Surv Ophthalmol [JOURNAL]
Sun
200 papers
Trends in pediatric uveitis: A systematic review and meta-epidemiological investigation of geographic, economic, and climate factors.
LaMattina KC, Zhou Y, Lauer DA … +2 more , Brennan AT, Minkus CL
Surv Ophthalmol · 2026 Jul · PMID 42392272 · Publisher ↗
Literature on pediatric uveitis frequently describes the disease as noninfectious, bilateral, and anterior with a female sex predilection. This characterization misrepresents epidemiology studies from many parts of the w...
Literature on pediatric uveitis frequently describes the disease as noninfectious, bilateral, and anterior with a female sex predilection. This characterization misrepresents epidemiology studies from many parts of the world. This systematic review and Bayesian meta-analysis combines demographic and clinical data representing 43 studies from 26 countries over the last 10 years to create a global picture of the epidemiology of pediatric uveitis. We performed additional Bayesian meta-regression analyses to explore how geography, economy, and climate may have played a role in inter-study variability. While there was a greater proportion of females in studies from high-income countries, there was a male sex predilection in lower-middle-income countries. We found that climate had a greater bearing on proportion of infectious etiologies than economic or regional designation, and that these factors played varying roles with regards to specific infectious and noninfectious etiologies. Income alone proved to be a significant moderator of vision at presentation, with high-income countries having the highest proportion of patients with good vision and the lowest proportion of patients with poor vision. Our study helps to better characterize the complex global picture of pediatric uveitis.
Efficacy and safety of different intraocular therapies for non-infectious uveitis: A network meta-analysis.
Yang HA, Jheng WL, Hwang YS … +10 more , Wu WC, Lai CC, Wang NK, Chou HD, Kang EY, Liu L, Chao AN, Chen YT, Chen KJ, Chen YH
Surv Ophthalmol · 2026 Jul · PMID 42386095 · Publisher ↗
Systemic corticosteroids and immunosuppressants remain the standard first-line therapy for non-anterior, non-infectious uveitis (NIU), but prolonged use carries significant systemic and ocular adverse effects. Several in...
Systemic corticosteroids and immunosuppressants remain the standard first-line therapy for non-anterior, non-infectious uveitis (NIU), but prolonged use carries significant systemic and ocular adverse effects. Several intraocular agents have recently emerged as effective alternative or adjunctive options. Our meta-analysis included 9 randomized controlled trials and 1 retrospective case series, investigating the efficacy and safety profiles of intravitreal fluocinolone acetonide implant (FAi), intravitreal dexamethasone implant, intravitreal or suprachoroidal triamcinolone acetonide (SCTA), intravitreal methotrexate, intravitreal ranibizumab, and standard of care (SOC) for NIU. Our results demonstrated that all the studied intraocular agents excluding ranibizumab demonstrated a better best-corrected visual acuity gain compared to SOC at 6 months. The 4mg SCTA demonstrated the greatest central macular thickness reduction surpassing other intraocular steroid therapies and SOC at 6 months for uveitic macular edema. With regards to side effects, 0.59mg FAi was associated with a higher risk of 2-year and 3-year intraocular pressure elevation ≥10 mmHg when compared to SOC. Understanding the advantages and limitations of intraocular therapies is essential for initiating personalized treatment strategies in NIU.
Macular telangiectasia masqueraders.
Shiromani S, Gandhi P, Mohan S … +3 more , Venkatesh R, Hatcher K, Chhablani J
Surv Ophthalmol · 2026 Jun · PMID 42379527 · Publisher ↗
Macular telangiectasia Type 2 (MacTel 2) is a bilateral retinal disease characterized by progressive neurodegenerative and telangiectatic changes in the macula. Its subtle early presentation and overlap with a variety of...
Macular telangiectasia Type 2 (MacTel 2) is a bilateral retinal disease characterized by progressive neurodegenerative and telangiectatic changes in the macula. Its subtle early presentation and overlap with a variety of retinal conditions often lead to diagnostic uncertainty and delayed intervention. As clinical understanding of MacTel 2 has evolved, advanced imaging modalities such as optical coherence tomography, fundus autofluorescence, fundus fluorescein angiography, and optical coherence tomography angiography have become essential tools for accurate diagnosis and differentiation from mimicking disorders. Key features such as parafoveal telangiectatic vessels, pigment plaques, and ellipsoid zone loss help establish the diagnosis, while multimodal imaging enhances confidence in distinguishing MacTel from its many masqueraders. The recent Food and Drug Administration approval of a long-acting ciliary neurotrophic factor implant has marked a significant advancement in the treatment of MacTel, highlighting the urgent need for timely recognition. In this review, we propose a practical, algorithm-based framework for diagnosing MacTel 2, with an emphasis on key clinical and imaging features and common diagnostic pitfalls. By improving recognition of characteristic patterns and differentiating features, this article aims to support clinicians in making confident, early diagnoses and implementing appropriate management strategies for MacTel 2.
Utilization of anterior segment optical coherence tomography in childhood glaucoma: A systematic review.
Abdelaal A, Kawji A, Gad W … +8 more , Alzein A, Chang TC, Bitrian E, El Sayed YM, Gawdat GI, Hassan AK, El-Fayoumi D, Elhusseiny AM
Surv Ophthalmol · 2026 Jun · PMID 42364735 · Publisher ↗
We review the current evidence on the use of anterior segment optical coherence tomography (AS-OCT), including handheld systems (HH-AS-OCT), in the diagnosis, monitoring, and surgical evaluation of childhood glaucoma. We...
We review the current evidence on the use of anterior segment optical coherence tomography (AS-OCT), including handheld systems (HH-AS-OCT), in the diagnosis, monitoring, and surgical evaluation of childhood glaucoma. We conducted a systematic review through PubMed, EBSCO, Web of Science, and Google Scholar. Studies were eligible if they reported original data on AS-OCT in childhood glaucoma patients aged ≤ 18 years. Fifteen studies met the inclusion criteria, encompassing 406 glaucomatous eyes with diverse etiologies such as primary congenital, juvenile open-angle, post-cataract, and syndromic glaucoma. AS-OCT enabled high-resolution visualization of the trabecular meshwork, Schlemm canal, iris, and anterior chamber angle. Several studies proposed diagnostic thresholds for iris thickness and angle width, with area under the receiver operating characteristic curves ranging from 0.69 to 0.87. Postoperative imaging documented drainage device position and angle anatomy, while HH-AS-OCT facilitated imaging in infants and uncooperative children, revealing subclinical abnormalities undetectable by gonioscopy; however, these structural findings do not consistently predict clinical outcomes. Heterogeneity in devices, imaging protocols, and glaucoma phenotypes limits standardization, and no definitive AS-OCT biomarker has yet emerged in childhood glaucoma. Larger longitudinal studies and pediatric normative databases are needed before AS-OCT can be regarded as more than an adjunctive imaging modality in this setting.
Peripapillary pachychoroid syndrome: Clinical and imaging features, diagnostic differentiation and therapeutic strategies.
Feo A, Quarta A, Boscia G … +10 more , Forte P, Borrelli E, Bousquet E, Cabral D, Popovic MM, Chan HH, Viggiano P, Boscia F, Mastropasqua R, Romano MR
Surv Ophthalmol · 2026 Jun · PMID 42336295 · Publisher ↗
Peripapillary pachychoroid syndrome (PPS) is a recently recognized member of the pachychoroid disease spectrum characterized by peripapillary choroidal thickening, pachyvessels, intra- and sub- retinal fluid and associat...
Peripapillary pachychoroid syndrome (PPS) is a recently recognized member of the pachychoroid disease spectrum characterized by peripapillary choroidal thickening, pachyvessels, intra- and sub- retinal fluid and associated serous pigment epithelial detachment. We summarize current knowledge on its clinical presentation, multimodal imaging features, differential diagnosis, and available treatment strategies, with emphasis on reported outcomes. PPS predominantly affects older, hyperopic men with short axial lengths and may coexist with other pachychoroid entities, focal choroidal excavation, chorioretinal folds, or secondary choroidal neovascularization (CNV). Multimodal imaging, particularly enhanced-depth imaging optical coherence tomography and indocyanine green angiography, is essential for distinguishing PPS from optic disc pit maculopathy, tractional macular schisis, and inflammatory or neovascular disorders. Anti-vascular endothelial growth factor therapy has shown limited benefit in the absence of CNV, whereas photodynamic therapy appears to achieve anatomical improvement in a substantial proportion of persistent or refractory cases, albeit with variable functional gains. PPS exhibits a variable natural history, and treatment outcomes remain heterogeneous. Well-designed prospective studies are required to refine therapeutic algorithms and identify imaging biomarkers predictive of response, enabling more tailored management of this emerging chorioretinal disorder.
Prognostic factors and postoperative outcomes in pediatric cataract patients: A systematic review and meta-analysis.
Schiavetti I, Lembo A, Bersani E … +1 more , Nucci P
Surv Ophthalmol · 2026 Jun · PMID 42336294 · Publisher ↗
We provide updated pooled estimates of the incidence of major postoperative complications after congenital or pediatric cataract surgery--visual axis opacification (VAO), VAO requiring reintervention, and secondary glauc...
We provide updated pooled estimates of the incidence of major postoperative complications after congenital or pediatric cataract surgery--visual axis opacification (VAO), VAO requiring reintervention, and secondary glaucoma--and identify clinical and surgical prognostic factors associated with these outcomes. We conducted a systematic search of PubMed, Scopus, and Web of Science. Studies reporting postoperative outcomes after pediatric cataract surgery were included. Pooled incidence rates were calculated using fixed- and random-effects models. Univariable and multivariable meta-regression analyses evaluated associations between outcomes and covariates including age at surgery, sex, anterior vitrectomy, primary intraocular lens (IOL) implantation, preoperative axial length (AL), and intraocular pressure. Eighty-seven studies (mean sample: 60.8 patients; 94.9 analysed eyes) met inclusion criteria. Under the random-effects model, pooled incidences (95% CI) were 12% (8%-16%) for VAO, 9.2% (6.0%-13.8%) for VAO requiring surgical reintervention, and 2.3% (1.3%-3.9%) for secondary glaucoma. Shorter preoperative axial length was significantly associated with higher risk of all 3 outcomes. Primary IOL implantation was independently associated with increased risk of VAO and reintervention, while anterior vitrectomy showed a significant association with secondary glaucoma in univariable analysis. Long-term postoperative visual acuity could not be meta-analyzed due to inconsistent reporting. We found that shorter AL and primary IOL implantation are predictors of postoperative complications following pediatric cataract surgery. These findings support careful surgical planning and highlight the need for standardized reporting and long-term follow-up, particularly for glaucoma surveillance.
Predicting the progression of proliferative diabetic retinopathy: Pathophysiology, imaging phenotypes, and determinants of disease persistence despite therapy.
Luu B, van Dijk EHC, Hein M … +3 more , An D, Yu DY, Balaratnasingam C
Surv Ophthalmol · 2026 Jun · PMID 42314860 · Publisher ↗
Proliferative diabetic retinopathy (PDR) is a leading cause of severe visual loss in working-age adults and represents the end stage of chronic neurovascular injury in diabetes. Despite advances in screening and treatmen...
Proliferative diabetic retinopathy (PDR) is a leading cause of severe visual loss in working-age adults and represents the end stage of chronic neurovascular injury in diabetes. Despite advances in screening and treatment, including panretinal photocoagulation (PRP), intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and pars plana vitrectomy (PPV), outcomes remain heterogeneous: many eyes stabilise, whereas others progress to vitreous hemorrhage, tractional retinal detachment or neovascular glaucoma despite apparently adequate therapy. This review synthesises current knowledge on the pathophysiology, morphological phenotypes and treatment paradigms of PDR, with a specific focus on predictors of onset, progression, and recurrence. PDR is contextualised as a multifactorial neurovascular and inflammatory disease, integrating data on hypoxia-driven angiogenesis, glial activation, microvascular rarefaction, neurodegeneration, and vitreoretinal interface remodelling. Histopathological and multimodal imaging characteristics of neovascular complexes and the vitreoretinal interface are described, highlighting how phenotypes on colour fundus photography, widefield fluorescein angiography, optical coherence tomography (OCT), and OCT angiography relate to ischemic burden and clinical behaviour. Systemic, ocular, imaging, biomarker, and genetic factors associated with progression from non-proliferative diabetic retinopathy to PDR and with progression within established PDR after PRP, anti-VEGF therapy, and PPV are critically appraised. Across modalities, younger age, diabetes duration, poor glycaemic control, renal disease, extensive non-perfusion, high neovascular burden, complex fibrovascular proliferation, and incomplete or unsustained treatment consistently emerge as determinants of guarded outcomes. Outstanding gaps in mechanistic understanding, risk stratification, regenerative therapy, and implementation are identified, alongside a proposed research agenda aimed at delivering mechanistically grounded risk-prediction tools and disease-modifying interventions for PDR.
Comment on "Quantitative imaging for assessing uveitis activity: A comprehensive review".
Dave S, Solebo AL
Surv Ophthalmol · 2026 Jun · PMID 42314859 · Publisher ↗
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Artificial intelligence and medical retina training: A scoping review of educational opportunities, emerging risks, and curricular responses.
Hanhart J, Brosh K, Zur D … +2 more , Loewenstein A, Zadok D
Surv Ophthalmol · 2026 Jun · PMID 42269942 · Publisher ↗
Autonomous artificial intelligence (AI) systems for retinal image interpretation are being deployed in routine clinical practice, fundamentally altering the training environment of retinal specialists. We map available e...
Autonomous artificial intelligence (AI) systems for retinal image interpretation are being deployed in routine clinical practice, fundamentally altering the training environment of retinal specialists. We map available evidence on how AI integration affects medical retina specialist training, addressing educational opportunities, developmental risks, and curricular responses. Following the PRISMA extension for scoping reviews and Joanna Briggs Institute methodology, we searched PubMed/MEDLINE, Embase, Web of Science, the Cochrane Library, and gray literature from major ophthalmological and medical education organizations from inception to March, 2026. Six thematic domains emerged: deployment context, artificial intelligence as educational tool, explainability and pedagogy, risks to trainee development, large language models and assessment validity, and institutional responses. AI creates genuine opportunities for personalized case allocation, synthetic dataset generation, explainable visual feedback, and knowledge scaffolding in medical retina training, while simultaneously posing documented risks including deskilling, never-skilling, automation bias, and disruption of established assessment frameworks. The professional identity formation of trainees in environments where AI routinely matches or exceeds first-year resident performance remains an underexplored concern. Institutional and accreditation responses lag substantially behind clinical deployment, ophthalmology-specific competency frameworks validated for residency training are largely absent, and targeted research and coordinated curriculum reform are urgently needed.
Postoperative hypotony after retinectomy in rhegmatogenous retinal detachment surgery: A systematic review and meta-analysis.
Ağın A, Artunay O
Surv Ophthalmol · 2026 Jun · PMID 42251867 · Publisher ↗
We estimate the incidence of postoperative hypotony after retinectomy performed during rhegmatogenous retinal detachment surgery and explore clinical, surgical, and methodological factors associated with hypotony risk. W...
We estimate the incidence of postoperative hypotony after retinectomy performed during rhegmatogenous retinal detachment surgery and explore clinical, surgical, and methodological factors associated with hypotony risk. We include human clinical studies reporting postoperative intraocular pressure (IOP) outcomes after retinectomy or retinotomy for retinal detachment. Postoperative hypotony was defined as IOP ≤ 6 mmHg, with alternative thresholds (≤5 or ≤3 mmHg) retained for sensitivity analyses. A random-effects meta-analysis was used to pool hypotony incidence, with prespecified subgroup and sensitivity analyses according to retinectomy extent, tamponade strategy, hypotony definition, assessment timepoint, and vitrectomy gauge size. Study-level associations with visual outcomes and proliferative vitreoretinopathy (PVR) severity were also explored. Thirty-three studies comprising 2673 eyes were included. The pooled incidence of postoperative hypotony was 13.71% (95% CI, 10.40-17.40), with substantial heterogeneity (I² = 83.2%). Hypotony incidence did not increase linearly with retinectomy extent, and similar rates were observed for extents of 180°-269° and ≥ 270°. Stricter hypotony definitions and later postoperative assessment timepoints were associated with a higher reported incidence. A significant negative association was observed between hypotony incidence and visual improvement rates (Spearman ρ = -0.47, p = 0.03). In contrast, no significant study-level difference in hypotony incidence was observed according to PVR severity grouping or vitrectomy gauge size. Postoperative hypotony after retinectomy is a frequent and clinically relevant complication, moderately associated with poorer visual outcomes and influenced by methodological factors rather than retinectomy extent alone.
Corticosteroids for the treatment of diabetic macular edema with massive hard exudates: An evidence-based update.
Mai S, Chen J, Wang Y … +3 more , Yu Y, Tian M, Yu X
Surv Ophthalmol · 2026 Jun · PMID 42248421 · Publisher ↗
Diabetic macular edema (DME) often presents with scattered punctate or massive hard exudates (HE), which can lead to visual acuity impairment. Plaque-like HE, a special type of massive HE, are even an independent risk fa...
Diabetic macular edema (DME) often presents with scattered punctate or massive hard exudates (HE), which can lead to visual acuity impairment. Plaque-like HE, a special type of massive HE, are even an independent risk factor for subfoveal fibrosis. Therefore, the elimination of HE is necessary for the treatment of DME. Triamcinolone acetonide (TA) and dexamethasone (DEX) implant are the most commonly used corticosteroids in the management of DME with HE, which can reduce HE through many pathways. Their pharmacokinetics differ in non-vitrectomized and vitrectomized eyes. We analyze the effectiveness and safety of TA and DEX implant in the treatment of DME with HE in non-vitrectomized eyes and vitrectomized eyes, with emphasis on plaque-like HE. Many studies based on HE-related biomarkers have shown that both TA and DEX implant are effective in promoting scattered punctate and plaque-like HE resorption in non-vitrectomized eyes and vitrectomized eyes, but DEX implant are preservative-free and have more stable drug concentration than TA in vitrectomized eyes. Complications should also be monitored, including ocular hypertension, cataracts, sterile endophthalmitis, retinal toxicity, ocular hypotony and migration into the anterior chamber. Combining vitrectomy with corticosteroids targets various pathophysiological mechanisms and may be an attractive alternative for DME with massive HE.
Association of hydroxyurea use and sickle cell retinopathy: A systematic review and meta-analysis.
Naveed F, Tao BK, Ashamalla M … +9 more , Mihalache A, Xie JS, Pereira A, Popovic MM, Kertes P, Aboobaker S, Arjmand P, Ballios BG, Yan P
Surv Ophthalmol · 2026 Jun · PMID 42242558 · Publisher ↗
Hydroxyurea (HU) is prescribed to reduce systemic complications of sickle cell disease; however, its association with sickle cell retinopathy (SCR) remains unclear. This meta-analysis (PROSPERO: CRD420251079006) evaluate...
Hydroxyurea (HU) is prescribed to reduce systemic complications of sickle cell disease; however, its association with sickle cell retinopathy (SCR) remains unclear. This meta-analysis (PROSPERO: CRD420251079006) evaluates the pooled association between HU use and SCR. In the primary analysis, HU use was not associated with a statistically significant reduction in SCR (OR = 0.90, 95% CI [0.41, 1.97], p = 0.79; I² = 77%). In a prespecified leave-one-out analysis, exclusion of the outlier study did not produce a statistically significant association, although the estimate shifted toward a stronger protective effect with reduced heterogeneity (OR = 0.70, 95% CI [0.39, 1.27], p = 0.25; I² = 67%). In a subgroup analysis excluding high-risk-of-bias studies, HU use was also not associated with a statistically significant reduction in SCR (OR = 0.84, 95% CI [0.39, 1.82], p = 0.66; I² = 77%). In post hoc analyses, HU use was not associated with a statistically significant reduction in SCR in non-adult populations (OR = 1.14, 95% CI [0.43, 3.05], p = 0.79; I² = 81%) or genotype-restricted analyses (OR = 1.22, 95% CI [0.81, 1.84], p = 0.35; I² = 0%). In post hoc analyses restricting studies to retinopathy phenotype, however, HU was associated with statistically significant lower odds of non-proliferative SCR (OR = 0.73, 95% CI [0.54, 0.98], p = 0.04; I² = 0%) and proliferative SCR (OR = 0.24, 95% CI [0.09, 0.60], p = 0.002; I² = 12%). Very low-certainty evidence suggests mixed associations between HU and SCR. Prospective studies are needed to clarify its role in SCR prevention.
Update on the structure-function relationship in glaucoma.
Wong D, Chua J, Hemelings R … +7 more , Tan B, Zhang C, Ling T, Garhöfer G, Cherecheanu AP, Stalmans I, Schmetterer L
Surv Ophthalmol · 2026 Jun · PMID 42242557 · Publisher ↗
The relationship between structural and functional damage in glaucoma, the structure-function relationship, forms the cornerstone of disease assessment, monitoring, and prognosis. We provide an updated synthesis of curre...
The relationship between structural and functional damage in glaucoma, the structure-function relationship, forms the cornerstone of disease assessment, monitoring, and prognosis. We provide an updated synthesis of current knowledge on the structure-function relationship, emphasizing recent advances in imaging, analytical methodologies, and artificial intelligence (AI)-driven modelling. We summarize merging evidence from optical coherence tomography (OCT), OCT angiography, and related imaging technologies, highlighting their integration with functional measures such as standard automated perimetry. We also evaluate classical, mechanistic, statistical, and hybrid models that link retinal microstructure and visual function and discusses the role of AI-based approaches in predicting visual field loss and improving clinical interpretation. The structure-function relationship in glaucoma is predominantly nonlinear for currently used clinical metrics, reflecting biological redundancy, psychophysical variability, and measurement constraints with current tools. Stage-dependent changes reveal strong correlations during moderate disease but increasing divergence in early and advanced stages due to floor effects and functional compensation. Emerging frameworks, such as anatomically compensated mapping, multimodal fusion, and deep learning, enhance accuracy and allow individualized structure-function relationship modelling. Data quality, myopia-related anatomical variability, and cross-device harmonization remain key limitations. Integrating multimodal imaging, AI-based harmonization, and longitudinal data will advance structure-function relationship modelling beyond static correlations toward dynamic, personalized biomarkers of neurovascular and neurofunctional health. These developments promise earlier detection, more precise monitoring, and individualized glaucoma management through a deeper mechanistic understanding of the link between retinal structure and visual function.
Orbital involvement in sickle cell disease: A systematic review.
Paris J, Almater AI, Mackenzie C … +2 more , Ang T, Selva D
Surv Ophthalmol · 2026 Jun · PMID 42235647 · Publisher ↗
Orbital involvement in sickle cell disease (SCD) is rare but potentially vision-threatening and often misdiagnosed due to overlap with infectious orbital disease. We conducted a systematic review of case reports and seri...
Orbital involvement in sickle cell disease (SCD) is rare but potentially vision-threatening and often misdiagnosed due to overlap with infectious orbital disease. We conducted a systematic review of case reports and series describing orbital complications in patients with confirmed SCD, following PRISMA and MOOSE guidelines. Across 53 studies, 76 cases were identified. Patients were predominantly male (77.6%), with an average age of 13.2 years. Orbital disease was the initial SCD manifestation in 6.6%. Presentations included periorbital edema in all, proptosis in 64.1%, restricted ocular motility in 56.5%, reduced visual acuity in 28.1%, and bilateral involvement in 38.2%. Laboratory findings commonly included leukocytosis (73%) and raised inflammatory markers (86.7%). Radiologically, orbital subperiosteal hematoma were observed in 70%, combined orbital bone infarction and hematoma in 38.2%, and orbital bone infarction alone in 19.7%. Magnetic resonance imaging is critical for accurate diagnosis. Intracranial hemorrhage was present in 9.2%. Less frequent manifestations included orbital apex syndrome, lacrimal gland disease, and nonspecific soft tissue swelling. Management was primarily conservative (82.9%), and surgery was reserved for vision-threatening or intracranial complications. Complete recovery was achieved in 93.1% of cases. While severe vision-threatening complications are uncommon, early recognition remains critical to optimising outcomes in sickle cell orbitopathy.
Xerophthalmia and ocular manifestations of vitamin A deficiency in children in high-income countries: A systematic review.
Ouyang CMH, Fan L, Kandel H … +1 more , Watson SL
Surv Ophthalmol · 2026 May · PMID 42176959 · Publisher ↗
Xerophthalmia is a vision-threatening eye condition caused by vitamin A deficiency (VAD). Cases of xerophthalmia in high-income countries (HICs) are vulnerable to misdiagnosis, causing delays in treatment and adverse vis...
Xerophthalmia is a vision-threatening eye condition caused by vitamin A deficiency (VAD). Cases of xerophthalmia in high-income countries (HICs) are vulnerable to misdiagnosis, causing delays in treatment and adverse visual outcomes. We define the features, causes and complications of VAD and xerophthalmia in children of HICs. Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42024492023). We performed a search for eligible articles on Scopus, Web of Science, Cochrane, PubMed and Medline. Cases reporting on children under 18 years of age residing in HICs with ocular features of VAD were eligible for inclusion. The search yielded 2474 results; 43 case reports and case series met the inclusion criteria consisting of a total of 61 cases (mean age 9.9 ± 4.2 years, range 3-17 years). Xerophthalmia was graded according to the most advanced finding for each case: 21.3% had night blindness only; 29.5% had conjunctival xerosis or Bitot spots; 29.5% had corneal xerosis, ulceration or scarring; 1.6% had xerophthalmia fundus only; and 18.0% had ocular manifestations associated with VAD that are not encompassed under the WHO classification. These features included swollen optic discs, optic neuropathy, or ocular dryness. Restrictive dietary practises were the most common mechanism of deficiency (75%), and autism was the most common underlying condition (49%). This shows that VAD remains a cause of severe visual impairment in HICs, especially when associated with delays in diagnosis and treatment. Further research is required to establish the prevalence of xerophthalmia in HICs.
Disorganization of inner retinal layers and disruption of outer retinal layers as predictors of anti-vascular endothelial growth factor treatment outcomes in diabetic macular edema: A scoping review.
Nadimpalli S, Vijendran S, Bhandary SV
Surv Ophthalmol · 2026 May · PMID 42176958 · Publisher ↗
We systematically map the evidence on optical coherence tomography (OCT) biomarkers-mainly disorganization of the retinal inner layers (DRIL), disruption of the retinal outer layers (DROL), including ellipsoid zone, and...
We systematically map the evidence on optical coherence tomography (OCT) biomarkers-mainly disorganization of the retinal inner layers (DRIL), disruption of the retinal outer layers (DROL), including ellipsoid zone, and external limiting membrane--and others like central retinal thickness -as predictors of visual and anatomical response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in diabetic macular edema (DME). DME remains the leading cause of vision loss in diabetic retinopathy. Despite anti-VEGF therapy being the standard treatment, patient responses vary. OCT biomarkers have emerged as promising noninvasive predictors, but inconsistencies in definitions and methodologies across studies limited their clinical use. We included studies assessing OCT biomarkers in DME patients treated with anti-VEGF agents, regardless of geography or language. Databases searched were PubMed, Embase, Scopus, and ProQuest. Screening and data extraction were conducted independently by 2 reviewers. Thirteen studies (∼1150 eyes) met inclusion criteria. Baseline DRIL and DROL were consistently associated with poorer visual outcomes, while their resolution correlated with improved recovery. Reported odds ratios ranged from 2.8 to 8.7. Approximately 60% of patients without these disruptions experienced favorable outcomes. We concluded that DRIL and DROL have strong potential as OCT biomarkers for predicting anti-VEGF response in DME. Standardized definitions and artificial intelligence-based longitudinal studies are warranted.
Multimodal artificial intelligence in retinopathy of prematurity: A comprehensive narrative review.
Zhao X, Wu Z, Wu S … +9 more , Cui K, Lam WC, Wu WC, Yang W, Lei B, Huang S, Wei W, Chi W, Zhang G
Surv Ophthalmol · 2026 May · PMID 42134610 · Publisher ↗
Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness globally, particularly in regions with limited screening resources. Traditional diagnosis relying on subjective interpretation o...
Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness globally, particularly in regions with limited screening resources. Traditional diagnosis relying on subjective interpretation of fundus images faces challenges of inter-observer variability and manual analytical limitations. Recent advances in artificial intelligence (AI) have demonstrated substantial potential to achieve intelligent ROP management. We present a comprehensive review that synthesizes contemporary advances in AI-driven ROP management and reviewed the AI technologies based on retinal imaging, clinical text data, and smartphone-captured images transform ROP diagnosis, risk prediction, and treatment suggestion. We also illustrate the applications of AI in intelligent diagnosis and treatment of ROP through multimodal imaging. Despite remarkable progress, challenges persist in data heterogeneity, model generalizability, and real-world integration. By mapping technical breakthroughs to unmet clinical needs, we provide actionable insights to accelerate the development of equitable, clinically deployable AI solutions for preventing ROP-related vision loss.
The global prevalence of horizontal strabismus: A systematic review and meta-analysis with a focus on ethnic variation.
von Bartheld CS, Hagen MM, Jiang J … +2 more , Yang W, Agarwal AB
Surv Ophthalmol · 2026 May · PMID 42106004 · Publisher ↗
The prevalence of the 2 types of horizontal strabismus, esotropia and exotropia, varies considerably between studies. This variability has been attributed to factors such as geography/environment, research methodology, a...
The prevalence of the 2 types of horizontal strabismus, esotropia and exotropia, varies considerably between studies. This variability has been attributed to factors such as geography/environment, research methodology, age of study subjects, and/or ethnicity. Comprehensive estimates of regional and global prevalences of esotropia and exotropia are lacking, making it difficult to recognize true patterns, trends, and etiologies. We compile prevalences and ratios of esotropia to exotropia from 315 population-based studies and 374 clinic-based studies. We analyze data to assess effects of ethnicity, geography, age, and we identify generational changes of horizontal strabismus. Major ethnicities differ in patterns and ratios of esotropia and exotropia prevalence, not only in Caucasians and East Asians, but also Latinos/Hispanics, South Asians, Africans, and Native Americans. Compared to population-based studies, clinic-based studies underestimate exotropia frequency. By weighing prevalences according to the population size of ethnicities, we estimate the worldwide prevalence of horizontal strabismus in the current generation at 1.81% (138.5 million people), comprising 60.0 million people with esotropia (0.67%) and 87.5 million with exotropia (1.14%). In the previous generation, the worldwide prevalence of horizontal strabismus was 1.64% (86.5 million people), comprising 50.5 million with esotropia (0.96%) and 36.0 million with exotropia (0.68%). Esotropia and exotropia prevalences differ between generations within the same ethnicity, indicating that extrinsic factors can modify the underlying intrinsic (genetic) disposition.
Retinopathy of prematurity: A global review of screening guidelines.
Ahmad N, Chaaya C, Pandiri S … +8 more , Malek D, Oncel D, Gabriel A, Hoyek S, Martinez-Velasquez L, Brant A, Moshfeghi DM, Patel NA
Surv Ophthalmol · 2026 May · PMID 42106003 · Publisher ↗
We assess the presence and specifics of national retinopathy of prematurity (ROP) screening guidelines in all 195 countries to understand variances, identify gaps, and guide global practice. PubMed, government websites,...
We assess the presence and specifics of national retinopathy of prematurity (ROP) screening guidelines in all 195 countries to understand variances, identify gaps, and guide global practice. PubMed, government websites, and World Health Organization articles were searched for national guidelines in any language. Documents published between 1998 and 2024 were included. National ROP screening guidelines were found for only 65 countries (33%). Screening cutoffs varied greatly for gestational age (30-37 weeks) and birth weight (1250-2500 g). Higher income countries were more likely to have guidelines (χ² = 19.4, p < 0.001). Thirty-two of the 65 countries (49%) had guidelines for termination of acute phase screening, 26 countries (40%) had post-acute phase screening follow-up guidelines, and 37 countries (57%) had treatment guidelines. No countries had risk-tailored approaches to screening. Most countries lack national ROP guidelines, and many have variations for screening criteria, follow-up, and treatment. There is a significant need for global initiatives and collaboration to address major policy gaps, particularly in Africa, and ultimately improve ROP outcomes.
Glaucoma filtering surgery combined with phacoemulsification in the era of new aqueous humor filtration devices: A systematic review.
Gassama S, Bastelica P, Baudouin C … +1 more , Labbé A
Surv Ophthalmol · 2026 May · PMID 42103032 · Publisher ↗
We evaluate the efficacy and safety of filtering glaucoma surgeries combined with phacoemulsification (PCE)-including new aqueous humor drainage devices-compared to standalone procedures. We performed a systematic search...
We evaluate the efficacy and safety of filtering glaucoma surgeries combined with phacoemulsification (PCE)-including new aqueous humor drainage devices-compared to standalone procedures. We performed a systematic search up to March 23, 2025, including all comparative studies assessing trabeculectomy (TRAB), non-penetrating deep sclerectomy (NPDS), Xen® Gel Stent (XEN), or Preserflo® MicroShunt (PMS) combined with PCE, versus the same surgery alone. Key exclusion criteria include inadequate follow-up (less than 12-month), absence of a defined success criterion, more than 50% of loss to follow-up at 12-month, and lens extraction performed without PCE. Main outcome was surgical success at ≥ 12 months. Secondary outcomes included intraocular pressure (IOP) reduction, decrease in hypotensive medications, and rates of complications. A total of 27 studies were included for analysis. Among studies comparing TRAB/PCE with standalone TRAB, half reported similar success rates, while others favored standalone TRAB, particularly using strict IOP thresholds. Safety profiles were comparable. For NPDS/PCE, data mostly showed equivalent outcomes versus standalone NPDS, with comparable safety. In studies on XEN/PCE and PMS/PCE, results suggested similar rates of surgical success, efficacy in IOP and medication reduction, and safety compared to their stand-alone procedures. Small differences occasionally favored standalone procedures under stricter success definitions. Current evidence suggests that combined filtering glaucoma surgery provides long-term efficacy and safety comparable to standalone, though some subgroups and outcome thresholds may slightly favor standalone approaches. The limited availability of high-quality prospective trials underscores the need for further large-scale robust studies.
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