sight-threatening...PURPOSE: Lattice degeneration (LD) of the retina is a peripheral retinal disorder marked by retinal thinning, vitreoretinal adhesions, and abnormal pigmentation. LD is often asymptomatic but can lead to sight-threatening complications, such as retinal tears and rhegmatogenous retinal detachment. Despite its prevalence, there is limited research on its structural characteristics using advanced imaging. This study aims to characterize the optical coherence tomography (OCT) features of lattice degeneration, which may be useful in guiding future management strategies. METHODS: This cross-sectional, prospective study analyzed ultra-widefield (UWF) OCT images from 53 eyes of 39 patients, collected from 2 clinical centers (Doheny-UCLA Eye Centers in Los Angeles and AIIMS-New Delhi) over a 1-year period. Lattice degeneration was confirmed by retina specialists through ophthalmoscopy and verified by pseudocolor UWF imaging (Optos Silverstone), and only cases with peripheral OCT scans obtained through the lattice region were included. Various OCT features were assessed at the location of the lattice lesion, including vitreoretinal adhesion, retinal and choroidal thickness, intraretinal hyperreflective foci (IHRF), retinal cystoid spaces, atrophic holes, retinoschisis, and subretinal fluid. Inter-grader reliability was measured using Cohen's κ coefficient. RESULTS: All lattice degeneration lesions exhibited retinal thinning, and 96.2% demonstrated vitreoretinal adhesion at the lesion borders. Choroidal abnormalities were observed in 90.5% of cases, with 81.1% showing choroidal thinning and 9.4% exhibiting choroidal thickening. IHRF was identified in 54.7% of lesions, while increased retinal reflectivity was present in 45.3%. Retinal cystoid spaces and atrophic holes were detected in 24.5% and 17% of lesions, respectively. Less common features included subretinal fluid in 11.3% and retinoschisis in 3.8% of cases. CONCLUSIONS: This peripheral OCT study confirms that while retinal thinning and vitreoretinal adhesion are frequent and consistent findings in lattice degeneration lesions, choroidal abnormalities are also nearly always present. The relevance of these findings to the pathophysiology of these lesions and their impact on progression warrants further study.
OBJECTIVE: To evaluate aqueous humour biomarker concentrations in patients with angle-closure glaucoma (ACG) compared to cataract controls. METHODS: A systematic review and meta-analysis were performed as per the Preferr...OBJECTIVE: To evaluate aqueous humour biomarker concentrations in patients with angle-closure glaucoma (ACG) compared to cataract controls. METHODS: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive literature search was conducted using Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to August 2024 to identify comparative studies assessing aqueous humour biomarkers in adult patients with ACG versus cataract controls. Biomarkers analyzed included cytokines, chemokines, growth factors, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs), among others. The primary analysis compared biomarker levels between ACG and cataract controls. Meta-analyses were performed using a random-effects model, with heterogeneity evaluated using the I² statistic. RESULTS: Seventeen observational studies involving 919 eyes (500 ACG [54.4%] and 419 cataract controls [45.6%]) were included. ACG eyes had significantly elevated levels of VEGF (standard mean difference [SMD] = 2.73; 95% CI = 0.61-4.86]; p = 0.01), IL-8 (SMD = 2.87, 95% CI = 0.03-5.70; p = 0.05), MMP-2 (SMD = 1.14, 95% CI = 0.53-1.75; p = 0.0002), monocyte chemoattractant protein-1 (SMD = 1.00, 95% CI = 0.52-1.49; p < 0.0001), and TIMP-1 (SMD = 1.75, 95% CI = 0.72-2.78; p = 0.0009). Subgroup analysis revealed significantly higher tumour necrosis factor-α (SMD = 3.41, 95% CI = 0.58, 6.23; p = 0.02) and IL-6 (SMD = 2.43, 95% CI = [0.00, 4.85]; p = 0.05) levels in patients with acute primary angle closure compared to controls. CONCLUSIONS: Several biomarkers were elevated in the aqueous humour of patients with ACG compared to cataract controls, providing insights into the molecular mechanisms of angle closure and elevated intraocular pressure. Future studies should focus on the potential for biomarker-driven diagnostics and longitudinal designs to further advance personalized management strategies.
OBJECTIVE: To determine the outcomes of extending anti-VEGF injection intervals to 4 months in neovascular age-related macular degeneration (nAMD). DESIGN: A prospective cohort study. PARTICIPANTS: Patients undergoing in...OBJECTIVE: To determine the outcomes of extending anti-VEGF injection intervals to 4 months in neovascular age-related macular degeneration (nAMD). DESIGN: A prospective cohort study. PARTICIPANTS: Patients undergoing injections with standard-dose anti-VEGF (aflibercept, ranibizumab) with documented disease stability at 3-month injection intervals for ≥2 years. METHODS: The injection interval was extended to 4 months. The primary outcome of disease stability was defined as no clinical evidence of lesion growth, blood, or intraretinal or new subretinal fluid seen on ocular coherence tomography (OCT). Demographic data, visual acuity, exam findings, and OCT data were collected. RESULTS: This study included 88 eyes (83.4 ± 7.3 years, 64.8% female) with nAMD extended to injection intervals of 4 months (56 eyes with aflibercept and 32 with ranibizumab). The recurrence rate was 10.2% (9/88). Four eyes recurred after the first 4-month extension interval, 2 eyes at the 8-month follow-up, 2 eyes at 16 months, and 1 eye at 22 months. In eyes with a recurrence (n = 9), there was no significant difference (p > .05) between mean visual acuity prior to recurrence (0.18 ± 0.13 [20/30]) and at final follow-up postrecurrence (0.21 ± 0.17 [20/30]). All but 1 case returned to within 1 Snellen line of visual acuity at final follow-up. All eyes were able to regain stability at 3- or 4-month injection intervals. CONCLUSIONS: In nAMD patients with disease stability at 3-month injection intervals for at least 2 years, the majority remained stable when extended to 4 months. Recurrences were able to achieve stability again with shorter injection intervals, without a persistent decline in visual acuity.
BACKGROUND: The term "choked disc," was historically synonymous with papilledema, which indicates optic disc swelling due to increased intracranial pressure (ICP). Originally used to describe visible changes during ophth...BACKGROUND: The term "choked disc," was historically synonymous with papilledema, which indicates optic disc swelling due to increased intracranial pressure (ICP). Originally used to describe visible changes during ophthalmoscopic examinations in the late 19th century, its use has evolved. This review of literature aimed to investigate the contemporary application of "choked disc" across various medical disciplines, assess its diagnostic significance, and evaluate its consistency in usage METHODS: A comprehensive search of literature published from January 2000 to January 2024 was conducted using Ovid MEDLINE and EMBASE. The review included peer-reviewed articles discussing "choked disc" in the context of case reports or observational studies. RESULTS: A total of 25 studies met the inclusion criteria, encompassing case reports, observational studies, and case series from diverse medical fields, such as neurosurgery, ophthalmology, and neurology. Our findings indicate that "choked disc" is predominantly used to indicate papilledema (72%), representing optic disc swelling associated with elevated ICP. However, the term was also applied to conditions like central vein retinal occlusion (4%), hypertensive retinopathy (4%), and other optic neuropathies (12%), reflecting a broader diagnostic usage. CONCLUSIONS: The term "choked disc" is most often used in the medical literature to refer to papilledema. However, it was also used to refer to other optic neuropathies or hypertensive retinopathy. We recommend the use of standardized terminology (e.g., papilledema) to ensure accurate diagnosis and enhance interprofessional communication, ultimately improving patient management.
OBJECTIVE: To evaluate the efficacy of a long-acting fluocinolone acetonide 0.19 mg Iluvien intravitreal (FAc) implant for the treatment of radiation maculopathy (RM). DESIGN: Retrospective case series. PARTICIPANTS: Sev...OBJECTIVE: To evaluate the efficacy of a long-acting fluocinolone acetonide 0.19 mg Iluvien intravitreal (FAc) implant for the treatment of radiation maculopathy (RM). DESIGN: Retrospective case series. PARTICIPANTS: Seven patients treated for uveal melanoma with palladium-103 plaque brachytherapy who developed RM. METHODS: Patients initially received intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Those who were intolerant or refractory to anti-VEGF were transitioned to the FAc implant. The main outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central foveal thickness (CFT) on optical coherence tomography. RESULTS: The median radiation dose to the fovea was 45.9 Gy (mean: 61.8, range: 6.4-135.6). RM onset occurred at a median of 12 months post-radiation. Patients received anti-VEGF therapy for 71 months (mean) before FAc implantation. A median of 1 (mean: 2, range: 1-3) FAc implant was placed per patient, beginning in 2018. Median follow-up was 45 months (mean: 39, range: 14-52). Median BCVA improved from 20/63 (mean: 20/63, range: 20/30-20/160) to 20/50 (mean: 20/50, range: 20/20-20/400). Median CFT decreased from 390 μm (mean: 458, range: 301-845) to 300 μm (mean 427) at 6 months, and 383 μm (mean 413) at the last follow-up. One patient required IOP-lowering treatment, and 3 were able to discontinue anti-VEGF therapy. Two patients required additional FAc implants after 4 years. CONCLUSIONS: FAc implants were an effective treatment for RM patients who were refractory or intolerant to maximal intravitreal anti-VEGF therapy. They achieved positive results in the stabilization of macular edema and visual acuity, as well as reduced the intravitreal anti-VEGF injection burden for some patients.
OBJECTIVE: We describe the evolution of the demographics in the Canadian ophthalmology workforce and compare these trends to other surgical specialists. STUDY DESIGN: A longitudinal observational study. PARTICIPANTS: Sur...OBJECTIVE: We describe the evolution of the demographics in the Canadian ophthalmology workforce and compare these trends to other surgical specialists. STUDY DESIGN: A longitudinal observational study. PARTICIPANTS: Surgical specialists identified in the Canadian Institute for Health Information's "Supply, Distribution, and Migration of Physicians in Canada" (SDMP) database from 1971 to 2022. Categories included cardiac, general, orthopedic, plastic, and vascular surgery; obstetrics and gynecology; ophthalmology; otolaryngology; and urology. METHODS: Demographic data were extracted from the SDMP database. Descriptive statistics were used to determine mean age, male-to-female ratio, urban-to-rural ratio, percentage of physicians under age 40 and above age 65, Canadian-to-foreign trained ratio, and physicians-to-100,000 population ratio for ophthalmologists and other surgeons by decade. RESULTS: Ophthalmologists and other surgeons aged significantly, and ophthalmologists were significantly older than other surgeons (mean age: 52.15 vs 49.73 years; p < 0.01). The percentage above age 65 doubled for both groups, reaching 21.51% for ophthalmologists and 15.31% for other surgeons. Male-to-female ratios decreased 11-fold for ophthalmologists, now 2.54:1, and 17-fold for other surgeons, now 2.01:1. Surgeon-to-100,000 population ratio increased from 22.97 to 25.53 (p < 0.001), whereas ophthalmologist ratios increased slightly from 3.27 to 3.51 (p < 0.001). Urban-to-rural distribution increased by 34.67% for surgeons but decreased by 32.27% for ophthalmologists. Both groups saw an increase in Canadian-trained practitioners, with ratios rising to 5.23:1 for surgeons and 5.41:1 for ophthalmologists by the 2020s. CONCLUSIONS: The percentage of ophthalmologists and other surgeons above age 65 years has doubled. Ophthalmologists remain significantly older than other surgeons. The ophthalmologists-to-100,000 population ratio, presently 3.51, meets the recommended goal of 3.37-to-100,000 population.
OBJECTIVE: While radiographic measurements of orbital structures are used to both diagnose thyroid eye disease (TED) and assess treatment response, the specific extraocular muscle (EOM) changes in TED have not been estab...OBJECTIVE: While radiographic measurements of orbital structures are used to both diagnose thyroid eye disease (TED) and assess treatment response, the specific extraocular muscle (EOM) changes in TED have not been established. This study aims to systematically review and analyze the difference in EOM sizes in TED patients. DESIGN: Systematic review. METHODS: The full protocol was registered on PROSPERO (42024566103). The electronic databases EMBASE, Web of Science, and OVID MEDLINE were searched from inception to June 5, 2024, using keywords related to TED and EOMs. Studies were included if they reported EOM measurements in both a TED group and a control group. Data were analyzed using random-effects model meta-analyses, with subgroup analyses based on EOM measurement parameters (i.e., diameter, cross-sectional area, volume). RESULTS: Twenty-three studies were identified, which together included a total of 2 708 orbits with TED and 1 221 control orbits. Eleven studies were retrospective cohort studies, and 12 were prospective cohort studies. Meta-analysis revealed a mean difference between TED patients and controls in EOM diameter for the inferior rectus of 1.9 mm (95% confidence interval: 1.4-2.3; p < 0.01), medial rectus 1.6 mm (95% CI: 1.1-2.0; p < 0.01), lateral rectus 0.89 mm (95% CI: 0.4-1.4; p < 0.01), and superior rectus 1.3 mm (95% CI: 1.0-1.6; p < 0.01). The mean difference between TED patients and controls in EOM volume for the inferior rectus was 515 mm (95% CI: 230-801; p < 0.01), superior rectus was 609 mm (95% CI: 327-891; p < 0.01), medial rectus was 551 mm (95% CI: 293-810; p < 0.01), and lateral rectus was 288 mm (95% CI: 182-393; p < 0.01). CONCLUSIONS: Across studies, there is an apparent enlargement of the inferior rectus in TED compared to controls, but the relative extent of involvement of the medial rectus, superior rectus, and lateral rectus is less consistent.
OBJECTIVE: To explore potential racial differences in vascular, visual, and systemic outcomes among Black and non-Black patients with giant cell arteritis (GCA). DESIGN: A retrospective cohort study using the TriNetX glo...OBJECTIVE: To explore potential racial differences in vascular, visual, and systemic outcomes among Black and non-Black patients with giant cell arteritis (GCA). DESIGN: A retrospective cohort study using the TriNetX global database. PARTICIPANTS: 30,513 patients diagnosed with GCA, including 3 068 Black (10.1%) and 27,445 non-Black (89.9%) patients. After propensity score matching, 3 022 patients were included in each group. METHODS: A propensity score-matched analysis was conducted to compare the risks of stroke, ischemic optic neuropathy (ION), visual defects/blindness, emergency department (ED) visits, myocardial infarction (MI), aortic aneurysm/dissection, and death at 6-month and 1-year follow-ups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. RESULTS: Black patients appeared to have a higher likelihood of stroke at 6 months (HR 1.33, 95% CI: 1.07-1.65) and 1 year (HR 1.38, 95% CI: 1.13-1.69), as well as more ED visits at 6 months (HR 1.29, 95% CI: 1.17-1.42) and 1 year (HR 1.29, 95% CI: 1.18-1.41) compared to non-Black patients. In contrast, Black patients had a lower likelihood of ION at 6 months (HR 0.60, 95% CI: 0.43-0.85) and 1 year (HR 0.59, 95% CI: 0.42-0.82). No notable differences were observed in MI, visual defects/blindness, aortic aneurysm/dissection, or death. CONCLUSIONS: These findings suggest potential racial differences in GCA-related outcomes, with Black patients experiencing a higher likelihood of stroke and ED visits but a lower likelihood of ION. Further research is needed to better understand the underlying factors contributing to these differences and to ensure equitable care for all patients with GCA.
OBJECTIVE: To report 5-year real-world outcomes of Hydrus Microstent implantation with cataract surgery (Hydrus+CS) in mild to severe open-angle glaucoma (OAG). DESIGN: A retrospective, consecutive case series. PARTICIPA...OBJECTIVE: To report 5-year real-world outcomes of Hydrus Microstent implantation with cataract surgery (Hydrus+CS) in mild to severe open-angle glaucoma (OAG). DESIGN: A retrospective, consecutive case series. PARTICIPANTS: OAG eyes undergoing Hydrus+CS with 5-year follow-up. METHODS: The primary outcome was surgical success using various criteria based on intraocular pressure (IOP) thresholds (≤21, ≤18, and ≤15 mm Hg), stability or reduction in antiglaucoma medication (AGM) use, and absence of secondary glaucoma surgery. Predictors of failure were analyzed using Cox proportional hazard models. Secondary outcomes included changes in IOP, AGM use, vision, and optic nerve structural measures. RESULTS: Sixty-four OAG eyes with a baseline IOP of 17.8 ± 4.6 mm Hg on 2.8 ± 1.1 AGMs were included. Surgical success ranged from 91% to 25%, depending on the criteria. Six eyes (9%) required secondary glaucoma surgery, and selective laser trabeculoplasty (SLT) was performed in 41% of these cases. AGM use decreased without IOP increases in 56% of eyes. Success rates for those maintaining the same or fewer AGMs at IOP thresholds of ≤21, ≤18, and ≤15 mm Hg were 75%, 70%, and 58%, respectively. For those with reduced AGM use, success rates were 61%, 58%, and 45% at the same thresholds. Predictors of failure included higher preoperative IOP (p < 0.001) and post-operative IOP spikes (p = 0.010). IOP decreased by 26%, from 17.8 mm Hg at baseline to 13.2 mm Hg at 5 years, with AGM use declining from 2.8 to 2.2 medications (p < 0.001). CONCLUSIONS: This study provides the longest follow-up data on Hydrus+CS, confirming its safety and efficacy in mild to severe OAG.
OBJECTIVE: To quantify the prevalence and trends of artificial intelligence (AI)-generated content in ophthalmology manuscripts, particularly following the public release of OpenAI's ChatGPT on November 30, 2022. METHODS...OBJECTIVE: To quantify the prevalence and trends of artificial intelligence (AI)-generated content in ophthalmology manuscripts, particularly following the public release of OpenAI's ChatGPT on November 30, 2022. METHODS: A retrospective bibliographic analysis was conducted on 1 036 manuscripts from 30 ophthalmology journals, divided into pre-December 2022 (519 manuscripts) and post-December 2022 (517 manuscripts) periods. AI-generated content was evaluated using the Originality Standard 2.0.0 model, which calculates AI probability scores (AIPS) ranging from 0% to 100%. Readability metrics (e.g., Flesch-Kincaid Score) and journal impact metrics (e.g., impact factor) were analyzed. RESULTS: AIPS remained stable from 2014 to 2022 but increased significantly after December 2022 (p < 0.001). The mean AIPS rose from 4.95% in 2022 to 11.2% by mid-2024, with projections estimating 17.51% by mid-2026. Editorials exhibited the highest mean AIPS (12.8%), while surgical technique studies had the lowest (4.33%). Higher AIPS were associated with lower journal impact factors (Spearman's ρ = -0.54; p < 0.001) and simpler language, as reflected by lower Automated Readability Index scores (Spearman's ρ = -0.12; p < 0.005). None of the included manuscripts disclosed AI usage, including 44 manuscripts with AIPS exceeding 25%. CONCLUSIONS: AI-generated content in ophthalmology has risen significantly since ChatGPT's release. Higher AIPS correlates with lower journal impact factors and reduced literary complexity. The lack of AI usage disclosure raises ethical concerns and emphasizes the need for transparent reporting and guidelines to ensure the integrity of scientific research.