OBJECTIVE:To evaluate the improvement in vision-related quality of life, as measured by validated patient-reported outcome measures (PROMs) (NEI-VFQ-14, NEI-VFQ-25) after cataract surgery, and to explore sources of variability in outcomes. METHODS:MEDLINE, EMBASE, and CINAHL were searched, with supplementary grey‑literature screening, for primary studies reporting preoperative and postoperative PROM scores following cataract surgery. Eligible instruments were the Visual Function Index (NEI-VFQ-14), National Eye Institute Visual Function Questionnaire (NEI‑VFQ‑25/‑14), Catquest‑9SF, and related tools. Two reviewers independently performed study selection, data extraction, and risk‑of‑bias assessment using design‑specific CLARITY/U.S. National Institutes of Health frameworks. Random-effects meta-analyses pooled mean change scores for NEI-VFQ-14 and NEI-VFQ-25. Heterogeneity (τ², I²), 95% prediction intervals, small-study effects (Egger's test), and trim-and-fill were assessed. Risk of bias used design-specific CLARITY/NIH tools. RESULTS:From 3473 records, 122 studies met inclusion criteria. Forty‑seven were prospective cohorts, 9 were randomized controlled trials, and 38 were case series; 52% were judged at moderate risk of bias. Fifty-six NEI-VFQ-14 cohorts (k = 56) and 33 NEI-VFQ-25 cohorts (k = 33) were pooled. Mean improvements were +21.8 points (95% CI: 17.4-26.3; I² = 99.9%; PI: -11.3 to 54.9) for NEI-VFQ-14 and +19.3 points (95% CI: 17.0-21.6; I² = 99.4%; PI: 6.5-32.1) for NEI-VFQ-25. For NEI-VFQ-25, Egger's test suggested small-study effects (p = .002); trim-and-fill imputed 3 studies, yielding +18.2 (95% CI: 16.0-20.4). CONCLUSIONS:Cataract extraction consistently enhances patient‑perceived visual function and quality of life. Unfortunately, high heterogeneity limits precision and suggests that gains in PROM score may vary by patient and procedural factors, and small-study effects may overestimate the true benefit recorded by NEI-VFQ-25. Routine integration of validated PROMs into cataract pathways will better capture outcomes that matter to patients, given that the very high heterogeneity, standardized reporting, and longer follow‑up are priorities.
OBJECTIVES:To evaluate visual outcomes and identify risk factors for poor visual prognosis and dropped nucleus following posterior capsule rupture (PCR) during cataract surgery over a 5-year period in an Asian tertiary institution. DESIGN:A retrospective chart review. PARTICIPANTS:All eyes that were complicated by PCR during cataract surgery at Tan Tock Seng Hospital, Singapore, between January 2016 and December 2020. METHODS:Medical records were reviewed for demographics, preoperative, intraoperative, and postoperative data. The primary outcome measures were best-corrected visual acuity (BCVA) ≥20/40 at 3 months (short-term visual outcome) and at final follow-up (long-term visual outcome). Logistic regression identified independent predictors of poor visual outcomes and intraoperative dropped nucleus. RESULTS:Among 31,663 phacoemulsification cataract surgeries performed during the study period, 234 (0.74%) were complicated by PCR. Of 211 eyes with PCR analyzed for vision, 191 (90.5%) achieved BCVA ≥20/40 at 3 months, and 174 (83.3%) maintained this at final follow-up (median 35 months). Predictors of poor final vision included increasing age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.00-1.10; p = .042), postoperative complications (OR: 8.17; 95% CI: 3.34-20.56; p < .001), and non-in-the-bag lens status (OR: 3.89; 95% CI: 1.56-9.69; p = 0.003). Dropped nucleus was associated with early PCR (OR: 8.37; 95% CI: 2.39-32.61; p = 0.001) and vitreous loss (OR: 20.66; 95% CI: 3.95-386.89; p = 0.004). CONCLUSIONS:Despite PCR, most patients achieved favourable long-term visual outcomes. Poor long-term visual prognosis was associated with older age, postoperative complications, and non-in-the-bag lens status. Early PCR and vitreous loss were key predictors of dropped nucleus.
OBJECTIVE:To compare the intraocular pressure (IOP)-lowering, adverse event profile, and risk factors for failure of the SIBS (poly[styrene-block-isobutylene-block-styrene]) microshunt implantation in refractory versus nonrefractory glaucoma. DESIGN:A multicentre, retrospective interventional cohort study. PARTICIPANTS:A total of 236 glaucoma eyes were analyzed with an IOP above target or progressing on maximal medical therapy. Refractory glaucoma was defined as a history of prior subconjunctival filtering surgery. One-to-one nearest-neighbor matching yielded 118 refractory eyes (111 patients) and 118 nonrefractory eyes (105 patients). METHODS:This study evaluated 1-year outcomes of consecutive eyes undergoing ab externo SIBS microshunt implantation with mitomycin-C (MMC) between July 2015 and August 2020. MAIN OUTCOME MEASURES:Primary outcome was surgical success, defined as IOP 6-17 mm Hg with ≥20% reduction, classified as complete (without medications) or qualified (with medications). Secondary outcomes included success at IOP thresholds 14 and 21 mm Hg, median IOP, medication burden, risk factors for failure, and postoperative complications, interventions, and reoperations. RESULTS:Complete success was lower in refractory compared with nonrefractory eyes (63.6% vs 77.9%; p = .022). Refractory status (hazard ratio [HR] 1.98; 95% CI: 1.11-3.55) and MMC dose <0.4 mg/mL (HR 2.08; 95% CI 1.21-3.58) were significant risk factors for failure. Serious adverse events were more frequent in refractory eyes (7.6% vs 0.8%; p = .0097), as were reoperations (9.3% vs 1.7%; p = 0.019). CONCLUSIONS:In SIBS microshunt implantation, refractory eyes demonstrated lower surgical success and higher rates of serious adverse events and reoperations compared with nonrefractory eyes.
OBJECTIVE:To evaluate radiological changes in extraocular muscle (EOM) and orbital fat sizes in thyroid eye disease (TED) patients after receiving monoclonal antibody therapy. METHODS:The protocol was registered on PROSPERO (CRD420251129246). The electronic databases Embase (OVID), Medline, and PubMed were searched from inception to August 18, 2025, using keywords related to TED, EOMs, and monoclonal antibodies. Eligible studies reported baseline and follow-up imaging outcomes in monoclonal antibody-treated TED patients. Two reviewers independently conducted screening, data extraction, and RoB2 (or the revised Cochrane risk-of-bias tool for randomized trials) or ROBINS-I (or Risk of Bias in Non-randomized Studies-of Interventions) risk of bias assessment. Data were pooled using random-effects models to estimate mean differences in EOM and orbital fat volumes. RESULTS:Fourteen studies were identified-3 randomized controlled trials, 4 retrospective cohort studies, and 7 prospective cohort studies-comprising 566 orbits from 304 TED patients. Pooled analysis revealed a total EOM volume mean difference of -1377 mm3 (95% CI: -2012 to -743; I2 = 90.8%; p < .001), representing a 26.7% ± 7.0% reduction with treatment, and an orbital fat volume mean difference of -1732 mm3 (95% CI: -3002 to -461; I2 = 82.8%; p < 0.001), representing a 16.2% ± 6.3% volume reduction with treatment. Cohen's-D effect sizes for individual EOM changes were superior rectus -0.67 (95% CI: -1.00 to -0.33; p < 0.01), inferior rectus -1.07 (95% CI: -1.89 to -0.25; p = 0.01), medial rectus -0.75 (95% CI: -1.12 to -0.37; p < 0.01), and lateral rectus -0.86 (95% CI: -1.53 to -0.18; p = 0.01). DISCUSSION:Monoclonal antibody therapy is associated with significant EOM and orbital fat volume reductions in TED. Despite nonrandomization and heterogeneity limitations, these findings suggest that biologics improve clinical activity and remodel orbital soft tissues, supporting their role in disease modification.
OBJECTIVE:To characterize the long-term clinical and multimodal imaging (MMI) features of extensive macular atrophy with pseudodrusen (EMAP) in a US cohort. DESIGN:Multicentre retrospective case series. PARTICIPANTS:Patients diagnosed with EMAP between 2015 and 2025. METHODS:Clinical records and MMI-including colour fundus photography, fundus autofluorescence, OCT, and OCT angiography-were reviewed at baseline and last follow-up. RESULTS:Fifteen patients (30 eyes) were included, with longitudinal MMI analysis available in 11 patients (22 eyes). Median age at referral was 72 years (range, 40-76 years), and median baseline visual acuity was 0.3 logMAR (20/40). All eyes demonstrated diffuse pseudodrusen-like deposits and retinal pigment epithelium-Bruch membrane separation consistent with basal laminar deposits. Four eyes (13.3%) showed no macular atrophy at baseline, suggesting an early disease stage (stage 0). Peripheral retinal degeneration was identified in approximately 50% of eyes, and macular neovascularization developed in 23% including 2 eyes (6.7%) with type 3 macular neovascularization. Median visual acuity declined to 0.54 logMAR (20/70) at final follow-up (P < 0.001), and 27% met criteria for U.S. legal blindness. Disease progression was observed in 59% after a median follow-up of 40 months (range, 4-114 months). CONCLUSIONS:EMAP may represent a high-risk variant of age-related macular degeneration characterized by rapid progression to geographic atrophy. Critical diagnostic features include pseudodrusen-like deposits and basal laminar deposits, whereas a vertical pattern of atrophy represents the typical outcome. Atrophy may be absent in early disease stages. Genetic validation and consideration for inclusion in future atrophic AMD interventional trials are warranted.
OBJECTIVE:To determine the prevalence of retinal pigment epithelium (RPE) microrips within serous pigment epithelial detachments (PEDs) in first-episode acute central serous chorioretinopathy (CSCR) and to assess their spatial relationship with focal angiographic leakage using multimodal imaging. DESIGN:Retrospective observational case series. PARTICIPANTS:Thirty-nine eyes of 39 patients with acute CSCR (symptom duration <3 months). METHODS:All eyes underwent spectral-domain OCT, fluorescein angiography, and indocyanine green angiography (ICGA). Imaging biomarkers at leakage sites included PEDs, RPE microrips, outer retinal erosion and outer retinal pinching, pachyvessels, midphase ICGA hyperfluorescent plaques, and subfoveal choroidal thickness. Clinical outcomes included best-corrected visual acuity, subretinal fluid (SRF) resolution, recurrence, and progression to chronic disease. RESULTS:Mean age was 44.5 ± 10.0 years, and 61.5% of patients were male. PEDs colocalized with the focal leakage site in all eyes, whereas RPE microrips colocalized with the site of focal angiographic leakage in 66.7% of eyes, with good interobserver agreement (κ = 0.79) observed. Outer retinal erosion and outer retinal pinching were observed in 38.5% and 12.8% of eyes, respectively. Midphase ICGA hyperfluorescent plaques were observed in 56.4% and pachyvessels in 46.2% of cases. Mean best-corrected visual acuity improved from 0.24 ± 0.25 (20/34 Snellen) to 0.10 ± 0.17 logMAR (20/25 Snellen) at final follow-up, with complete SRF resolution in 68.4%. Baseline subfoveal choroidal thickness correlated with SRF height (P = 0.018), but no baseline imaging biomarkers predicted final visual or anatomical outcomes. CONCLUSIONS:RPE microrips within serous PEDs frequently are observed and precisely colocalize with focal leakage in acute CSCR, supporting a mechanical model of focal RPE dehiscence driven by increased choroidal pressure. These findings provide insight into CSCR pathophysiology and may inform therapeutic strategies.
OBJECTIVE:Ophthalmological patient education materials (PEMs) are written at a reading level of grades 10.4-12.6, higher than the recommended 8th-grade level. This study quantitatively assesses the readability of large language model (LLM)-generated chatbot responses to patient queries, de novo PEM creation, and simplification of existing PEMs. METHODS:This systematic review and meta-analysis article was registered in PROSPERO (CRD420251123401). We searched Ovid MEDLINE, Embase, CINAHL, Web of Science, and Scopus (August 11, 2025). The primary outcome was readability, measured by the Flesch-Kincaid Grade Level (FKGL). Random-effects meta-analysis compared ChatGPT-generated PEM readability with existing control PEMs (i.e., clinician- or organization-authored websites, brochures, and clinical guidelines). A binomial test evaluated the proportion of studies achieving an 8th-grade reading level. Joanna Briggs Institute and Grading of Recommendations Assessment, Development, and Evaluation tools assessed risk of bias and quality. RESULTS:Of 1660 studies screened, 57 were included, with 11 contributing to the meta-analysis. Pooled FKGL scores were 9.82 (95% CI: 7.93-11.70) for ChatGPT PEMs and 9.54 (95% CI: 8.68-10.40) for control PEMs. There was no significant difference in FKGL readability between ChatGPT and control PEMs (mean difference = 0.21; 95% CI: -1.52 to 1.94; p = 0.81; I2 = 97.08%). Seventeen studies (29.82%) included LLM(s) at or below 8th-grade reading level. Grade-level prompting significantly improved LLM-generated PEM readability. Risk of bias was low to moderate. Reasons for downgrading were inconsistency and imprecision. CONCLUSIONS:In the context of high heterogeneity and low certainty, it appears that LLMs do not produce ophthalmology PEMs that are more readable than existing materials.
OBJECTIVE:To describe the frequency and causes of visual impairment (VI) among Indigenous adults experiencing homelessness or marginal housing in Toronto and Hamilton, Ontario. DESIGN:Serial cross-sectional study. PARTICIPANTS:Indigenous adults 18 years or older attending 5 ocular screening clinics at Indigenous-led shelters (September 2021 to October 2023) who had not received an eye examination in the previous 12 months and were not currently seeing an ophthalmologist. METHODS:We collected sociodemographic data and medical history and performed presenting and pinhole visual acuity, intraocular pressure measurement, autorefraction, and anterior and posterior examination. VI was defined using the North American threshold (better-eye visual acuity <20/50). World Health Organization VI categories also were recorded. We report categorical variables as counts and percentages and continuous variables as means and SDs. RESULTS:Ninety-seven participants were included. VI was present in 30.9% (n = 30) of participants on the basis of presenting acuity and 9.3% (n = 9) after pinhole. By World Health Organization categories, 25.8% (n = 25) had moderate impairment or blindness at presentation and 6.2% (n = 6) after pinhole. Most participants were dissatisfied with their vision (75.3%, n = 73), and 48.5% (n = 47) currently owned glasses, despite 73.2% (n = 71) having previously owned a pair. Cost was the most commonly reported barrier to eye care (30.9%, n = 30). The mean time since last eye examination was 6.3 years (SD 6.5 years). CONCLUSIONS:Indigenous adults experiencing homelessness or marginal housing had a high burden of correctable VI and long intervals without care. Refractive services with on-site dispensing and facilitated follow-up may reduce vision loss in this population.
OBJECTIVE:Visual impairment affects ∼2.18 million Canadians and is associated with reduced quality of life and substantial economic burden. Although low-vision services (LVS) improve independence and functioning, utilization remains low. This systematic review examines barriers to accessing and utilizing LVS in Canada. METHODS:A systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL, grey literature sources, and Google Scholar was conducted from inception to June 15, 2025, and registered with PROSPERO: (CRD420251082000). English-language studies examining barriers to accessing or utilizing LVS in Canada were included. Screening and data extraction were performed independently by multiple reviewers following PRISMA guidelines. Thematic analysis categorized barriers into systemic/structural, personal, and societal domains. Study quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). RESULTS:Of 730 records identified, 25 studies met inclusion criteria. Systemic barriers included limited-service availability, inconsistent provincial funding, high out-of-pocket costs, geographic maldistribution, and provider-related gaps in referral knowledge and training. Personal barriers included lack of awareness of LVS, financial insecurity, lower educational attainment, comorbid health conditions, and psychosocial resistance, such as stigma or denial. Societal barriers included negative attitudes toward disability, limited family support, cultural and linguistic challenges, and inaccessible public infrastructure. Study quality was moderate to high, with 60% rated 4 stars or higher on MMAT. DISCUSSION:Access to LVS in Canada is limited by intersecting structural, personal, and societal factors. Coordinated reforms in provider education, public awareness, funding policy, and inclusive design are needed to improve equitable access and reduce underutilization of low-vision rehabilitation services.
OBJECTIVE:To describe the national epidemiology, injury patterns, and temporal trends of sports-related retinal injuries presenting to U.S. emergency departments. DESIGN:Retrospective, cross-sectional study. PARTICIPANTS:Patients presenting to U.S. emergency departments with sports-related retinal injuries recorded in the National Electronic Injury Surveillance System from 2005 through 2024. METHODS:National Electronic Injury Surveillance System records involving ocular injuries were screened for confirmed retinal pathology, defined as traumatic involvement of the neurosensory retina or retinal vasculature. National estimates were calculated using survey weights to account for the complex sampling design. Temporal trends were evaluated using survey-weighted annual estimates and Spearman's rank correlation. RESULTS:A total of 335 unweighted cases were identified, representing approximately 9787 cases nationwide. The mean age was 30.4 ± 19.7 years, and 70.2% of injuries occurred in male patients. Adolescents aged 10-19 years represented the largest affected group (41.8%). Retinal detachment (19.5%), vitreous hemorrhage (18.9%), and commotio retinae (13.5%) were the most common diagnoses. Soccer was most frequently implicated (25.2%), followed by gas-, air-, or spring-operated guns (8.4%) and basketball (7.1%). Both the annual national frequency (ρ = 0.711; P < 0.001) and proportion relative to total sports-related ocular trauma (ρ = 0.857; P < 0.001) increased significantly from 2005 to 2024. CONCLUSIONS:Sports-related retinal injuries remain uncommon but have increased significantly over time, particularly among adolescents. Ball sports and activities that involve projectiles account for most cases, with retinal detachment and vitreous hemorrhage representing the most frequent pathologies. These findings highlight the growing burden of retinal injury, underscoring the need for targeted prevention and improved detection in acute care settings.
OBJECTIVE:To compare the clinical and sociodemographic characteristics of limited and persistent uveitis cases and temporal trends in incidence in Ontario. METHODS:A retrospective population-based study using Ontario health administrative data identifying individuals with limited or persistent uveitis. The analysis described demographics, comorbidities, aggregated diagnosis groups (ADGs), resource utilization, income quintiles, and systemic therapy use. Annual age/sex-standardized, and age-specific incidence rates of limited and persistent uveitis were determined. RESULTS:Between 2000 and 2023, 289 031 limited and 41 482 persistent uveitis cases were identified, with mean index ages of 56.8 (SD 21.0) and 58.3 (SD 20.3) years, respectively. A higher proportion of children and youth were identified with limited duration uveitis. Sex distribution was similar between groups, and 89%-91% of cases resided in urban areas. Persistent uveitis cases had significantly more moderate to high ADGs (86.0%) compared with limited cases (16.2%), with hypertension being the most prevalent comorbidity in both limited (43.8%) and persistent (46.4%) uveitis cases. Persistent cases also had substantially higher resource utilization than limited uveitis cases. Incidence rates were higher for limited uveitis overall and among older age groups. Annual age-specific incidence declined in older age groups but increased over time for children with limited duration uveitis. CONCLUSIONS:This study highlights significant age-related trends in uveitis incidence, including an increase in pediatric cases and a high incidence of uveitis among the elderly. Age-specific health care strategies and resource planning are essential for adapting interventions and ensuring timely access to care.
OBJECTIVE:To assess long-term functional and structural outcomes in eyes treated with laser photocoagulation for retinopathy of prematurity (ROP). METHODS:Patients treated for ROP (1997-2004) underwent best-corrected visual acuity (BCVA) assessment, autorefraction, biometry, OCT, and OCT angiography of the macula and optic disc. Patient characteristics were retrieved from neonatal medical records. RESULTS:Sixty-three eyes of 33 patients with a mean follow-up of 19 years, and 22 eyes of 11 age-matched controls were included. The laser-treated group had a mean BCVA of 0.133 (±0.17) logMAR. Poor anatomical outcome occurred in 6.3% (n = 4), with 2 eyes requiring surgery. Mean spherical equivalent was -5.04 (±5.13) D. Corneal curvature and lens thickness were significantly higher in the study group (p < .001). Central macular thickness was greater in ROP eyes (311.97 μm vs 252.57 μm; p < .001). Vascular density was increased in the foveal region and decreased in other regions (p < .001), and the foveal avascular zone was smaller (p < .001). Optic disc analysis showed a reduction in cup-to-disc ratios and peripapillary capillary density (p < .001). CONCLUSIONS:Two decades after laser treatment, our patients demonstrated excellent visual acuity and favourable anatomic outcomes. Myopia was linked to increased corneal curvature and lens thickness. Significant alterations in the vascular plexuses of the macula and optic disc occur and may impact visual function in adulthood.
OBJECTIVE:Management of inherited retinal diseases (IRDs) traditionally has been viewed as nonsurgical, but there are known complications of IRDs that may warrant surgical intervention. Patterns of procedural interventions among patients with IRDs remain poorly characterized, given their relatively small representation among individual institutions. The objective of this study is to characterize patterns of surgical diagnoses and procedures in patients with IRD compared with a control cohort. DESIGN:This retrospective cohort study used deidentified aggregated electronic health records from January 1, 2003, through March 30, 2024, from TriNetX, a network with data from more than 119 million patients across 85 health care organizations in 4 countries. METHODS:Patients with IRDs and a control group with other posterior segment pathologies were identified and propensity score matched for age, sex, and ethnicity and race. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes for inherited retinal diseases (hereditary retinal dystrophy, hereditary choroidal dystrophy, congenital night blindness, achromatopsia, or other colour blindness) or posterior segment pathologies (disorders of choroid and retina, disorders of vitreous body and globe, glaucoma, visual disturbances and blindness, disorders of optic nerve and visual pathways, other disorders of eye and adnexa) were searched. Rates of surgical diagnoses and subsequent procedures in the IRD group were compared with the control group. RESULTS:Each cohort resulted in 69 235 patients after propensity-score matching. Among patients with IRDs, there was an increased rate of age-related cataracts (risk ratio [RR] 1.39, P < 0.001), other cataracts (RR 1.52, P < 0.001), macular edema (RR 2.98, P < 0.001), epiretinal membrane (RR 1.68, P < 0.001), macular hole/cyst/pseudohole (RR 1.93, P < 0.001), and slightly lower rates of rhegmatogenous retinal detachment (RR 0.87, P = 0.003). There was a greater rate of in-office vitreoretinal procedures, such as intravitreal injections (RR 2.22, P < 0.001), laser (RR 1.32, P < 0.001), and cataract surgery (RR 1.28, P < 0.001). However, there were lower rates of membrane peel (RR 0.74, P = 0.017) and retinal detachment repair (RR 0.60, P < 0.001) and no difference in the rate of macular hole repair (RR 1.09, P = 0.331). CONCLUSIONS:The discordance observed between the prevalence of potential surgical pathologies and the rates of subsequent intervention highlights the complexities in surgical decision-making for patients with IRDs.
